Percutaneous retrieval of a chronic foreign body with both intravascular and extravascular components FSK Chu, 1 WK Tso 1 and AKW Lie 2 Departments of 1 Radiology and 2 Medicine, Queen Mary Hospital, Hong Kong SUMMARY Removal of unwanted intravascular foreign body is a useful but infrequent procedure carried out by interventional radiologists. We study a patient who had a long guidewire left in her body following central venous catheter placement by a surgeon. The guidewire was later found in situ, with both intravascular and extravascular compo- nents in continuity. We successfully removed the guidewire without causing any complications. Standard interven- tional techniques, Amplatz gooseneck snare (Microvena, White Bear Lake, MN, USA) and 6-Fr Multipurpose catheter were used. Key words: catheters and catheterization; central venous access; foreign body; fluoroscopy . CASE REPORT N. Y. W. was a 46-year-old woman with a human leucocyte locus A-matched sibling bone marrow transplant carried out for acute lymphocytic leukaemia. This was complicated by chronic graft-vs-host disease with repeated admission to our hospital between January 2003 and December 2003. Chest radiograph on admission showed a long guidewire in the right side of neck and mediastinum. In view of her unstable haemoto- logical condition, the haematologist in charge decided to leave the foreign body alone for the time being. The inferior extent of the guidewire was not ascertained during that admission. In November 2003, the patient developed sepsis. After elim- inating other causes, the guidewire left in situ was thought to be the most likely culprit. Percutaneous removal of the guidewire using an endovascular technique was considered. Frontal chest and abdominal radiographs showed a J-tip guidewire extending from the right side of neck all the way to the pelvis, projecting over the medial aspect of the right acetabulum. An ultrasound examination of the right jugular vein was carried out (Fig. 1), confirming the intravascular location of the wire. Non-contrast CT of the pelvis showed the entire extent of the guidewire on the scanogram (Fig. 2). The inferior tip of the guidewire was situated anterior to the right piriformis muscle. A small loculated fluid collection measuring 3 cm · 4.5 cm · 5 cm was seen in the Pouch of Douglas and is just anterior to the distal tip of the guidewire (Fig. 3). Two possible approaches were considered for removal of the guidewire: first, a transjugular approach and second, a transfemoral approach. However, the upper extent of the guidewire was too high and it was not feasible to make a punc- ture at a more cephalic location for access. Hence, the left transfemoral approach was chosen. A puncture was made using a standard one-piece puncture needle (Cordis, Miami, FL, USA.) followed by insertion of an 8-Fr vascular sheath. A 10-mm loop Amplatz gooseneck snare (Microvena) was inserted through a 6-Fr MPA2 multipurpose catheter (Cordis). The upper end of the guidewire was snared and it was easily made to double up. It was pulled down through the right jugular vein, superior vena cava, right atrium, inferior vena cava, left common iliac vein and the left femoral vascular FSK Chu MB BS, LLB, FRCR, FHKAM (Radiology), FACLM; WK Tso MB BS, DMRD, FRCR, FHKAM (Radiology); AKW Lie MB BS, FRCP, FHKAM (Medicine), FRCPA, FRCpath Correspondence: Dr Ferdinand SK Chu, Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. Email: fskchu@netvigator.com Submitted 6 October 2004; accepted 14 February 2006. doi: 10.1111/j.1440-1673.2007.01694.x Case Report Australasian Radiology (2007) 51, 179–181 ª 2007 The Authors Journal compilation ª 2007 Royal Australian and New Zealand College of Radiologists