Innovative Pleuroscopic Retrieval of an Intrathoracic Metallic Foreign Body- A Case Report

Background This case underscores the need to consider factitious disorder in patients with recurrent unexplained injuries. It showcases the efficacy of medical thoracoscopy (MT) in safely removing intrapulmonary foreign bodies, thereby avoiding thoracotomy. The successful retrieval of the foreign body (FB) using MT highlights the utility of minimally invasive techniques, especially in resource-constrained settings, offering a valuable alternative to surgical extraction and emphasizing the importance of innovative approaches in thoracic care. Case Presentation A 40-year-old woman from Pakistan presented with a metallic FB embedded in her right upper lung lobe. Despite previous attempts at removal, the object remained in place. Psychiatric evaluation revealed anxiety, oversensitivity, and self-inflicted injuries, raising concerns about a factitious disorder, possibly Munchausen syndrome. Intervention MT was performed under general anesthesia. One lung ventilation was achieved by selective intubation of left main bronchus (LMB). Right sided pleural space was explored after induction of an artificial pneumothorax, adhesions were lysed, and the FB, a 5.5 cm long sewing needle, was successfully removed from right upper lobe. Outcome The patient had an uneventful post-procedure course and was discharged. This case demonstrates the dual importance of clinical innovation and psychiatric consideration in managing complex cases. Conclusion MT is a safe and cost-effective approach for retrieving intrathoracic FBs, offering a valuable alternative to surgical extraction. This case highlights the dual importance of clinical innovation in thoracic care using innovative techniques like pleuroscopic retrieval, and the need for psychiatric consideration in managing complex cases with underlying factitious disorders.