Meng Shushi, Liu Ganwei, Wang Shaodong, Yang Fan
Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
J Cardiothorac Surg. 2020 Jun 23;15(1):151. doi: 10.1186/s13019-020-01194-z.
The incidence of the iatrogenic foreign body retained after surgery is extremely low. Iatrogenic foreign body retained is surrounded by normal tissue, which responds to foreign matter to form inflammatory pseudotumors. Surgical sponge or swap is the most common type of foreign body. There were no reports of medical sutures remaining as foreign bodies in the lung parenchyma to form inflammatory pseudotumors.
A CT scan of a 50-year-old female showed an irregular soft tissue mass in the left upper lobe with rough edge and spiculation. After 20 months, the size increased from 2.8 × 1.9 cm to 3.2 × 2.2 cm. The patient underwent a ventricular septal repair surgery for congenital Fallot tetralogy 35 years ago and a left breast surgery for breast cancer. She had a family history of lung cancer. Evaluation of this mass highly suggested a lung malignant lesion. The patient underwent video-assisted thoracoscopic surgery (VATS) lobectomy and her pathology revealed an intrapulmonary inflammatory pseudotumor caused by a medical prolene suture. Based on her medical history and other reports of iatrogenic foreign bodies, we believe that this suture retained from the heart surgery 35 years ago entered the pulmonary artery, moved to the distal branch, and eventually formed an inflammatory pseudotumor in the lung parenchyma. Here we reported and analyze this rare case.
We reported a rare case of inflammatory pseudotumor in the lung parenchyma caused by a medical suture, and determined it was a prolene suture retained in the body during a cardiac surgery 35 years ago. Diagnosis of this rare disease required sufficient imaging experience. Besides, appropriate surgical exploration can help with the diagnosis and treatment.
手术后医源性异物残留的发生率极低。医源性异物残留被正常组织包围，正常组织会对外来物质作出反应形成炎性假瘤。手术海绵或拭子是最常见的异物类型。此前尚无关于医用缝线作为异物残留在肺实质中形成炎性假瘤的报道。
一名50岁女性的CT扫描显示左上叶有一个不规则软组织肿块，边缘粗糙且有毛刺。20个月后，肿块大小从2.8×1.9厘米增至3.2×2.2厘米。该患者35年前因先天性法洛四联症接受了室间隔修复手术，还因乳腺癌接受了左乳手术。她有肺癌家族史。对这个肿块的评估高度怀疑是肺部恶性病变。患者接受了电视辅助胸腔镜手术（VATS）肺叶切除术，病理显示为医用普理灵缝线引起的肺内炎性假瘤。根据她的病史以及其他医源性异物的报道，我们认为这条35年前心脏手术残留的缝线进入了肺动脉，移至远端分支，最终在肺实质中形成了炎性假瘤。在此我们报告并分析了这一罕见病例。
我们报告了一例罕见的由医用缝线导致的肺实质炎性假瘤病例，并确定是35年前心脏手术中残留的普理灵缝线。诊断这种罕见疾病需要足够的影像诊断经验。此外，适当的手术探查有助于诊断和治疗。
