Correct!
3. Consult interventional radiology for endovascular retrieval
Consultation with interventional radiology for percutaneous endovascular retrieval of the metallic fragment is the correct choice. Fluoroscopic evaluation of the fragment will show dynamic movement of the fragment during the cardiac cycle and provide localization information, but probably will add little information to what is already known through review of the thoracic and abdominal CT scans. Percutaneous retrieval is not possible given the intracavitary location of the fragment within the right ventricle. Upper endoscopy would play no role in the evaluation or management of this metallic fragment- the fragment is not located anywhere near the esophagus. Conservative management is reasonable, but concerns regarding the potential for this fragment to perforate the right ventricle suggest that removal may be the best course of action.
Interventional radiology was consulted and percutaneous retrieval was attempted. However, during the course of the retrieval procedure, it was noted that the metallic fragment was substantially embedded within the trabeculae of the right ventricle and the retrieval procedure was abandoned as it was determined to be potentially too hazardous. After the attempted percutaneous retrieval procedure, thoracic CT (Figure 5) was performed.
Figure 5. Representative images from the axial contrast-enhanced repeat thoracic CT.
Which of the following is correct regarding the description of the thoracic CT findings? (Click on the correct answer to proceed to the eighth and last panel)