ai Dcoartment of Thoraeie and Cardıovaseular Sur~ery, Cerrahpaşa i\lıcdieal Faculıy, University of istanbul,
('"ıraIııleışd, Istanbul, Turkey
b) Department of Pneumology, Aegcan Am)y Baspita!, Izmir, Turkey
10 yıl önce göğsünün sol tarafından kurşunla yaralanan 30 YJşındaki erkek hastada Engula bronşu içinde knr'jıın s3rt~mnış ve bmnşicktazik değişimler gösteren lingı.ıh, kurşıın ilc bi.rlikte. çıkanlmış!ıf.
Summary
/\n in!.rabmncnial bulkt was delcclcd in a 30-year-old male who had suffered a gunsho! injur} to his left cbcsı ten years prior to his presentation. Due to the maıked destıııction, the liııgula was removcd along wiı}ı the. r;;l.liJled bullcl.
Ke) WU"I',: In!rabronchia! bul/et -Bmnchiecıasis
Tracheobronchial foreign bodies are most oftcn duc LO aspiration, especially İn
childhood
agegroup
cı).Imrabronchial
locationof a hullet following a
guns!ıotinjury
İs encoııntcred rarely (2). This papcr presents a ca<;e ofan intrabronchial
bulJet which presentE'd wıth sign and symptoms of bronchiectasis ren years arter the injury.A mak, 30-year-old, was admitted to the Aegcan Arıny Ilospiıal complaimng of fatigue and purulent spuıum produclion. He. had stutfcd a gunshot iııjuıy to his ldı chesı ten years prior to prescnıation, and had bccn trcale.d ","illı tu be thoraeostomy for the pncuınoıhocax which had dcvdüpcd. Adnıissiorı chest X-rays showed infiltrales i"l '.he Jiııguhr portion of the left lung alo"lg wiıh a metaLii. foreign hody closc ıo L'ı.c lıilum (Fig~. J ,2). Fiheroptie hronchoscopy demonstrated ocdusion of the. orifice of the lingıılar bmııchtıs .Mark.cd destructinn nf the lingular hroııchı were se.en on the bronchı)grams (Figs. 3,4). Thoracotomy was pcı[vmıed in October v[ 1988 and Üıe lİlıgula was removeli dlong with the rctained Dunet. Tnc patholvgic
cxanııııalion uf the spccir:ıcn showcd atelectasİs, hcmorrhagic and pneun10nic iııfuır"tcs, and marked dUalaıion
of i lı. e brenchi ıviıh struelural changes. The buJlct was lodged in the lingular bronchus.
Aili Tıp Oag., S.20} 203 (1989)
ADL
İ TIP DERGİSİ
Journal of Forensic Medicine
202
Figun ı. Infillfates in the lingular po/tion of the ldt lung alorıg wiıh a nıetallie foreign body do. e LO the hilum.
--ı
Figurc 3. P-A brondıograrn demonwate, rnarked dcSltuction of ılıe lingular brotlchi.
Il. TÜZÜ;-;. E GUNSOR
Figu",,,, 2. L..dt iateral chesı. X-ray wiıh a i ingular infiltratian.
Figu!'c 4. A cavıty is secn in the lateral
bronchogram.
Adli T
ıp Dergisi 1989; 5(3-4): 201-203
Retaincd Intrahronchial Bullet Prcsenıing as Brondıiccıasis 203
DISClJSSıON
Tuhc thoraeüstomy is the only treatment requireel in most instaııces of missile injuries of ıhe chest (3). Thor:ı.costomy m::ıy be considered when the fragments are large and close to the heart, major vessels or the esophagus (4). Retained intrabronchıa!
bullcts may bceomc symptomatic many years artcr the injury (4). Intraparcnchimal fraglTIeots may migrate and erode bronchi. A ease of removal of a bullet fragmenı by bronehotomy 25 years arter the original injury has been described (5).
Kelly
and James (4) removcd a missik that had changed pasition seven years afıer the injury by lobectomy.Bogedain
(5) described a ease in which a !cft upper Iobe fragıncnt was remoyed from ıhe riglıt mainstern bronehııs via a rigid hronchoscopc.In those nı.re cascs of inırabronchial missik locations at the time of the injury, the missik temains asymptomatic for many years only to present
!aler
wıth pulmonary suppuration if early bronchscopie rcmova! has not been carried out (2). This silent periodin our
casewas
tenyears.
Earlybronchoseopie
rcmoya! of intrabronchia! fragments should be perfonned beleıre significant mucosa! or distal "uppuraüye changesoeeur.
Choh
andAdler
(2) described a case of suecesful bronchoscopic removal of an intrabronchial bul1et in the first day of injury. The hazards of attcmpting to bronchoscopicaIly remove intrabronchia! foreign bodies after a prolonged period foHowing ıhe loelgement were well demonstrated by the case of massiye hemorrhage requiring emergency thoracotomy thatRees
described (6). Thoracotomy and rcsectıon are recommcndcd for distal suppurative changes.The opinion of the authcrs af ter reviewing. the litefature is that mare liberal application of bronchoscopy in the evalualion of gunshot wounds of the chest miglıı
eliminate future thoracotomies.
REFERE'\CES
O'Neill, J.A. (1983) 1. Pedialr. Surg., 18, 475-479.
2 Choh, l.}!., Adler, R.B. (1981) J. Thorac, Cardioyil.:;'C. Surg., 82, 150-153.
3 Hood, R.M. (1983) in Gibbon's Surgery of ıhe Chest, fourth cdn, pp. 302, WB Saundcrs Co.,
Philadclphia. London, Toronıo.
4 Kelly, W.A .• James, E. (1976)1 Tra unuı , 16, 153~154.
:1 Bogedaio. W. (1984) J.kMA .. , 25], 1862~lX63. 6 Rees, I-R (j 985) Chesı, 3, 475-476.
Rcprints request Lo: Dr. H.Tiızün
Cerrahpaşa Tıp Fakülte,d
Gögüs-Kalp-Damar Cerrahisi Anabilim Dah
Ceırahpaşa, !stanbul, Türkiye
