Hemopericardium caused by a mobile retained epicardial pacing wire after ventricular septal defect repair: A case report.

BACKGROUND: Epicardial pacing wires (EPWs) are commonly employed for diagnosis and treatment of arrhythmia in the acute phase after cardiac surgery. Although rare, retained EPWs may cause mild-to-catastrophic complications. The present case demonstrates hemopericardium caused by a mobile retained EPW. METHODS: A 49-year-old woman presented to our emergency department with clinical signs of impending cardiac tamponade. She had undergone ventricular septal defect repair 7 years before this admission. An initial computed tomography (CT) scan revealed hemopericardium with suspicion of a possible intracardiac lesion. Review of the first and second CT scans, however, revealed a mobile retained EPW penetrating the pericardium in the first scan, which had moved out of the pericardium in the second scan. RESULTS: Because cardiac injury by the EPW was suspected, the patient was transferred to another medical center for further treatment. CONCLUSION: According to our experience with this case, diagnosis may be incorrect if CT is unable to obtain decisive images of the mobile EPW at the correct time. Multiplanar reconstruction and volume rendering can increase diagnostic accuracy. In conclusion, if hemopericardium is present without clear etiology in a patient with a retained EPW, a nearby mobile EPW may be the cause.

A computed tomography phantom study of foam earplugs: Uncommon but potentially hazardous foreign body ingestion in children.

Ingestion of a foreign body is common among children. However, ingestion of foam earplugs (FEPs) has not been reported previously. A 7-month-old female infant presented with small bowel obstruction, which was finally proved to be a case of FEP ingestion.Computed tomography (CT) phantom study was performed to examine the imaging features of FEPs. We studied the following dry and fully wet FEPs, FEPs squeezed in pure water to varying degrees, and FEPs with different degrees of compression in the dry and wet states from day 0 to 6 and all scanned with a CT scanner.The density of a dry FEP is -843.5 ±â€Š4.5 Hounsfield units (HU) and it increases to 0.76 ±â€Š9.3 HU when fully wet. The densities of FEPs ranged from -844.2 to 1.0 HU with different water/air ratios, and some showed a heterogeneous geographic pattern. The densities of FEPs increase due to compression and gradual water absorption.FEPs can be potentially hazardous objects to children. Owing to the special foam structure of the FEP, it can mimic a fatty lesion if the density ranges from -100 to -50 HU; moreover, it can hide in the water if fully wet. However, it should not be mistaken as air, as the density of a dry FEP is -843.5 HU, and the contour can be observed if the window level is set appropriately. Because of its soft texture, the surgeon should be careful not to miss an FEP during the operation. Moreover, radiologists should be familiar with the CT features of FEPs so that they can be identified before surgery.