Presentation
Presents with persistent pulmonary infiltrates for 4 months. Got into the garbage 4 months previously and possibly ate chicken on a bamboo skewer.
Patient Data
On the right lateral projection, there is an ill-defined region of increased opacity superimposed over the heart. The opacity is visible on the ventrodorsal projection in the left caudal lung lobe. On the ventrodorsal projection, the opacity continues to contact the diaphragm. The pulmonary parenchyma is otherwise normal. The cardiovascular structures are normal in size and shape. There is mild increased opacity dorsal to the second sternebra.
Impression:
Lung lobe consolidation may be inflammatory or less likely neoplastic. The diaphragmatic contact may indicate extension into the pleural, peritoneal, or retroperitoneal space.
There is a well defined hyperattenuating linear structure in the dependent caudal portion of the left cranial and left caudal lung lobe. This structure is surrounded by a focal alveolar pattern. The linear structure thought to represent a foreign body extends cranially at the level of the 5th rib. At this level there is focal periosteal reaction noted in the medial aspect of the rib just dorsal to the costochondral junction. The foreign body appears in close apposition with the mediastinum and heart at this level. More caudally the foreign body crosses the diaphragm. It extends in the liver where there is a break in the foreign body. Caudal to the liver, the foreign body is surrounded by soft tissue attenuating material and extends into the gastric wall.
The soft tissue surrounding the foreign body is contrast enhancing. The left sternal lymph
node is mildly enlarged however remains within normal limits. At the level of the stomach,
there is focal thickening of the gastric wall. The foreign body does not penetrate the gastric
lumen and remains within the gastric wall. There is no evidence of peritonitis or pleural effusion.
Impression:
Thoracic-peritoneal foreign body with mild surrounding inflammatory reaction.
Case Discussion
The bamboo skewer was suspected to be ingested four months previously. The chronicity of the inflammation has resulted in a tract surrounding the skewer, but surprisingly little inflammation. The pleural space and peritoneum were perforated, and the skewer originated from the stomach. There is no significant pleural or peritoneal inflammation despite the foreign body. Surgery was performed to remove the skewer.
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