Introduction Stylets are used daily in the Delivery Room and Neona- tal Intensive Care Unit (NICU) during endotracheal in- tubation of infants. The stylets are plastic coated or covered by a plastic sheath to prevent injury to the air- way. A rare complication of endotracheal intubation is obstruction of the endotracheal tube by the plastic stylet sheath that has sheared off [1±3]. We report the fourth case in which the sheath of a stylet sheared off and be- came dislodged in the tracheobronchial tree. Using a special retrieval system and fluoroscopic guidance, we withdrew the sheath through the existing endotracheal tube. Case report A 26-year-old female presented at 26 weeks' gestation with prema- ture labor, full cervical dilatation, and the fetus in transverse lie. A 930-g female infant delivered by cesarean section was cyanotic, hy- potonic, and bradycardiac. She was intubated without difficulty with a 2.5 mm, uncuffed endotracheal tube (Mallinckrodt Medical). A Satin Slip 6 french, plastic-coated stylet (Mallinckrodt Medical, Cat. No. 85863, Argyle, N.Y.) was used during the intubation and was removed successfully after intubation. The infant's color, heart rate, and tone improved within 1 min. The infant received two doses of exogenous surfactant via the endotracheal tube, without compli- cation. Anteroposterior and lateral chest radiographs demonstrat- ed improving hyaline membrane disease, umbilical arterial and venous catheters, and endotracheal tube in satisfactory position, and, adjacent to the appropriately positioned endotracheal tube, a radioopaque tube in the trachea and left main bronchus (Fig. 1 a,b). The infant was in no respiratory distress. The neonatologist and pe- diatric radiologist considered options for retrieval of the foreign body, taking into consideration the small size of the patient, the air- way, and the presence of the 2.5 mm endotracheal tube. They elect- ed to attempt to retrieve the foreign body using a retrieval snare. Roland L. Boyd Harold A. Bradfield Edward M. Burton Brian S. Carter Fluoroscopy-guided retrieval of a sheared endotracheal stylet sheath from the tracheobronchial tree in a premature infant Received: 24 November 1998 Accepted: 11 March 1999 R.L. Boyd ´ B. S. Carter Department of Pediatrics, Section of Neonatology, Medical College of Georgia, Augusta, Georgia, USA H.A. Bradfield ´ E. M. Burton Department of Pediatrics, Department of Radiology, Medical College of Georgia, Augusta, Georgia, USA E.M. Burton ( ) ) Department of Radiology, Medical College of Georgia, 1120 15th Street, Augusta, GA, 30912, USA Abstract Endotracheal intubation of premature infants with respirato- ry distress is a commonly perform- ed procedure in the neonatal intensive care unit. We report a rare complication of this procedure, shearing of the plastic sheath that is bonded to and surrounds the stylet used to assist intubation and lodg- ing of the sheared stylet in the tra- cheobronchial tree of a small premature infant. We suggest a method for removing the plastic foreign body using fluoroscopy and an Amplatz gooseneck snare di- rected through the existing endo- tracheal tube, a technique not previously reported. Pediatr Radiol (1999) 29: 575±577 Ó Springer-Verlag 1999