Accidental penetrating chest injury with concealed retained wooden stick: A diagnostic dilemma and management.

Sir,

A 54-year-old woman reported to our hospital 2 days after accidental penetrating injury to left hemithorax after falling over wooden furniture. On clinical examination, there was no visible foreign body in chest wound. Her vitals were stable except mild dyspnea. Contrast-enhanced computed tomography scan of chest shows a long tubular air attenuation track in the left lung field with mild pleural collection [Figure 1]. There was a dilemma in diagnosis about retained foreign body in the chest and its nature as only air containing track was noted in computed tomography scan (CT) with average CT Hounsfield of − 360. On surgical exploration, a long wooden stick was retrieved from the depth of the wound. She was managed with proper wound care and chest tube drainage of left hemothorax.

Figure 1

Contrast-enhanced computed tomography scan of chest shows the suspected foreign body as a long tubular air attenuation track in the left lung field close to the left ventricle of heart with mild left hemothorax, which is better seen in thick minimum intensity projection images (bottom pictures)

The CT attenuation of a wooden foreign body varies in relation to air content, fluid in the interstices and surface coating such as paint over the wood. Dry wooden material with high gas content may mimic gas collection.[1]

The detection of retained wooden foreign bodies always remains a difficult and challenging task in spite of advanced imaging technique.[2] High index of suspicion, clinical history with imaging finding are essential for diagnosis of foreign body. Tube thoracostomy was the main treatment modality for the majority of chest injury.[3]