Some retained intrathoracic missiles are best left in place, while others must be removed. The decision on whether or not to operate depends on balancing the various risks involved.
Missiles that should be surgically removed:
(1) sharp-edged and/or pointed
(2) located near or migrating towards a vital structure (the airway, a major blood vessel or the heart, esophagus)
(3) has resulted in a serious complication (hemoptysis, pneumothorax, infection, etc)
Missiles that can be observed:
(1) round or smooth edged, blunted
(2) fixed by fibrous tissue
(3) remote from a vital structure
(4) asymptomatic
The decision to remove the missile or not depends on the risk of the missile staying vs the risk of the procedure to remove it.
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