Migrating hook wire that travels to the heart via the bloodstream: A case report

Abstract

Rationale: This report documents the intracardiac migration of a hook wire in a 47-year-old male patient after computed tomography (CT)-guided percutaneous hook wire localization of pulmonary ground-glass opacities. Patient concerns: The patient underwent CT-guided hook wire localization before video-assisted thoracoscopic surgery (VATS) wedge resection for a pulmonary nodule in the right upper lung field. However, the hook wire was not found in the specimen obtained from the wedge resection. A right upper lobectomy was performed to locate the hook wire; however, it was not found. Diagnosis: A transesophageal echocardiogram was performed, and the hook wire was found in the left ventricle (LV). Interventions: The patient subsequently underwent exploratory cardiotomy to remove the foreign body. The patient was admitted to the intensive care unit for postoperative care. Outcomes: Postoperatively, no complications were observed, and the patient was discharged from the hospital 7 days postoperatively. He received standard lung cancer treatment afterwards. Lessons: The present case was unique because the hook wire migrated through the bloodstream from the pulmonary vein to the left atrium, before finally reaching the LV. Based on the patient preoperative CT images, the ground glass opacities were proximal to a 2.5 mm wide vein, which drained into the pulmonary vein. The proximity of the hook wire to a blood vessel was reportedly attributed to an increased risk of hook wire migration through the bloodstream. Hematogenous hook wire migration into the heart can result in fatal complications. Early diagnosis and timely removal of the hook wire are recommended to prevent the worsening of this complication.