Retained central line guidewire traversing the heart: An unusual case of iatrogenic pericarditis-case report

A man in his early 40s with peripheral arterial disease and prior ultrasound-assisted catheter-directed thrombolysis using the EKOS™ system (Boston Scientific) for arterial thrombosis presented with severe pleuritic chest pain. Initial evaluation demonstrated an acute right-sided segmental pulmonary embolism and a small-to-moderate pericardial effusion. His D-dimer was elevated at 2.8 µg/mL FEU, and his Wells’ score was calculated at 6, indicating moderate-to-high clinical probability. He was treated with intravenous heparin and colchicine for pulmonary embolism with suspected pericarditis. Persistent severe pain prompted repeat imaging, which revealed a retained intravascular guidewire extending from the inferior vena cava into the right atrium, associated with fibrin sheath formation and interval enlargement of the pericardial effusion. Endovascular retrieval achieved partial removal, but a residual intracardiac fragment remained. Two weeks later, the patient re-presented with recurrent symptoms, and an additional 10 cm retained guidewire fragment was successfully retrieved. This rare case of a retained intravascular guidewire causing iatrogenic pericarditis highlights the importance of careful post-procedural imaging review, multidisciplinary management, and confirmation of complete foreign body removal.