PT - JOURNAL ARTICLE AU - A. Baydur AU - M. N. Koss AU - O. P. Sharma AU - G. E. Dalgleish AU - D. V. Nguyen AU - F. G. Mullick AU - L. A. Murakata AU - J. A. Centeno TI - Microscopic pulmonary embolisation of an indwelling central venous catheter with granulomatous inflammatory response AID - 10.1183/09031936.05.00134204 DP - 2005 Aug 01 TA - European Respiratory Journal PG - 351--353 VI - 26 IP - 2 4099 - http://erj.ersjournals.com/content/26/2/351.short 4100 - http://erj.ersjournals.com/content/26/2/351.full SO - Eur Respir J2005 Aug 01; 26 AB - Indwelling catheters can disintegrate into tiny fragments and embolise. Once the fragments are detected radiographically, they can be removed using vascular intervention techniques. Rarely, indwelling catheters dwindle into inextricable pieces that embolise into minute pulmonary vessels and lymphatics, causing granulomatous changes microscopically. The present study reports a 54-yr-old female who had received several indwelling central lines during several abdominal surgeries over a 5-yr period. The patient developed a noncaseating granulomatous skin lesion followed by exertional dyspnoea a few months later. Chest radiographs and computed tomography showed diffuse interstitial infiltrates. Open lung biopsy showed two types of granulomas: 1) peri-lymphangitic and peri-bronchiolar non-necrotising granulomas consistent with sarcoidosis; and 2) distinct foreign body granulomas. In some of the foreign body granulomas, confocal Raman spectroscopy identified the presence of bisphenol-A-polycarbonate, a polymer commonly used in biomedical devices. The patient improved following treatment with prednisone followed by methotrexate. The present case illustrates an interesting combination of two causes of granulomatous disease, the importance of examining all biopsy specimens from sarcoidosis patients for foreign particles and the rare occurrence of microscopic embolisation of catheter fragments to the lung with foreign-body giant cell reaction to them.