We are presenting a nightmare case of successful retrieval of the broken distal tip of a multipurpose catheter which embolised into the left pulmonary artery (LPA) during atrial septal defect device closure. During the course of snaring it initially slipped once in the LPA and subsequently while snaring it into the delivery sheath it slipped again in the inferior vena cava and yet again embolised into the LPA!! Subsequent attempt was successful but the distal fragment itself broke into two parts while being pulled inside the delivery sheath. Luckily the fragments did not embolise again as they were stuck at the tip of the sheath. The distal fragments were pulled out en masse along with the delivery sheath maintaining negative pressure at the side port of the delivery sheath using a 20 mL syringe. The final outcome was successful and the patient was unharmed by this potentially grave complication.

DESCRIPTIONWe present an interesting image of a 'floating left atrial (LA) appendage' in a 5-month-old female infant with pericardial tamponade. Clinical features of respiratory distress, lethargy and difficulty in suckling were present and the jugular venous pressure ( JVP) was raised, although the wave forms were not easily assessable due to the child being in respiratory distress and uncooperative.The echocardiographic evaluation revealed the signs of tamponade along with another interesting finding that the left atrial appendage (LAA) was elongated and membrane like and was freely moving and ballooning with atrial contraction in the pericardial fluid around it as though 'floating'. Cath tracings were not performed as the first priority was an emergency lifesaving pericardiocentesis. There was another abnormal bulge posterolaterally.The other cardiac chambers were normal and there was no obvious echocardiographic evidence of any pressure overload of LA in the form of LA dilation (figures 1 and 2; see videos 1-4).Pericardiocentesis revealed the presence of chylous fluid. (figure 3). CT confirmed the finding and revealed no mediastinal or cardiac mass and no obvious thoracic duct anomaly (figure 4).The child was planned for conservative management followed by thoracic duct ligation if required in view of the high surgical risk in exploratory thoracotomy in absence of a definite diagnosis and a definitive understanding of the pathophysiology.On follow-up at 1 month the appendicular abnormality had recovered completely and the fluid had decreased.This is an unusual interesting image of membranous LAA in an infant with large chylous PE.

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Seven-year-old boy presented with pain in right lower limb and abdomen after a fall from a bullock cart. He was referred for management of pseudoaneurysm of the right common iliac artery. After CT angiogram, the vascular surgeon opined that child was not suitable for surgical patch or graft or endovascular stenting as there was no landing zone for the stent. Hence the child was treated with transcatheter closure with two Amplatzer duct occluder II (ADO II). On follow-up the symptoms and bruit disappeared. To the best of our knowledge this is the first case of pseudoaneurysm, treated with ADO II.