Spontaneous Elimination of Inhaled Grass Inflorescences through the Lung and Chest Wall.

Grass inflorescences as foreign bodies in the respiratory tract are rare, 45 cases having been recorded to date. Jackson (1960) made a comprehensive study of the subject and reviewed the published material as far back as 1794: he found reports of only 35 cases. In 1955, Woolley reported 3 cases of inhaled grass inflorescences and Godfrey (1957) added 2 new cases. Holinger and Johnston (1954), in a classification of 2,042 cases of various types of foreign bodies in the air and food passages, made no mention of grass inflorescences. According to Jackson (1960), the fate of inflorescences entering the respiratory tract depends upon their botanic characteristics which produce two distinct clinical types. In the first, because of their construction, inflorescences remain in the bronchi until removed bronchoscopically; in the second, to which the majority of cases belong, inflorescences, owing to their ability to travel towards the periphery, penetrate the parenchyma of the lung, the pleural layers, and the intercostal muscles and finally protrude under the skin of the chest wall. There are a few points that should be emphasized. (1) Grass inflorescences belong to the group of foreign bodies inhaled mainly by young children. (2) Because of their shape, inflorescences do not produce bronchial obstruction and therefore give no acute symptoms. (3) During their stay in the lung (which varies from a few days to many months) it is difficult to detect them with the bronchoscope, while the clinical signs are persistent and rather bizarre, thus creating a difficult diagnostic problem. The following are reports of two cases of inhaled grass inflorescences that were spontaneously eliminated from the thoracic wall.