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Thorax Online First, published on June 16, 2015 as 10.1136/thoraxjnl-2015-206807 Chest clinic

IMAGES IN THORAX

An unusual cause of pulmonary embolism M Bruyneel,1 A Peeters,1 P G Silance,2 S Alard,3 D Horn4 1

Chest Service, CHU Saint Pierre, Brussels, Belgium Department of Cardiology, CHU Saint Pierre, Brussels, Belgium 3 Department of Radiology, CHU Saint Pierre, Brussels, Belgium 4 Vascular Surgery Service, CHU Saint Pierre, Brussels, Belgium 2

CASE REPORT A young patient presented with acute dyspnoea. Anamnesis revealed the loss of metallic guide wire

(GW) during a jugular cannulation 4 years before. Consecutive bilateral pulmonary embolism (PE) was diagnosed by thoracic angio-CT that confirmed

Correspondence to Dr Marie Bruyneel, Chest Service, CHU Saint-Pierre, Rue Haute, 322, Brussels 1000, Belgium; Marie_Bruyneel@ stpierre-bru.be

Chest clinic

Received 3 February 2015 Revised 11 March 2015 Accepted 19 March 2015

Figure 1 Sagittal reconstruction obtained from CT angiography showing metallic guide wire from superior vena cava to right external iliac vena.

To cite: Bruyneel M, Peeters A, Silance PG, et al. Thorax Published Online First: [ please include Day Month Year] doi:10.1136/ thoraxjnl-2015-206807

Figure 2 Transparietal cardiac echography showing the extremity of the guide wire (white arrow) and above, attached mobile thrombi in the right atrium. Bruyneel M, et al. Thorax 2015;0:1–2. doi:10.1136/thoraxjnl-2015-206807

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Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd (& BTS) under licence.

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Chest clinic presence of GW in the vena cava and in the right atrium (figures 1 and 2). Tinzaparin was started. Two weeks later, right iliac veinotomy allowed finally extracting the GW after two unsuccessful transcutaneous attempts. Clinical course was favourable despite occurrence of supraventricular tachycardia, secondary to right atrium lesions. Loss of GW is extremely rare,1 and usually faster removed. Secondary PE has never been described previously.

Contributors AP, MB, PGS, DH have managed the patient. DH, SA, MB have prepared the manuscript and images and the final manuscript version was revised and approved by all the authors. MB is the guarantor and takes responsibility for the integrity of the work as a whole.

Correction notice This article has been corrected since it was published Online First. The provenance and peer review statement has been corrected.

1

Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.

REFERENCE

Chest clinic

Srivastav R, Yadav V, Sharma D, et al. Loss of guide wire: a lesson learnt review of literature. J Surg Tech Case Report 2013;5:78–81.

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Bruyneel M, et al. Thorax 2015;0:1–2. doi:10.1136/thoraxjnl-2015-206807

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An unusual cause of pulmonary embolism M Bruyneel, A Peeters, P G Silance, S Alard and D Horn Thorax published online April 8, 2015

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An unusual cause of pulmonary embolism.

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