Presentation
ICU chest radiograph.
Patient Data
Endotracheal tube is demonstrated 5 cm above the carina. A left internal jugular central line is demonstrated with the tip at the SVC. A right-sided PICC line is demonstrated with the tip at the cavoatrial junction. Heart is normal size. Thoracic aorta is partially calcified.
Lungs are clear with normal vascularity and inflation.
A small metallic birdshot like radiopaque foreign body projects at the right atrium-IVC junction.
Scout radiograph from the CT shows multiple birdshot pellets.
Right greater than left pleural effusion.
Right lower lobe alveolar opacity.
Artefact from the bullet in the IVC-RA junction trapped in the Eustachian valve.
Case Discussion
Actually, on the CT the resident thought the linear artefact as a retained pacemaker wire.
A metallic density is identified within the inferior aspect of the right atrium, which is favored to represent a small segment of retained pacer lead. Results have been communicated by radiology to the primary team regarding this small fragment of a retained pacer lead.
It is important not forget to review the scout.
CT obtained in a beating heart and see how the computer generates a line on sagittal and coronal images and will fool you.
Unable to process the form. Check for errors and try again.