Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2023; 11(10): 2329-2335
Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2329
Formation of a rare curve-shaped thoracolith documented on serial chest computed tomography images: A case report
Fu-Chieh Hsu, Tsai-Wang Huang, Ta-Wei Pu
Fu-Chieh Hsu, Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
Tsai-Wang Huang, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
Ta-Wei Pu, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
Author contributions: Hsu FC contributed to data collection and manuscript writing; Huang TW and Pu DW contributed to manuscript revision and study supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsai-Wang Huang, MD, PhD, Professor, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, No. 325 Section 2, Chenggong Rd, Neihu District, Taipei 114, Taiwan. chi-wang@yahoo.com.tw
Received: December 26, 2022
Peer-review started: December 26, 2022
First decision: January 5, 2023
Revised: January 11, 2023
Accepted: March 6, 2023
Article in press: March 6, 2023
Published online: April 6, 2023
Processing time: 94 Days and 1.9 Hours
Abstract
BACKGROUND

Thoracolithiasis is a rare benign condition that manifests with one or more small nodules in the pleural cavity. In most cases, it is asymptomatic and found incidentally on chest imaging or during thoracic surgery. The thoracolithiasis formation process is rarely documented. Herein, we present a case of a rare, large, curve-shaped thoracolith, the formation of which was documented on serial computed tomography (CT) images.

CASE SUMMARY

A 46-year-old male patient who denied any prior systemic disease was evaluated due to intermittent right-sided lateral chest pain lasting for a year. Chest radiography and CT revealed a circumscribed calcified nodule measuring 3.5 mm in the right lower lung lobe. Nodule biopsy revealed fungal infection, which was treated with antifungal medication. After 2 years of follow-up, the patient developed intermittent chest discomfort caused by pleural adhesions, and underwent video-assisted thoracic surgery with pneumolysis. Postoperatively, he developed empyema, which fully resolved with antibiotic therapy. Thereafter, he was followed up at the outpatient clinic and underwent chest CT twice per year. Over time, we observed thickening of the right distal pleura near the lower posterior mediastinum, and several sporadic calcified nodules with gradually increasing intensity, which eventually merged into a single calcified curve-shaped thoracolith measuring approximately 9 cm in length during the 5-year follow-up.

CONCLUSION

This study documented the formation of a rare thoracolith shape observed for the first time.

Keywords: Thoracolithiasis; Thoracolith; Pleural stone; Intrathoracic calculus; Pleurolith; Case report

Core Tip: Thoracolithiasis, a rare benign condition manifesting with one or more small nodules in the pleural cavity, is usually asymptomatic and discovered incidentally on imaging or during surgery. We present the case of a 46-year-old man who was treated for lung fungal infection and subsequently underwent video-assisted thoracic surgery with pneumolysis due to pleural adhesions. The serial chest computed tomography images obtained during the 5-year follow-up showed right pleural thickening near the lower posterior mediastinum with formation of a large curve-shaped thoracolith from sporadic calcified nodules. Thoracolithiasis formation is rarely observed, and this is the first case of such thoracolith shape.