Retained intravascular or intracardiac foreign bodies are rare but well-recognized in the surgical literature. However, delayed septic pulmonary embolism resulting from a retained transcardiac foreign body has not been previously reported. This case report describes a 57-year-old woman who presented with fever and cough for one month and worsening dyspnea over three days. Two years prior, she had been struck by a metallic object from a lawnmower but did not seek medical attention. Chest radiography demonstrated a linear metallic foreign body in the right lower lung field. Transthoracic echocardiography showed a rod-shaped structure confined to the right atrium, with vegetations surrounding the foreign body and extending into the right ventricle. CT angiography was subsequently performed, which identified a metallic foreign body traversing the diaphragm from the liver into the right heart, as well as emboli in the distal branches of the right pulmonary artery. Surgical exploration via median sternotomy confirmed a metallic rod measuring 10 cm in length and 0.5 cm in diameter penetrating the liver, diaphragm, and right atrium. The rod was successfully removed together with the pulmonary emboli. Pathological analysis demonstrated Aspergillus infection. The patient was discharged in stable condition and completed postoperative oral voriconazole therapy. Although penetrating cardiac foreign bodies may initially be nonfatal, the present case illustrates their potential for late-onset fungal colonization and embolic complications, highlighting the importance of timely surgical removal and vigilant follow-up.
Tong et al. (Mon,) studied this question.