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Chen A, Xu G, Cai Q, Song Y, Ruetzler K, Merritt RE, Chen C. Chest wall trauma leading to a metallic foreign body in the right subclavian vein: a case report. J Thorac Dis 2021; 13:1286-1290. [PMID: 33717599 PMCID: PMC7947543 DOI: 10.21037/jtd-21-68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anping Chen
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Gang Xu
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qingyong Cai
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yongxiang Song
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Main Campus, Cleveland, OH, USA
| | - Robert E Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cheng Chen
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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2
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Scheggi V, Mariani T, Mazzoni C, Stefàno PL. A case of needle embolism in a drug abuser, a diagnostic and therapeutic challenge. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00036-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Needle embolism is a rare complication of intravenous habit. Clinical manifestations include recurrent pericarditis, tamponade, cardiac perforation, and infective endocarditis. We describe the case of needle embolization in a young intravenous opiate abuser.
Case presentation
We describe a rare complication of intravenous misuse in a 23-year-old patient. He presented at the emergency department with chest pain and shortness of breath. He complained of remittent fever ensued 6 months before. Echocardiographic and radiologic images revealed pericardial effusion and a needle fragment inside the pericardium. The needle was removed through left-anterior mini-thoracotomy, after CT-guided carbon tracking.
Conclusions
The presence of a foreign body within the heart resulted from the migration of a needle fragment from a peripheral vessel. It caused fever and recurrent pericarditis. In similar cases, surgical extraction is the therapy of choice.
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Elmassry M, Del Rio-Pertuz G, El-Nawaa S, Abdelmalek J, Ansari MM. A Fractured Inferior Vena Cava Strut Migrating to the Right Ventricle Without Any Cardiovascular Complaint: A Case Report and Review of Literature. Cureus 2020; 12:e9779. [PMID: 32953297 PMCID: PMC7491686 DOI: 10.7759/cureus.9779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022] Open
Abstract
The use of inferior vena cava filter (IVCF) as one of the last resorts for pulmonary embolism prevention has expanded over the decades. The migration of a broken strut to the right ventricle is a very unusual complication that, when present, has been associated with life-threatening events. We report a case of a 34-year-old female with an inferior vena cava (IVC) strut that migrated and was incidentally found embedded in the right ventricle without any cardiovascular signs or symptoms. This case provides evidence that such filters probably have higher rates of complications than what has been thought because those complications might remain asymptomatic.
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Affiliation(s)
- Mohamed Elmassry
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Saif El-Nawaa
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - John Abdelmalek
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Mohammad M Ansari
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
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4
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A foreign body in the blood vessel: A diagnostic and therapeutic dilemma. Am J Emerg Med 2020; 38:1697.e5-1697.e7. [PMID: 32482484 DOI: 10.1016/j.ajem.2020.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 11/21/2022] Open
Abstract
Foreign body(FB) in soft tissue is a common injury in trauma, but it is rare for FB to enter the blood vessel. Typical causes of intravascular FB include iatrogenic and non-iatrogenic factors.A 65-year-old Chinese worker's left hand was hit by two colliding metal blocks while operating a machine tool. Then, he referred to our hospital's emergency department of orthopedics. The X-rays showed that metal FB could be seen in trapezium bone regions of the left hand. During the operation, the FB was found in the cephalic vein of his left hand, so the FB was removed by surgery. After six weeks of follow-up, he has returned to normal working conditions.The purpose of this article is to describe the diagnosis and treatment of a rare condition in the emergency department. In our emergency work, it is easy to miss the diagnosis of intravascular FB caused by trauma. To our knowledge, this is the third reported intravascular FB caused by trauma and the first reported intravascular FB was located in the vein of the hand. Detailed medical history and auxiliary examinations are the key to the diagnosis of FB in the blood vessels.
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Yen AF, Homer CM, Mohapatra A, Langnas E, Gomez A, Hendrickson CM. Embolic Hypodermic Needle Causing Traumatic Cardiac Tamponade: A Case Report. Crit Care Explor 2019; 1:e0038. [PMID: 32166279 PMCID: PMC7063948 DOI: 10.1097/cce.0000000000000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We present a unique case of a broken fragment of a hypodermic needle breaking and embolizing to the heart. This needle subsequently penetrated the right ventricle and the patient developed hemopericardium which resulted in cardiac tamponade physiology. DATA SOURCES None. STUDY SELECTION None. DATA EXTRACTION None. DATA SYNTHESIS Recognizing the potential for unusual and serious complications of IV illicit drug use is an important part of providing effective and timely medical care in this vulnerable population. CONCLUSIONS An embolic needle phenomenon can have significant sequela, including direct cardiac trauma leading to tamponade and subsequent cardiac collapse. Partnering with the patient to take a detailed history was critical in uncovering the underlying etiology of this patient's cardiogenic shock.
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Affiliation(s)
- Albert F Yen
- Division of Critical Care, Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Christina M Homer
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexander Mohapatra
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Erica Langnas
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Antonio Gomez
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Carolyn M Hendrickson
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Poliwoda S, Suthar R, Suraci N, Garcia P, Behrens V, Goldman H. Inferior vena cava filter removal - Hope for the best and prepare for the worst: An anesthesiology perspective. Ann Card Anaesth 2019; 22:337-339. [PMID: 31274503 PMCID: PMC6639879 DOI: 10.4103/aca.aca_159_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient presented to our institution for an elective removal of an inferior vena cava (IVC) filter under local anesthesia. Once removed, it was noticed that the filter had a missing secondary leg. The patient had a chest CT done which showed a hyper-attenuating structure in the region of the tricuspid valve highly suspicious for the fractured strut of the filter. Upon these findings, the patient was taken once again to the surgical suite for an endovascular retrieval of the strut. For fear of a possible cardiac injury and a potential need for a sternotomy, the patient received general anesthesia and was placed with appropriate IV access and full cardiac monitors. The strut was removed successfully without any complications. Despite the relative benign nature of this endovascular procedure, one should always be prepared for an appropriate resuscitation in case of an occurrence of a surgical complication.
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Affiliation(s)
- Salomon Poliwoda
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Rekhaben Suthar
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Nicholas Suraci
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Pedro Garcia
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Vicente Behrens
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Howard Goldman
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
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Abstract
RATIONALE Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient. PATIENT CONCERNS Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury. DIAGNOSES X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location. INTERVENTIONS The foreign body was removed completely following a microsuture of the cephalic vein. OUTCOMES The procedure was uneventful, and the patient remained asymptomatic after 6 months of clinical follow-up. LESSONS This case indicated that the foreign body in the superficial tissue needed to be accurately diagnosed and located. X-ray and C-arm fluoroscope imaging should be combined with the patient's medical history to ensure sufficient preoperative preparation.
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Affiliation(s)
- Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area
| | - Maohua Wei
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of General Surgery, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area, Liaoning, China
| | - Ze Song
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian
| | - Liang Li
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of General Surgery, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area, Liaoning, China
| | - Jifeng Fan
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian
| | - Mozhen Liu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian
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Sako Z, Avula SR, Gaies E, Daniel R. Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart. BMJ Case Rep 2018; 2018:bcr-2017-222054. [PMID: 29563124 DOI: 10.1136/bcr-2017-222054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Inferior vena cava (IVC) filters are increasingly used in patients with recurrent venous thromboembolism in whom anticoagulation is contraindicated or intolerable. Migration of fragments is a known complication of IVC filter use. We present a case of a 32-year-old man, who presented with right-sided chest pain believed to be caused by a migrated IVC fragment to the right ventricle. The filter was removed by an endovascular cook forceps with the assistance of intracardiac echocardiography. This case serves as an addition to the existing reports of successful removal of intracardiac fragments via minimally invasive endovascular approach, amid a larger number of intracardiac fragments that have been removed by an open-heart approach.
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Affiliation(s)
- Zeyad Sako
- Department of Internal Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
| | - Sindhu Reddy Avula
- Department of Internal Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
| | - Elissa Gaies
- Department of Internal Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
| | - Rebecca Daniel
- Department of Internal Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
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9
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Ju NR, Conlon LW. Inferior Vena Cava Filter Migration. J Emerg Med 2015; 50:e151-3. [PMID: 26433430 DOI: 10.1016/j.jemermed.2015.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/30/2015] [Accepted: 07/25/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Na Rae Ju
- Emergency Medicine Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren W Conlon
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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