title: Empyema, acute respiratory failure, and septic shock after aspiration of a soft-shelled turtle (Pelodiscus sinensis) bone by an adult.
abstract: BACKGROUND
  The common late complications of foreign body aspiration include granulation formation, obstructive pneumonia, and atelectasis. However, a foreign body-induced pleural infection is very rare, and especially when it is not iatrogenic.
  
  
  METHODS
  A 64-year-old Chinese man was admitted to our hospital with septic shock and acute respiratory failure requiring intubation and mechanical ventilation. Computed tomography revealed multiloculated pleural effusion on the whole right side and right lung atelectasis, with enhanced thickening and calcification of pleura and a foreign body in the right intermediate bronchus. The effusion appeared as a cloudy fluid consistent with pus. A bedside bronchoscopy revealed an irregular foreign body lodged in the right intermediate bronchus. The hard bone was removed and confirmed to be a soft-shelled turtle bone. A final diagnosis of foreign body-induced empyema, acute respiratory failure, and septic shock was confirmed. The patient showed good recovery after completing a course of broad-spectrum antibiotics and undergoing chest tube drainage.
  
  
  RESULTS
  Although empyema has been reported previously as a rare complication of long-term retention of an aspirated foreign body, no case has been observed that was as serious as our current patient. In addition, a foreign body aspiration by a soft-shelled turtle bone was never reported before.
  
  
  CONCLUSIONS
  For the first time, we describe the successful treatment of an adult patient presenting with empyema, accompanied by serious conditions of acute respiratory failure and septic shock induced by aspiration of a soft-shelled turtle bone. Clinicians should consider the possibility of non-iatrogenic foreign body-induced empyema with acute onset of respiratory failure, when a patient's symptoms cannot be attributed to an alternative obvious cause.
authors.affiliation: Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 P.R. China.
authors.forename: Gensheng
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Cardiology, Binjiang Branch, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 China.
authors.forename: Shufang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 P.R. China.
authors.forename: Na
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 China.
authors.forename: Hao
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
keywords: Acute respiratory failure; Adult; Empyema; Foreign body aspiration; Septic shock; Soft-shelled turtle bone