Radiology #1: Lost & Found

The Patient

A 48 year old female patient presents following a recent discharge from a local private hospital. She was admitted there following a motor vehicle accident, about which there is limited information. She complains of on-going right-sided neck pain which has been present since admission and hasn't improved in the week since she was discharged. You request a series of plain film x-rays of the patient's neck, which reveals:

The Pictures

A chest x-ray is then subsequently ordered for the patient, which can be seen below:

What do you think?

click to reveal the answer

The radiographs show a radioopaque foreign body consistent with a retained guidewire. This can be seen traversing the right neck in the initial films, with the J-tip overlying the tip of the odontoid process on the lateral film. It can then be seen in the chest on the subsequent films, following the right heart border along the contour of the inferior vena cava. There is no abnormality of the visualised c-spine, though the C7-T1 junction is not adequately visible on the lateral view.

It transpired that the patient had previously had a femoral central venous catheter inserted during the course of their admission. The indication for the CVC is unclear, as is the nature of any imaging the patient had subsequently.

Lost guidewires are a rare but serious complication of CVC insertion. They can cause dysrhythmias, cardiac or vascular perforation, and venous thromboembolic events.

The patient was referred back to the original hospital for retrieval of the guidewire. Retrieval is typically an endovascular procedure that can be done percutaneously using specialised snares, but in some cases surgical retrieval may be necessary, especially if the wire has been there for some time.

---

Thanks to Dr Peris Kariuki for submitting this case.

References

click to see references

[1] Carroll MI, Ahanchi SS, Kim JH, Panneton JM. Endovascular foreign body retrieval. J Vasc Surg. 2013;57(2):459-63.