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March 11, 1968

Toothpick Pleurisy

JAMA. 1968;203(11):988. doi:10.1001/jama.1968.03140110080024

To the Editor:—  Toothpicks as foreign bodies are particularly dangerous because they are sharp at both ends, indigestible, and roentgenographically undetectable. After ingestion they may enter or pass completely through the bowel wall, causing peritonitis or abscess formation at, or distal to, the site of perforation.1,2 In the patient presented here, a toothpick lodged in the right hemidiaphragm and adjacent lung and gave rise to a pleural effusion. Our review of the medical literature in English uncovered no previous case of intrapulmonary toothpick or of toothpick-induced pleural disease.

Report of a Case:  A 57-year-old bricklayer was admitted to the hospital because of fever, chills, chest pain, pleural effusion, and weight loss of 13.6 kg (30 lb). Aside from frequent alcoholic debauches, he had been well until two months earlier when he came to the outpatient clinic complaining of constant, dull, epigastric pain of one week's duration. Physical examination revealed