Assist. Professor of Chest Diseases Zagazig University, Egypt Case presentation Is it a tumor mass??? Ashraf Sileem, MD. Assist. Professor of Chest Diseases Zagazig University, Egypt

History Male patient , 24 years old single works as a salesman from abokabeer, Sharkia, non smoker, no other special habits of medical importance Complaint: Cough, Expectoration, Coughing of blood, Chest pain and Rise of body temperature.

History of present illness Condition started one years by cough and expectoration of minimal yellowish sputum with no relation to specific time or posture, hemoptysis (mild) blood streaked sputum twice per day for two days, low grade continuous fever patient sought medical advice at GP who prescribed oral antibiotic twice daily for one week, cough syrup and antipyretic with improvement as regard hemoptysis and fever.

History of present illness Four months later, recurrent of the same symptoms (C, E, F) and hemoptysis was frank of 15 cc thrice daily for one day, patient SMA at outpatient clinic of general hospital where chest x-ray was done, patient was informed he had right sided pneumonia and medications were prescribed for 10 days and follow up.

History of present illness In re-visit, there was improvement as regard patient clinical condition apart from infrequent cough and expectoration but chest x-ray shadow remained. Patient reassured and advised to follow up after two weeks. Patient neglect his condition, not came back.

History of present illness Six months later, high grade fever, frank hemoptysis of 30 cc 5 times within 7 hours, cough and localized right sided pleuritic chest pain, pt SMA at chest consultant who asked for chest x-ray, pt informed he had right sided pneumonia and referred patient to be admitted in Chest Department ZUH.

Family history: irrelevant Past history History of Open heart surgery in 2003 for closure of ASD Family history: irrelevant

Positive data Diminished movement over right side Diminished vesicular breath sound over right sided mammary and axillary regions. Early and mid inspiratory consunating crepitations

Plain Chest X-Ray PA view

wedge shaped consolidation in lateral aspect of right mid and lower lung zones

Routine Lab

CT Chest with IV Contrast

Pleural based Soft tissue lesion of homogeneous opacity Size about 4 x6 cm With soft will demarcated margins No feeding vessels No pressure on surroundings with area of bronchiectasis

the consolidation shows soft tissue density with hyperdense area at its anterior aspect right middle lobe bronchiectasis is also noted

Bronchoscopy Right broncheal tree: Rush of purulent secretion Exaggerated mucosal rugea of intermediate bronchus Narrowing of middle lobe orifice, but bronchoscopy can be introduced through it

Bronchoscopy Whitish intraluminal filamentous lesion in the lateral segment of the middle lobe Using biopsy forceps (crocodile), testing the lesion that attached to the medial aspect of the lateral segment and free lateral side Trying to grasping the lesion from its attachment by the forceps Multiple mucosal projections of granulation tissue also seen bleed easily

Bronchoscopy

Gauze pieces

2 sessions of APC

Longstanding Gauze as an endobronchial foreign body: case report Our case is Longstanding Gauze as an endobronchial foreign body: case report

Post bronchoscopic chest x-ray

This occurrence has not been previously reported in the literature This occurrence has not been previously reported in the literature. As previously reported cases of surgical gauzes migrate to tracheobronchial tree from mediastinum Neglected FB 14 years Large pieces of gauze FOB plus APC solve the problem