Sheared off guidewire fragment with distal embolization

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Referred for chest radiograph for renal transplant evaluation.

Patient Data

Age: 30 years
Gender: Female

What is the finding?

X-ray

The guide wire fragment spans SVC-right atrium to IVC.

Use this radiograph to learn the superior and inferior cavoatrial junctions.

Use this to see where IVC ends into RA.

(abdomen radiograph using kv for KUB technique).

Annotated chest radiographs

Annotated image

The guide wire fragment spans SVC-right atrium to IVC.

Use this radiograph to learn the superior and inferior cavo atrial junctions.

Use this to see where the IVC ends into RA.

On KUB film one sees just the tip of the guidewire, so you should use the chest to complete the image in your mind.

Astute sonographer during acquisition spoke to patient and confirmed the finding on echo even before the chest radiograph was read. So made our finding easy to confirm and did not trigger more referrals and work up to retrieve as patient was aware.

I commend the echocardiographer for taking time to ask patient while scanning.

Case Discussion

Guidewire breakage is an infrequent complication, occurring in 0.2% of PTCAs, and it is more common in procedures using rotablator-type devices.

Patient knew the finding of this fragmented wire was there for 2 years and has not had it taken out.

If you notice her chest x-ray, she has probably had many angiograms for her dialysis-related fistula, etc. It will be hard to say when it happened.

So angiographers should be careful when doing procedures and keep this complication in mind.

Radiologists need to be aware of this complication when reading radiographs. This is a "call report" for retained foreign body for young radiologists in training.

Interventional radiologists and cardiologists have experience in explanting the guidewire fragments by non-invasive methods.

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