A 43-year-old male presented with a 3-day history of sharp pleuritic chest pain that came on suddenly while driving. For 12 months prior to this, he had similar 'niggling' intermittent pain. He had no other associated symptoms. His past medical history included a motorcycle accident 30 years ago in which he sustained a fracture dislocation of the sterno-clavicular joint. This was treated with internal fixation. According to the patient, the pin was supposed to be removed 6 weeks following the initial injury but on admission for pin removal it was noted that the pin had moved and so surgery was cancelled. More recently, the patient suffered a fall resulting in a left occipital and T12/L1 wedge fractures. A chest X-ray (Fig. la) at the time of this fall shows a metal foreign body in the left lateral mid-chest. At the time of the most recent admission, a chest X-ray (Fig. lb) shows that the foreign body had migrated inferiorly and medially. For further evaluation of his chest pain, a computerized tomography scan was also arranged. This showed a metallic pin between his T12 vertebral body and the left cms of the left hemi-diaphragm with the tip abutting (and pointing directly at) the aorta (Fig. 2). Given the proximity to the aorta and the patient's pleuritic symptoms, it was thought necessary to remove the foreign body.
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