Missed guidewire of CV line passing through right atrium

Case contributed by Muhammad Shoyab


Cough, fever. History of central venous catheterization and removal 1 year ago.

Patient Data

Age: 55 years
Gender: Male

Linear metallic density material having a hook at one end is floating along the line of superior vena cava - right atrium - inferior vena cava

Case Discussion

This is an OPD patient who is getting a chest x-ray for fever and cough. However, although the xray shows clear lungs, there is this thin long metallic density material — clearly a metallic wire — floating along the line of SVC-RA-IVC. The location of the wire is highly suggestive of a missed guidewire from a central venous access procedure.

The patient's previous medical records were sought, particularly inquiring whether he had been admitted in ICU / HDU / CCU any time in the past. The patient provided documents showing ICU admission about 1 year earlier, where CV line was used for treatment purposes. However, during insertion of the CV line, the guidewire was perhaps inadvertently left behind, and was not removed thereafter. No check xray was done after removing the CV line during patient discharge (quite obviously as that is never required).

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