Intrapericardial gossypiboma found 14 years after coronary artery bypass grafting

Abstract

Background Foreign body left after surgery surrounded by a foreign body reaction otherwise known as gossypiboma, have been first described in 1884. Although it occurs rarely, it can lead to various complications which include adhesions, abscess formation and related complications. Intrathoracic gossypiboma is a rare but serious consequence of negligence, mainly during abdominal and cardiothoracic surgery that can lead to severe medical consequences. This paper aims to raise awareness among surgeons and nurses in the operating room to prevent such errors and future complications. Case presentation A patient with a history of coronary arterial bypass grafting performed 14 years ago, presented with shortness of breath and dry cough. A chest X-ray revealed a large mass in the left hemithorax. The chest CT demonstrated the presence of a heterogeneous density mass of 11 cm and smooth edges in the middle mediastinum, next to the heart and partially intrapericardial. Because clinical and radiologic evidence revealed presence of a mass, we did proceed with CT guided FNA of the mass. The cytology findings confirmed an inflammatory lesion. Based on patient symptomatology and the evidence of a mass, allegedly compressing the cardiopulmonary structures in vicinity, we performed surgical exploration. An old and degraded piece of surgical swap was found and removed through an anterolateral left thoracotomy. The post-operative course was excellent. Conclusions Forgetting surgical swaps during surgery is a medical fault. To avoid them, surgical units should design and implement a surgical inventory process to account for surgical instruments or surgical swaps. Failure to make a proper diagnosis of cases such as these can lead to further health complications in these patients. The iatrogenic foreign material seen as a mass in the radiologic films had not been previously noticed by other health professionals although the patient had undergone X-ray and cardiac ultrasound examinations in the 14 years following coronary bypass surgery. Once the causative agent was identified and removed the patient returned to normal activity.

Case report: inflammatory pseudotumor in the lung parenchyma caused by a medical suture originating from a cardiac surgery 35 years ago

“…Iatrogenic inflammatory pseudotumors mainly manifest as solid tumors with smooth borders [2,5]. The preoperative CT in our case showed irregular lesion shape, rough border, pleural traction sign, and gradual enlargement, which could not rule out manifestations of a malignant mass.…”

Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background

“…Diagnosis is usually incidental in an asymptomatic patient who previously performed a surgical or intravascular procedure. However, sometimes patients can be highly symptomatic with chest pain and dyspnea caused by heart failure, perforation or obstruction of vessels or cardiac chambers [28][29][30][31]. The foreign body is encapsulated in fibroinflammatory tissue, clotted blood and/or thrombus, and the shape and type of the object is sometimes difficult to recognize by imaging.…”