Correct!
2. The thoracic CT shows a new intravascular metallic fragment
The thoracic CT shows that the metallic fragment within the right ventricular apex is still present and is unchanged. No pulmonary venous thromboemboli are present. The pericardium remains normal; there is no evidence of pericardial effusion to indicate right ventricular wall perforation. However, the examination is not unchanged from previous- there is a new metallic focus within the left lower lobe pulmonary artery (Figure 6, compare Figure 5 to Figure 3).
Figure 6. Following the attempted percutaneous retrieval procedure, a new metallic fragment is seen in the left lower lobe pulmonary artery. This metallic focus appears to loop on itself in the artery with two components along the opposite margins of the left lower lobe pulmonary artery, creating the impression of a flexible metallic focus conforming to an upside down “U” shape within the artery. Compare to panels A-C in Figure 2 which shows the left lower lobe pulmonary artery to be patent and free of an intravascular foreign body.
The repeat thoracic CT (Figure 6) shows a new metallic fragment located within the left lower lobe pulmonary artery, representing a fragment of wire or snare related to the attempted percutaneous retrieval of the metallic foreign body in the apex of the right ventricle. Another percutaneous retrieval procedure for the metallic foreign body in the right ventricle is planned by interventional radiology, but no attempt to remove the right ventricular fragment will be attempted; rather, cardiovascular surgery has been consulted regarding the need for removal for the latter.
Diagnosis: Inferior vena cava filter fracture with migration of fragment into the right ventricle, complicated by pulmonary artery non-thrombotic embolization of an additional metallic fragment related to attempted percutaneous retrieval.
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