Correspondence

Case 33-1997: A 75-Year-Old Man with Chest Pain, Hemoptysis, and a Pulmonary Lesion

N Engl J Med 1998; 338:925-926March 26, 1998

Article

To the Editor:

In the October 23 Case Records,1 the illustration showing the path of the inspired sprig (Figure 9) is anatomically incorrect. The right bronchus is wider, shorter, and more vertical in direction than the left. As a consequence, there is a more direct continuation between the trachea and the right bronchus, so that any foreign body dropping into the trachea would naturally be directed toward the right bronchus.

Patrick Martens, M.D.
Saint Jan Hospital, 8000 Brugge, Belgium

1 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 33-1997). N Engl J Med 1997;337:1220-1226
   Full Text | Web of Science | Medline

To the Editor:

With respect to the Case Records report of the 75-year-old man who inhaled plant material into his lung and in whom a focal pulmonary lesion developed: Of particular interest to us was the comment regarding the relative rarity of this syndrome in people — only 45 reported cases in almost 200 years of literature. In veterinary medicine, inhalation of plant material with resultant pneumonitis, pneumonia, pleuritis, or empyema is a very common occurrence.1,2 It occurs most often in hunting or sporting dogs that roam through fields of tall grass and inadvertently aspirate grass awns or blades. In California, the most common offending plant is the foxtail (Hordeum jubatum). In fact, foxtail penetration through any external orifice or penetration through intact skin is a frequent reason for veterinary-hospital visits.1 Like the plant in the Journal' s case, foxtail contains unidirectional barbs that make spontaneous expulsion of the offending awn unlikely. We submit these comments to suggest that clinicians and researchers in human medicine may occasionally gain insight into the mechanisms or pathophysiology of disease by searching the veterinary medical literature and to share an interesting tidbit of comparative medicine.

David Feldman, D.V.M.
Etienne Côté, D.V.M.
California Animal Hospital, Los Angeles, CA 90025

2 References

1. 1

   Brennan KE, Ihrke PJ. Grass awn migration in dogs and cats: a retrospective study of 182 cases. J Am Vet Med Assoc 1983;182:1201-1204
   Web of Science | Medline

2. 2

   Lotti U, Niebauer GW. Tracheobronchial foreign bodies of plant origin in 153 hunting dogs. Compend Contin Educ Pract Vet 1992;14:900-904
   Web of Science