RESUMEN
The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Remoción de Dispositivos , Migración de Cuerpo Extraño , Humanos , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Resultado del Tratamiento , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Masculino , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Femenino , Anciano , Ecocardiografía Transesofágica , Diseño de PrótesisRESUMEN
This case report details a rare case of contraceptive implant migration in a young woman. The migration was discovered three years post-insertion during a routine replacement visit. Despite the absence of pulmonary symptoms, a CT scan revealed the implant in the inferior lobe of the right lung. The patient was referred for further evaluation, but immediate surgical removal was deferred. This case report highlights the importance of healthcare providers recognising migration as a rare complication during implantation and suggests self-examination as a potential preventive strategy.
Asunto(s)
Anticonceptivos Femeninos , Implantes de Medicamentos , Migración de Cuerpo Extraño , Tomografía Computarizada por Rayos X , Humanos , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Implantes de Medicamentos/efectos adversos , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Femeninos/administración & dosificación , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Adulto , Desogestrel/efectos adversos , Desogestrel/administración & dosificaciónAsunto(s)
Prótesis Valvulares Cardíacas , Corazón Auxiliar , Humanos , Resultado del Tratamiento , Cateterismo Cardíaco/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Masculino , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapia , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Anciano , Femenino , EmbolectomíaRESUMEN
A woman in her 20s was referred to a tertiary hospital emergency department for management of a migrating Implanon NXT. The Implanon was inserted 1 week prior by the patient's general practitioner who was unable to palpate the Implanon after insertion and hence, ordered an ultrasound scan which showed an actively migrating Implanon in the left basilic vein. She had mild chest pain, and her physical examination, ECG and blood tests were unremarkable. A CT chest showed a 31 mm foreign body within the right lower lobar artery. The foreign body was removed by interventional radiology by accessing the right internal jugular vein under ultrasound guidance and inserting a 6 FR pig catheter into the pulmonary trunk. The position was confirmed with angiogram and the foreign body was removed using a goose neck snare. The patient was discharged the same day with no complications, and fell pregnant a few months afterwards.
Asunto(s)
Desogestrel , Migración de Cuerpo Extraño , Arteria Pulmonar , Humanos , Femenino , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/complicaciones , Arteria Pulmonar/diagnóstico por imagen , Desogestrel/efectos adversos , Desogestrel/administración & dosificación , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Femeninos/administración & dosificación , Remoción de Dispositivos , Procedimientos Endovasculares , Adulto Joven , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Fish bone ingestion is commonly encountered in emergency department. It poses a diagnostic and therapeutic challenge particularly when it migrates extraluminally, necessitating a comprehensive and multidisciplinary approach for successful management. CASE PRESENTATION: Here we reported four cases of extraluminal fish bone. The first patient was a 68-year-old Chinese man who had odynophagia shortly after a meal involving fish. The second was a 50-year-old Iban man who reported a sharp throat pain after consuming fish 1 day prior. The third patient was a 55-year-old Malay woman who developed throat pain and odynophagia after consuming fish 1 day earlier. The fourth patient, a 70 year-old Iban man, presented late with odynophagia, neck pain, swelling, and fever 1 week after fish bone ingestion. These unintentional fish bone ingestions faced challenges and required repeat computed tomography scans using multiplanar reconstruction in guiding the surgical removal of the fish bone. CONCLUSION: We underscore the significance of multiplanar reconstruction in pinpointing the fish bone's location, demonstrating the migratory route, and devising an accurate surgical plan.
Asunto(s)
Peces , Cuerpos Extraños , Tomografía Computarizada por Rayos X , Humanos , Anciano , Masculino , Femenino , Persona de Mediana Edad , Animales , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Huesos/diagnóstico por imagenRESUMEN
CASE: We present a unique case of a 45-year-old man with his right middle finger embedded with rings. Limited finger flexion was noted because of flexor tendon injury caused by the dorsal migration of the embedded ring through joint. The rings were removed under anesthesia, resulting in the resolution of swelling and recover of osseous structure. Follow-up examinations revealed no residual edema or numbness, indicating preserved neurovascularization, despite the dorsal migration of the ring. CONCLUSION: Our unique case reveals continuous finger ring migration without compromising neurovascular bundles, with review of 30 cases emphasizing the importance of psychiatric consultation. Timely intervention yielded nearly half of patients achieving full recovery.
Asunto(s)
Articulaciones de los Dedos , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de los Dedos/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagenRESUMEN
The current state of the literature for a bullet embolization to the heart and/or pulmonary vasculature indicates the occurrence is rare but could increase due to the rise in civilian low-kinetic-energy firearm acquisition and use. We present the case of an older teenage male who sustained a gunshot wound to the left flank. The bullet entered the iliac vein, travelled through the heart and lodged in the pulmonary artery. Successful relocation of the bullet to the internal iliac vein was performed by the interventional radiologist. This article highlights the advancement of interventional radiology as a successful non-invasive endovascular technique for bullet embolus removal.
Asunto(s)
Procedimientos Endovasculares , Migración de Cuerpo Extraño , Arteria Pulmonar , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Arteria Pulmonar/cirugía , Resultado del Tratamiento , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/terapia , Procedimientos Endovasculares/instrumentación , Adolescente , Radiografía Intervencional , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/lesiones , Vena Ilíaca/cirugía , Angiografía por Tomografía Computarizada , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/cirugía , Embolia Pulmonar/terapiaRESUMEN
Ventriculoatrial shunts are the alternative treatments when it is impossible to use ventriculoperitoneal shunts. Limited indication for ventriculoatrial shunt is due to the possibility of very serious complications inherent with this procedure. We present a case report of a young patient who suffered from disconnection of an atrial catheter from the valve after an accidental blow to his neck. The atrial catheter was dislocated to the heart and pulmonary artery and it was extracted through the femoral vein in the groin area using an endovascular technique. The procedure went without complications. A new atrial catheter was introduced under ultrasonic guidance during surgical revision.
Asunto(s)
Arteria Pulmonar , Humanos , Masculino , Arteria Pulmonar/cirugía , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Atrios Cardíacos/cirugía , AdultoAsunto(s)
Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Resultado del Tratamiento , Aortografía , Anciano de 80 o más Años , Masculino , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Angiografía por Tomografía Computarizada , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Anciano , Diseño de Prótesis , Dilatación Patológica , Femenino , Aorta/diagnóstico por imagen , Aorta/cirugía , Embolia/etiología , Embolia/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/etiologíaAsunto(s)
Colecistectomía Laparoscópica , Conducto Colédoco , Migración de Cuerpo Extraño , Instrumentos Quirúrgicos , Humanos , Colecistectomía Laparoscópica/métodos , Conducto Colédoco/cirugía , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Instrumentos Quirúrgicos/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugíaRESUMEN
PURPOSE: Catheter displacement is a common complication of peritoneal dialysis. The aim of this study was to explore the correlation between catheter morphology and displacement by analyzing CT data, providing a scientific basis for optimizing catheter morphology within abdominal wall layers. METHODS: We retrospectively analyzed the clinical data of 94 patients. The parameters for analyzing catheter morphology were defined based on six key points identified from CT images. The covariates considered in the analysis included demographics, primary disease, body size, peritoneal dialysis method, and total weekly urea clearance index. RESULTS: During a mean follow-up period of 1056 ± 480 days, only the angle of the intramuscular part (IM angle) of the catheter significantly correlated with the time to first catheter displacement according to the multivariate analysis (hazard ratio [HR]: 1.039, 95% confidence interval [CI] 1.02-1.058, p < 0.01). When the cut-off value of IM angle was 39.4 ∘ , the area under receiver-operating characteristic (ROC) curve for predicting catheter displacement was 0.791 (95% CI 0.701-0.881, p < 0.01), with a sensitivity and specificity of 82.9% and 66.0%, respectively. Kaplan-Meier survival curves showed that the catheter survival rate was significantly higher in the group with an IM angle < 39.4 ∘ than in the group with an IM angle > 39.4 ∘ (log-rank χ 2 =19.479, p < 0.01). None of the catheter morphology parameters were significantly correlated with technique survival in the multivariate analysis. CONCLUSION: There is a correlation between catheter morphology and catheter displacement. An IM angle > 39.4 ∘ is an independent risk factor for catheter displacement, while the position and angle of the subcutaneous part are not correlated with catheter displacement.
Asunto(s)
Catéteres de Permanencia , Diálisis Peritoneal , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Adulto , Diseño de Equipo , Curva ROC , Pared Abdominal/diagnóstico por imagen , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicacionesRESUMEN
This case report documents the management of a 66-year old man with atrial fibrillation with recent placement of a WATCHMAN® Flex atrial appendage occlusion device. The patient presented with renal failure, abdominal pain, and difficulty walking 2 months after placement. The WATCHMAN® Flex device was found to have embolized to his abdominal aorta at the level of the renal arteries with associated thrombus. Extensive workup revealed reduced left ventricular cardiac function and decreased renal function, both of which were felt to be potentially reversible with device removal. The patient then underwent retrieval of the device and all associated thrombus via an open retroperitoneal approach. This case demonstrates a potential consequence of implanting devices such as an atrial appendage occlusion device and describes a technique for removal.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Remoción de Dispositivos , Migración de Cuerpo Extraño , Humanos , Anciano , Masculino , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Fibrilación Atrial/diagnóstico , Resultado del Tratamiento , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Diseño de Prótesis , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Trombosis/etiología , Trombosis/diagnóstico por imagen , Trombosis/terapia , Trombosis/fisiopatología , Aortografía , Angiografía por Tomografía Computarizada , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapiaAsunto(s)
Falla de Prótesis , Dispositivo Oclusor Septal , Humanos , Dispositivo Oclusor Septal/efectos adversos , Falla de Prótesis/efectos adversos , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Femenino , Masculino , Defectos del Tabique Interatrial/cirugíaRESUMEN
BACKGROUND: Nexplanon implants are a common hormonal contraceptive modality. Though rare, these devices can embolize into the injured wall of the basilic vein, through the right heart, and finally wedge itself into a pulmonary artery. With adherence to the arterial wall over time, it becomes less amenable to endovascular retrieval. Patients may present with symptoms mimicking a pulmonary embolism, or without any symptoms at all. In asymptomatic cases, endovascular retrieval and/or surgery is required when patients wish to begin having children prior to biological inactivity. The current literature showed as little as nine case reports detailing lung tissue removal in the aim of reversing a patient's implanted contraceptive device. CASE PRESENTATION: A 22-year-old asymptomatic active-duty Caucasian female presented for elective outpatient Nexplanon removal. The suspicion of possible implant migration arose when it was discovered to be non-palpable in her left arm. After plain film x-rays failed to localize the implant, a chest x-ray and follow-up Computed Tomography (CT) scan revealed that the Nexplanon had migrated to a distal branch of the left pulmonary artery. Due to the patient's strong desires to begin having children, the decision was made for removal. Initial endovascular retrieval failed due to Nexplanon encapsulation within the arterial wall. Ultimately, the patient underwent a left video-assisted thoracoscopic surgery (VATS) for exploration and left lower lobe basilar S7-9 segmentectomy, which successfully removed the Nexplanon. CONCLUSIONS: Implanted contraceptive devices can rarely result in migration to the pulmonary vasculature. These radiopaque devices are detectable on imaging studies if patients and clinicians are unable to palpate them. An endovascular approach should be considered first to spare lung tissue and avoid chest-wall incisions, but can be complicated by encapsulation and adherence to adjacent tissue. A VATS procedure with single-lung ventilation via a double-lumen endotracheal tube allows surgeons to safely operate on an immobilized lung while anesthesiologists facilitate single-lung ventilation. This patient's case details the uncommon phenomenon of Nexplanon migration, and the exceedingly rare treatment resolution of lung resection to remove an embolized device.
Asunto(s)
Desogestrel , Remoción de Dispositivos , Migración de Cuerpo Extraño , Humanos , Femenino , Remoción de Dispositivos/métodos , Desogestrel/administración & dosificación , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Adulto Joven , Anticonceptivos Femeninos/administración & dosificación , Implantes de Medicamentos , Arteria Pulmonar/cirugía , Arteria Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Embolia Pulmonar/etiología , Resultado del Tratamiento , NeumonectomíaRESUMEN
Tension band wiring (TBW) is one of the most commonly used fixation techniques to fix olecranon osteotomies. Hardware prominence has been the most commonly reported complication of TBW. However, distal migration of Kirschner (K)-wire after TBW fixation for olecranon osteotomy has not been reported. In this case report, we presented distal migration of K-wire detected nine months after initial surgery in a 46-year-old male patient. The patient was operated on for an intraarticular distal humerus fracture using an olecranon osteotomy. The osteotomy was fixed with TBW fixation. The patient missed routine follow-ups and presented to the outpatient clinic with a complaint of skin irritation at the elbow nine months after the surgery. On radiological examination, distal migration of one K-wire was detected. The K-wire was surgically removed without any complication. Physicians should be aware of possible complications of TBW and remove fixation after fracture union to avoid unexpected complications.