Delayed massive hemoptysis 20 years after lung stabbing: an unusual presentation

The management of penetrating chest injury by bullet or shrapnel for prevention of later complications has remained controversial. A 45-year-old man presented with a history of 3 years recurrent hemoptysis. He had massive hemoptysis 20 h before admission. He underwent tube thoracostomy for the left hemothorax due to a penetrating chest injury that occurred 20 years previously during the Iran-Iraq war. Since then he had only vague pain in the left side of thorax without any respiratory sign. Chest radiography and computerized tomography revealed a 60 mm x 30 mm x 20 mm abnormal density in the hilum of the left lung near the main pulmonary artery. The hemoptysis was controlled by an emergency resection of the lower segment of left upper lobe and lingulae lobectomy. A large metallic foreign body was extracted. Pathology of the resected specimen revealed a metallic foreign body with chronic pneumonia of the lingulae lobe. This rare case reveals the important clinical fact that a penetrating chest trauma can present as massive life-threatening hemoptysis 20 years later.