To the Editor,
A 40-year-old woman presented to the accident and emergency department complaining of acute onset of headache and dizziness, along with right-sided pleuritic chest pain and shortness of breath. She had a history of a symptomatic right temporal lobe arachnoid cyst treated with a cysto-atrial shunt at the age of 25. Her vital signs were stable and ECG was unremarkable.
Chest radiography depicted a sizable, serpentine-shaped, foreign body within the left hilum (Figure 1A) and a lateral skull X-ray showed fragmentation of the cysto-atrial catheter at the level of the skull (Figure 1B). A noncontrast chest computed tomography demonstrated a large catheter fragment embolizing the pulmonary trunk and the left main pulmonary artery (Figure 2). Patient underwent urgent percutaneous fragment retrieval with a snare apparatus catheter followed by cystoperitoneal shunt implantation, and made an uneventful recovery.
Figure 1. A, Anteroposterior chest radiograph showing serpentine-shaped foreign body within the left hilum (arrows). B, Lateral skull X-ray demonstrating a fragmented cysto-atrial catheter (arrowheads).
Figure 2. Chest computed tomography scan showing extensive embolization of the pulmonary trunk and main left pulmonary artery by the fragmented catheter.
Placement of the distal catheter of a cerebrospinal fluid diversion apparatus in the right atrium is a well-established alternative when peritoneal insertion is contraindicated. Cardiac thrombus formation and chronic thromboembolic pulmonary hypertension are the most common cardiovascular complications.1, 2 Migration of catheter fragments to the pulmonary vessels is an extremely rare and potentially fatal complication requiring urgent invasive treatment.
Corresponding author: antonispav@yahoo.com