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Pictorial CME

An unusual cause of hemoptysis

Padmanabhan, Arjun,; Ameer, K Azeez; Balan, Ganesh; Neeloth, Nishal

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doi: 10.4103/lungindia.lungindia_472_21
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A middle-aged man was referred to us for the evaluation of hemoptysis. He had undergone the right upper lobectomy 20 years back for aspergilloma. For the past 10 years, he had cough with mucoid sputum on most days. For the past 1 year, he had repeated episodes of blood-stained sputum as well. He was a nonsmoker and denied having been treated for tuberculosis. His basic blood investigations were normal. A high-resolution computed tomography scan of the thorax was obtained and it was noncontributory. He underwent a flexible fiberoptic bronchoscopy and the lobectomy stump revealed the presence of two sutures [Figure 1]. These were removed using forceps. After the removal, two smooth intraluminal protrusions were seen in the adjacent mucosa [Figure 2], which when biopsied were shown to be composed of granulation tissue alone. The patient was completely relieved of his symptoms after the removal of the sutures.

Figure 1:
Bronchoscopic image showing the presence of retained suture material in the right upper lobectomy stump
Figure 2:
Bronchoscopic image showing the presence of granulation tissue alone after removal of the sutures

It is unusual for sutures applied to the bronchial stump to extrude out. In this case, a nonabsorbable, braided surgical suture composed of polyethylene terephthalate had been used. Exposed sutures apparently cause cough by producing local irritation, granuloma formation, and infection.[1] Cases of recurrent pneumonia due to the retained sutures have also been reported.[2] Removal of the sutures results in immediate resolution of symptoms as was seen in our case also. This implies that endobronchial sutures should be considered a cause of chronic and persistent cough which is unresponsive to specific therapy, in patients with a history, even remote, of previous thoracic surgery.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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1. Albertini RE Cough caused by exposed endobronchial sutures Ann Intern Med 1981 94 205 6
2. Zan Y, Liu H, Zhong L, Qiu L, Tao Q, Chen L Childhood recurrent pneumonia caused by endobronchial sutures:A case report Medicine (Baltimore) 2017 96 e5992
3. Shure D Endobronchial suture. A foreign body causing chronic cough Chest 1991 100 1193 6
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