A 74-year-old man who survived the tsunami after the Great East Japan Earthquake, was admitted to our department because of respiratory distress. He developed aspiration pneumonia and pleural empyema of the right thorax. Decortication was performed by video-assisted thoracoscopic surgery. An unsuspected aspirated pine tree branch and pulmonary pleural fistula were discovered. The branch was removed, the pleural fistula was opened for drainage of the intrapulmonary abscess, and the patient made a good recovery.
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