INTRODUCTION: A pleural mass in a young female has a limited differential diagnosis. We present a case of an enlarging pleural mass associated with chest pain.
CASE PRESENTATION: A 19-year-old girl presented with persistent right-sided chest pain. Past medical history was significant for admission to another hospital six months earlier for acute dyspnea and chest pain. She was diagnosed with a spontaneous right pneumothorax and a chest tube was inserted with reported difficulty. The chest tube was removed two days later and she was discharged. Since her discharge, she reported pain at the site of insertion of the chest tube, which she described as persistent, occasionally sharp, and partly relieved by ibuprofen. There was no relation of the pain to her menstrual cycle. She denied fever, weight loss, dyspnea, or cough. Review of systems was negative. Physical exam was unremarkable. Routine blood tests including a complete metabolic profile and blood count were within normal limits. A chest radiograph was unremarkable. Computed tomography (CT) of the chest revealed a 2.7 × 1.3 cm area of pleural thickening. Tuberculin skin test was negative. Due to persistence of the pain, the chest CT was repeated 7 months later and showed that the pleural based process had enlarged to 4.3 × 1.9 cm with central necrosis . She underwent video-assisted thoracic surgery (VATS) for resection of the pleural mass. On pathologic examination, there was extensive chronic inflammation and fibrous connective tissue surrounding retained foreign bodies, which were identified as two fragments of latex from a medical glove measuring 2.2 × 1.7 cm and 0.9 × 0.5 cm. She made a complete recovery.
DISCUSSIONS: The differential diagnosis of a pleural mass in a young female includes primary tumor of the pleura, metastatic disease, lymphoma, infection, endometriosis, and as in this case, retained foreign body. Though clinical clues may occasionally be helpful, a definite diagnosis is often made via pathology. The retained foreign body, in this case a ‘glove-boma’ (to allude to the related condition of gossypiboma –retained cotton surgical sponge) induces an aseptic foreign body reaction with subsequent fibrosis and granuloma formation. Because of its rare occurrence and non-specific clinical and radiographic presentations, the diagnosis is unlikely to be considered.
CONCLUSION: The diagnosis of retained foreign body may be easily overlooked and should be considered in patients who have had previous invasive procedures performed. Early recognition would allow for prompt treatment.
DISCLOSURE: Subani Chandra, No Financial Disclosure Information; No Product/Research Disclosure Information