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Clinical Image: A 65-year-old female with an unusual object

A 65-year-old female with an unusual object

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Presentation

A 65-year-old woman was presented with an unusual object sticking out of her chest. The patient has no pain, dyspnoe or fever. Her medical history included a mitral and tricuspid valve repair 15 years ago. Six months ago, a central venous catheter was placed for dialysis.

Unusual object

Question about the skin lesions.

I.M. Harmsen & K.P.G.M. Hurkens

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The correct answer is C. The guidewire was lost six months ago, during placement of a central venous catheter for dialysis in the right femoral vein. Over the past months, the wire has migrated and protruded through the chest and moved with every heartbeat. Computed tomography (image) shows a 40 cm guidewire protruding through the right atrium and subsequently the anterior chest wall. The iron wire was extracted by pulling its end under trans-oesophageal echocardiography surveillance. A cardiac surgery team and heart-lung machine were on stand-by in case complications as pericardial tamponade would occur.

Computed tomography scan

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