A Sempiternal Chest Tube?

To the Editor:

The following case merits addition to the ever-expanding list of medical oddities.

A 31-year-old man complained of a sore throat of several days' duration. On physical examination, he had purulent tonsillitis and a startling finding in his chest. Protruding about 5 inches from the surface, in the posterolateral area on the right side, was a tube between the 6th and 7th ribs. When questioned further, the patient said that the tube had been inserted 10 years earlier during hospitalization for an empyema. He was discharged with the tube in place; however, fearing that its removal would be painful, he did not return for his follow-up appointments. Throughout the ensuing decade, he remained amazingly well—tube in place—never requiring or receiving medical attention. He was careful, however, to hide the tube from public view.

A plain radiograph, together with conventional and 3-dimensional computed tomographic scans (Fig. 1), showed the tube encased by heterotopic bone and thickened pleura. Nevertheless, the tube came out easily.

Fig. 1 A) Radiograph of the chest shows the tube (arrows) in place with sclerosis and deformity of the contiguous ribs; B) computed tomographic scan of the chest shows the tube (white arrow) encased by heterotopic bone (black arrow) and thickened pleura; and C) 3-dimensional computed tomographic scan of the chest shows the tube (white arrows) and the heterotopic bone (black arrow).

Comment: That anyone could keep a chest tube in place for 10 years—much less without medical supervision or complications—defies imagination. Furthermore, had this patient not sought help for an unre-lated illness, who knows how long the tube's in vivo existence might have lasted?

Not surprisingly, I could find no report concerning indwelling chest tubes that even remotely resembled the case described here. But I did uncover a few examples of other foreign objects that lay dormant in the body for decades before manifesting themselves.

The longest recorded interval from the initial entry of a foreign body to its clinical presentation is 62 years.¹ In that instance, the culprit was a 9- × 10-mm piece of shrapnel presenting as an abscess of the chest wall. Other late presentations include swelling of the lip consequent to a piece of glass embedded there after a land mine explosion 39 years earlier,² biliary colic caused by a grenade splinter migrating into the common bile duct 34 years after injury,³ a choledochoduodenal fistula resulting from a migrating infantry bullet 32 years after injury,⁴ and a pectoralis muscle abscess brought about by a retained swab 32 years after a shoulder repair.⁵

Nature often allows amazing miracles to be produced ….

P.A. Kirchner (1602–?),

as quoted by

Wilhelm Conrad Roentgen, 1895