in december 2011 , a 51-year - old woman was admitted to our hospital due to massive hemoptysis .
she had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times .
the patient s vital signs were stable . on chest examination , decreased breathing sound and crackle were audible in the right lower lung field .
a chest x - ray showed patchy consolidation in the right lower lung ( fig .
1a ) . a computed tomography scan of the chest showed a small nodule , ground glass appearance , and consolidation around the nodule in the lateral basal segment of the right lower lobe ( fig
we performed an operation for the differential diagnosis between the possibility of a malignancy or life - threatening , massive hemoptysis . under general anesthesia with a double lumen endotracheal tube , we resected the right lower lobe through a posterolateral thoracotomy at the sixth intercostal space . in the operation field ,
we could palpate a round , hard mass 2.03.0 cm in the lateral basal segment of the right lower lobe .
the resected specimen consisted of the right lower lobe , weighed 177.5 g , and was sized 11.511.23.0 cm . on multiple serial sections , a cavity lesion measuring approximately 2.02.5 cm was identified ( fig .
histopathological examination confirmed it to be a vegetable foreign body , and clumps of actinomyces , indicating actinomycosis , were present within the abscess cavity ( fig .
actinomycosis is a chronic , suppurative pulmonary infection usually caused by actinomyces israelii , which is present in the oropharynx of humans .
pulmonary infection with species of actinomyces is uncommon , and usually results from aspiration of oropharyngeal secretions in those with chronic dental infections , extension from a cervicofacial infection , or hematogenous spread from a distant source .
bronchial involvement , a rare form of thoracic actinomycosis , has been reported to be associated with foreign bodies .
the first report of endobronchial pulmonary actinomycosis induced by a foreign body was the case of a spanish patient in 1991 , when a chicken bone was aspirated . according to chouabe et al .
, eleven cases of pulmonary actinomycosis secondary to endobronchial foreign body aspiration have been described .
most cases have occurred in middle - aged males with known risk factors such as a chronic debilitated state and poor dentition .
the main symptoms include cough , fever , expectoration of yellow pus , chest pain , and weight loss .
chest computed tomography shows a thickened bronchial wall , dense pulmonary alveolar opacity , atelectasis , pleural effusion , bronchiectasis , lymphadenopathy , or a radiopaque foreign body .
obstructive endoluminal masses have been found on bronchoscopy , but the actual foreign bodies are not easily detected in some cases . in the present case ,
usually the foreign body is likely to have become a host for subsequent actinomyces contamination once the patient had developed poor dentition .
mucosal breaches secondary to foreign body impaction must occur for actinomyces species to colonize and cause a marked granulomatous inflammatory reaction .
we could find only one case of pulmonary actinomycosis induced by a vegetable foreign body .
our case represents a very rare pathogenesis of pulmonary actinomycosis , which is an important disease in the differential diagnosis of a pulmonary mass .
 a 51-year - old woman visited our hospital with massive hemoptysis . 
 she had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times . 
 the patient had a history of pulmonary tuberculosis and bronchiectasis . 
 chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe . 
 we successfully performed a right lower lobectomy . 
 the histological study of the resected specimen showed a vegetable foreign body and clumps of actinomyces , indicating actinomycosis , which was suggested to be the cause of the hemoptysis . 
 this was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis . 
CASE REPORT
DISCUSSION