A 34-year-old Taiwanese man presented to our emergency department with a 3-day history of coughing and chest tightness. He had a history of essential hypertension and congestive heart failure followed up at our cardiovascular department and under medication control. He was an express delivery worker with right hand dominance.\nA chest radiograph on November 16, 2018, revealed metallic internal fixation pins and wire over his right clavicle, and an unidentified object of metallic density at the left side of his upper neck. A further cervical spine radiograph was arranged, which revealed a foreign body of metallic density crossing over the C2–C4 level on the left side of his neck (Fig. ) that indicated a loosened K-wire. He recalled that he had suffered from a right clavicle fracture which was operated on for wire fixation approximately 15 years ago, but had lost follow-up since then. Palpation of his neck revealed no palpable foreign body. His oral cavity was clear, and findings on nasopharyngoscopy were also normal. A series of chest radiographs from 3 years ago showed that the wire had migrated from the right AC joint to the left side of his neck (Fig. ). Computed tomography angiography was performed to evaluate the position of the K-wire regarding the major vessels. The wire was removed by exploratory neck dissection under C-arm fluoroscopy assistance. The wire was found beneath the carotid sheath and removed by gentle traction along its axis (Fig. ). His postoperation recovery was uneventful, and he was discharged 4 days later.
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.