An unusual cause of pulmonary embolism
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* M Bruyneel
* A Peeters
* P G Silance
* S Alard
* D Horn

*   Pulmonary Embolism

## Case report

A young patient presented with acute dyspnoea. Anamnesis revealed the loss of metallic guide wire (GW) during a jugular cannulation 4 years before. Consecutive bilateral pulmonary embolism (PE) was diagnosed by thoracic angio-CT that confirmed presence of GW in the vena cava and in the right atrium (figures 1 and 2). Tinzaparin was started. Two weeks later, right iliac veinotomy allowed finally extracting the GW after two unsuccessful transcutaneous attempts. Clinical course was favourable despite occurrence of supraventricular tachycardia, secondary to right atrium lesions. Loss of GW is extremely rare,1 and usually faster removed. Secondary PE has never been described previously.

![Figure 1](http://thorax.bmj.com/https://thorax.bmj.com/content/thoraxjnl/early/2015/04/08/thoraxjnl-2015-206807/F1.medium.gif)

[Figure 1](http://thorax.bmj.com/content/early/2015/04/08/thoraxjnl-2015-206807/F1)

Figure 1 
Sagittal reconstruction obtained from CT angiography showing metallic guide wire from superior vena cava to right external iliac vena.

![Figure 2](http://thorax.bmj.com/https://thorax.bmj.com/content/thoraxjnl/early/2015/04/08/thoraxjnl-2015-206807/F2.medium.gif)

[Figure 2](http://thorax.bmj.com/content/early/2015/04/08/thoraxjnl-2015-206807/F2)

Figure 2 
Transparietal cardiac echography showing the extremity of the guide wire (white arrow) and above, attached mobile thrombi in the right atrium.

## Footnotes

*   Contributors AP, MB, PGS, DH have managed the patient. DH, SA, MB have prepared the manuscript and images and the final manuscript version was revised and approved by all the authors. MB is the guarantor and takes responsibility for the integrity of the work as a whole.

*   Competing interests None.

*   Provenance and peer review Not commissioned; internally peer reviewed.

## Reference

1.  Srivastav R, Yadav V, Sharma D, et al. Loss of guide wire: a lesson learnt review of literature. J Surg Tech Case Report 2013;5:78–81. [doi:10.4103/2006-8808.128732](http://dx.doi.org/10.4103/2006-8808.128732)
    
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