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Table of Contents
INTERESTING IMAGE  
Year : 2021  |  Volume : 24  |  Issue : 1  |  Page : 77-78
Incidentally found guidewire during bacterial endocarditis workup


1 Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, USA
2 Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA

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Date of Submission01-Jun-2019
Date of Decision23-Jun-2019
Date of Acceptance17-Jul-2019
Date of Web Publication22-Jan-2021
 

   Abstract 


A 67-year-old female with recent hospitalization for pneumonia was transferred to our facility for high fevers and positive blood cultures for staph aureus. During her treatment for pneumonia, central venous catheter was placed. A systolic murmur was found in conjunction with fever and notable premature ventricular contractions on telemetry monitoring. Chest x-ray and transesophageal echocardiography were then performed, and a free guidewire was identified which was later successfully removed under interventional radiology.

Keywords: Endocarditis, guidewire, transesophageal echocardiography

How to cite this article:
Suraci N, Horvath SA, Barkin H, Santana O. Incidentally found guidewire during bacterial endocarditis workup. Ann Card Anaesth 2021;24:77-8

How to cite this URL:
Suraci N, Horvath SA, Barkin H, Santana O. Incidentally found guidewire during bacterial endocarditis workup. Ann Card Anaesth [serial online] 2021 [cited 2021 Oct 16];24:77-8. Available from: https://www.annals.in/text.asp?2021/24/1/77/307777





   History Top


A 67-year-old female was transferred to our facility with an 8-day history of being hospitalized at another institution with pneumonia; she was improving, however, on day 6 of her hospitalization, had recurrence of fevers and had positive blood cultures for Staphylococcus aureus. Over the course of her previous hospital stay, a central venous catheter was placed in the right internal jugular vein for fluid and pressor administration. She was transferred in order to obtain a TEE, and for further care. No information about previous imaging were reported on handoff. On physical examination, a systolic murmur was noted in the left parasternal region. Other exam findings noted were temperature of 102.1°F, heart rate of 110 beats per minute with frequent premature ventricular contractions noted on the telemetry monitor, and a respiratory rate of 21 breaths per minute. Urgent TEE obtained on her arrival demonstrated a free-floating guidewire extending into the pulmonary artery, which was subsequently confirmed on chest x-ray. [Figure 1] and [Figure 2]. Interventional radiology was consulted, and with the use of fluoroscopic guidance the guidewire was successfully removed with endovascular direct loop snaring. Following removal, the systolic murmur and the premature ventricular contractions resolved. Cultures of the guidewire grew S. aureus. The patient did well throughout her hospital stay with supportive treatment and antibiotics.
Figure 1: Mid-esophageal modified RV in-flow outflow view with arrow demonstrating a guidewire in the right ventricle extending into the main pulmonary artery. PA: Pulmonary Artery. Ao: Aorta

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Figure 2: Chest x-ray demonstrating the guidewire extending into the main pulmonary artery. Arrow demonstrates location of guidewire

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   Discussion Top


Incidental guidewire-related complications have been rarely reported, but are significantly associated with mortality and morbidity.[1] With over 5 million central venous catheters placed in the United States yearly, intravascular loss of guidewires represents a rare and potentially fatal complication that can be preventable.[2] Intravascular migration of guidewire has potential for inducing vascular and tissue damage, thrombosis, embolism and arrhythmias. However, in rare circumstances, it has been reported that wire migration into circulation may not induce symptoms and its loss may remain unnoticed for a significant period of time.[3] Guidewire-related perforation of central veins right-sided cardiac chambers, cardiac tamponade can be catastrophic, and have been reported in literature.[4] The presentation of our patient with symptoms suggestive of endocarditis in conjunction with premature ventricular complexes on electrocardiogram has been rarely documented in recent literature. Fortunately, endovascular direct loop snaring was successful for guidewire removal and the patient made full recovery with supportive care.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kashif M, Hashmi H, Jadhav P, Khaja M. A missing guide wire placement of peripherally inserted central venous catheter. Am J Case Rep 2016;17:925-8.  Back to cited text no. 1
    
2.
Shih A, Sankey C. Incidental discovery of retained triple lumen catheter guidewire. J Gen Intern Med 2016;32:361-2.  Back to cited text no. 2
    
3.
Abuhasna S, Abdallah D, Rahman M. The forgotten guide wire: A rare complication of hemodialysis catheter insertion. J Clinic Imaging Sci 2011;1:40.  Back to cited text no. 3
    
4.
Khasawneh F, Smalligan R. Guidewire-related complications during central venous catheter placement: A case report and review of the literature. Case Rep Crit Care 2011;2011:287261.  Back to cited text no. 4
    

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Correspondence Address:
Nicholas Suraci
Department of Anesthesiology, 4300 Alton Road, Miami Beach, FL - 33140
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_88_19

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