Challenging anatomic resection for intrathoracic gossypiboma—a case report

We report on a 58-year old male suffering from an unclear necrotizing pneumonia of the right lower lobe, which was already treated unsuccessfully with antibiotics. The patient presented with productive cough, fever and haemoptysis. As differential diagnosis we considered tuberculosis, aspergilloma and lung cancer. After a thoracic surgical procedure which was performed 15 years ago in Russia for an unknown indication he underwent a re-thoracotomy to clarify the aetiology of the cavernous lesion. Hence to the entirely adherent lung to the chest wall, the lower lobe being completely fused with the diaphragm and the central location of the lesion a challenging anatomic resection of the lower lobe had to be performed. Incision of the resected lobe showed a very thick fibrotic layer and underneath an old gauze swab, which was apparently forgotten during the former operation 15 years before. The postoperative course was uneventful. The patient was discharged 12 days after the surgery. This case illustrates how preoperative diagnosis of retained foreign bodies after former surgical procedures might be difficult to achieve, and the surgical procedure can be fairly complex, as our case shows, after 15 years of chronic infection.