A 55-year-old male patient was admitted to the emergency service with dyspnea, stabbing chest pain. The symptom had first appeared 3 days earlier. The patient’s medical history showed that he had undergone a fixation operation using K-wire and plate for treatment of the right sternoclavicular joint dislocation about 5 months prior(Fig. A, B). His vital signs were stable in physical examination. Chest radiograph showed a broken K-wire around sternoclavicular joint and a linear metallic foreign body in thorax (Fig. C). Chest computerized tomography revealed the metallic foreign body in the heart (Fig. D–F). There was no evidence of cardiac tamponade or segmental wall motion abnormality in preoperative transthoracic echocardiography. Removal of the wire was recommended and the patient underwent cardiac surgery under general anesthesia via median sternotomy without cardiopulmonary bypass. After pericardiotomy, there was about 50 ml old hematocele in pericardium. The broken K-wire was located between the aorta and the pulmonary artery, behind the right auricle (Fig. ). Because the wire had a linear shape, it was removed easily. There was an 8 millimeter diameter hematoma caused by K-wire in the anterior wall of the ascending aorta. After clearing the hematoma, the local bleeding tissue was sutured. There was no injury to the heart muscle. The pericardium was closed in standard fashion. There were not any cardiac conduction and rhythm disturbances intra-operatively. Then the K-wire retained around the sternoclavicular joint was removed. The entire intra-operative blood loss was about 100 ml. Follow-up chest radiograph was performed on the third postoperative day (Fig. G, H). The patient recovered without any complications and was discharged on the 7th postoperative day. In follow-up 1 year post-surgery, the patient had no particular symptoms such as cough, chest pain and irregular heartbeat.
A 69-year-old woman was admitted to the emergency department after an accidental fall. She presented with left shoulder pain and functional impairment. Clinical history included essential hypertension and obesity. Traditional X-ray series and computed tomography (CT) scan with three-dimensional reconstruction were performed. Examinations showed a 3-part fracture of the proximal left humerus, accounting to the Neer's classification (AO/ASIF: 11-B2) [Figure and ]. Two days after patient acceptance to our department, fracture was treated by closed reduction and fixation with two retrograde K-wires and one threaded wire, by mean of a modified “en palmière” technique: The first two wires were retrograde nonthreaded bent wires inserted at the deltoid “V” level, while the latter was an anterograde threaded wire percutaneously introduced to fix the great tuberosity [Figure and ]. Two days after surgery, the patient was discharged from the hospital. One month after surgery, the patient came back for routine clinical and radiographic control, to evaluate the fracture healing and eventually plan the wires removal. In that setting, she referred about global well-being and no pain at the shoulder. X-rays demonstrated the intrathoracic migration of the threaded wire used for tuberosity fixation [Figure and ]. A complementary CT scan was immediately performed to better show the spatial relationship between the wire and intrathoracic vital organs. It revealed the device was migrated through the fifth intercostal space to the left lung parenchyma, without the signs of pneumothorax, nor bleeding [Figure and ]. She was extensively interviewed and investigated for any symptom or sign. She only referred about episodic intercostal mild pain that onset 1 week after surgery and was elicited by a cough. Due to low severity of the symptom, it was completely underestimated by the patient. Physical examination, vital parameters, and blood examination resulted normal. The patient was immediately managed by mean of video-assisted thoracoscopic approach to remove the migrated wire from the lung parenchyma. Intraoperatively, a fibrin-coated spot was identified on the lung surface and excised. This allowed the foreign body to be visualized and easily removed []. Neither parenchymal bleeding nor pneumothorax was observed. A chest drain tube was inserted, and antibiotic prophylaxis was administered. The postoperative outcome was free of complications, and the patient was discharged 3 days after surgery with a normal chest radiogram. One month after surgery, the patient underwent new thoracic and left shoulder X-rays, confirming the healing of the shoulder fracture and the absence of radiographically evident sequelae about the lung. A specialist consultation by thoracic surgeons was performed, assessing the complete recovery of lung function without complications or negative outcomes.