A retained foreign body granuloma mimicking a left ventricular psuedoanuerysm.
BACKGROUND
Gossypiboma, also referred to as a textiloma, gauzoma or muslinoma describe a mass in the body composed of a central cotton core surrounded by a foreign body reaction. It has an estimated incidence of 1/1000-1/10000 surgeries, occurring in the abdomen (56%), pelvis (18%) and least commonly the thorax (11%) and represents an unfortunate event for both the patient and the operating surgeon with severe liability implications.


METHODS
We report a case of a 49-year-old male with Marfan Syndrome who was admitted to the cardiology department with a four day history of shortness of breath and associated dull, non-radiating chest pain. Past history included a previous Bentall procedure for a type-A aortic dissection and coronary artery bypass grafting involving a saphenous vein graft to the right coronary artery. A computed tomography (CT) scan showed a round, heterogeneous mass measuring 14×9cm with lobulated contours, situated adjacent to the left ventricle along the left posterior region of the aorta. The mass was resected and further dissection revealed a plastic band harboured from the core of the mass.


CONCLUSIONS
The majority of cases of intrathoracic gossypiboma present as intractable cough or an incidental finding on radiological evaluation. Dyspnoea alone is relatively underreported as a presenting symptom of this condition CONCLUSION: This case highlights the important clinical history features for diagnosing this surgical error, including persistent respiratory symptoms and a history of cardio-thoracic surgery. It also emphasizes on the need for implementing definite strategies to prevent the occurrence of gossypiboma in surgical practice.
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK. Electronic address: davide.patrini@uclh.nhs.uk.
Davide
D
Patrini
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK.
Mohamed Amirali
MA
Gulamhussein
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK.
Pasquale
P
Pellegrino
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK.
Marianna
M
Redaelli
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK.
Jonathan
J
Pararajasingham
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK.
David
D
Lawrence
Department of Cardiothoracic Surgery, The Heart Hospital, University College London Hospital (UCLH), London, UK.
Nikolaos
N
Panagiotopoulos
Cardiac surgery; Case report; Granuloma; Retained foreign body
Curr Opin Anaesthesiol. 2009 Apr;22(2):207-14
19390247
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):783-5
22786789
Iran J Radiol. 2014 May;11(2):e13933
25035699
Asian Cardiovasc Thorac Ann. 2015 Jun;23 (5):596-8
25348160