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We thank you very much for allowing us to respond to the letter by Marchiori et al1 submitted in response to our recently published paper titled ‘Parasitic infections of the lung: a guide for the respiratory physician’.2
We agree with the authors that the condition may be a difficult diagnostic challenge, but in textilomas (gossypibomas) there is nearly always a history of previous surgery. In a fairly large series of CT scans performed on textilomas, Kopka et al3 observed that in seven patients gas bubbles were found inside the textiloma with a typical pattern. These patients did not have any abscess formation; however, it is interesting to note that the radio-opaque marker inside a textiloma was seen in nine patients but did not lead to a diagnosis in all of them. The authors also found that, from in vitro studies, gas bubbles were demonstrated in all surgical sponges scanned 1 hour afterwards. It is interesting that the number of gas bubbles were not significantly reduced after 6 months. CT signs of thoracic textilomas include well-defined mediastinal or pleural-based masses with hyperdense rims, central air bubbles, with curvilinear high-density stripes occasionally seen in the early postoperative period.4 We agree that the appearance of retained surgical sponges (textilomas/gossypibomas) can lead to misdiagnosis with lesions mimicking malignancy and hydatid disease. Textilomas have been reported in a variety of places including the maxillary sinuses, the brain and the abdomen as well as the chest, and radiologists need to be aware and vigilant of this particular clinical problem.
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.