November 2023 Issue
ISSN 2689-291X
ISSN 2689-291X
Cranial Plate Embolization –
Right Ventricular Impingement!
Description
The above images demonstrate an incidental finding of a small metal clip-like object on a chest X-ray (A). A 2-dimensional echocardiography right ventricular (RV) inflow view revealed the object attached to the RV papillary muscles below the tricuspid valve (B). Coronary angiogram cine views showed the object more clearly as a cranial plate (C) which, in retrospect, embolized from plates in the skull (D) placed during a known remote brain surgery.
Discussion
Foreign bodies traveling in the heart can be due to migration from other organs or direct penetrating injury [1]. These can cause detrimental sequelae such as tamponade [2] and endocarditis [3], necessitating removal. Some objects may not cause problems [4], such as in the above image, and can be observed.
Removal of foreign objects, when indicated, can be accomplished traditionally by surgery [5]. However, more recently endovascular techniques are gaining momentum [6].
References
Authors:
Mustafeez Ur Rahman, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Mariam Riad, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Hajira Malik, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Brent Ruiz, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Celestine Odigwe, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Rajasekhar Mulyala, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Christopher Malozzi, D.O.
Associate Professor of Cardiology
University of South Alabama
Mobile, AL
Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL
The above images demonstrate an incidental finding of a small metal clip-like object on a chest X-ray (A). A 2-dimensional echocardiography right ventricular (RV) inflow view revealed the object attached to the RV papillary muscles below the tricuspid valve (B). Coronary angiogram cine views showed the object more clearly as a cranial plate (C) which, in retrospect, embolized from plates in the skull (D) placed during a known remote brain surgery.
Discussion
Foreign bodies traveling in the heart can be due to migration from other organs or direct penetrating injury [1]. These can cause detrimental sequelae such as tamponade [2] and endocarditis [3], necessitating removal. Some objects may not cause problems [4], such as in the above image, and can be observed.
Removal of foreign objects, when indicated, can be accomplished traditionally by surgery [5]. However, more recently endovascular techniques are gaining momentum [6].
References
- Lemaire A, Kennedy R, Ikegami H, Takebe M, Sunagawa G, Russo MJ, Lee L. Migrating Foreign Body in the Heart. Cureus. 2022 May 24;14(5):e25294.
- Yen AF, Homer CM, Mohapatra A, Langnas E, Gomez A, Hendrickson CM. Embolic Hypodermic Needle Causing Traumatic Cardiac Tamponade: A Case Report. Crit Care Explor. 2019 Aug 9;1(8):e0038.
- Melamed R, Shtark V, Levy M. Foreign body in the right ventricle causing bacterial endocarditis. Recovery following removal. J Thorac Cardiovasc Surg. 1968 Nov;56(5):754-9.
- Nguyen L, Sachdev S, Tahir H, Rahimi F, Burckhartt B, Malozzi C, Omar B, Awan GM. Lost Stents..Peek-aBoo! Cardiofel Newslet 2018 October;1(4):23-24.
- Alan Elison RM, Jose Antonio DE, Hector SM, Dolores LG, Francisco Xavier TG. Surgical management of late bullet embolization from the abdomen to the right ventricle: Case report. Int J Surg Case Rep. 2017;39:317-320.
- Ahmed O, Masrani A, Turba UC, March R, Ginsburg M, Arslan B. Percutaneous Endovascular Retrieval of a Migrated Permanent VenaTech LP Inferior Vena Cava Filter from the Right Ventricle. J Vasc Interv Radiol. 2017 Sep;28(9):1304-1306.
Authors:
Mustafeez Ur Rahman, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Mariam Riad, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Hajira Malik, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Brent Ruiz, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Celestine Odigwe, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Rajasekhar Mulyala, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL
Christopher Malozzi, D.O.
Associate Professor of Cardiology
University of South Alabama
Mobile, AL
Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL