Intrapulmonary Artery and Intrabronchial Migration and Extraction of a Fragment of J‐Shaped Atrial Pacing Catheter

Abstract

A fragment of a fractured Telectronics Atrial Accufix 330-801 lead asymptomatically perforated the adjacent bronchus and was detected on routine chest X-ray. The metallic fragment was located by chest CT scan and bronchial fluoroscopy to lie between the right lobar bronchus and the pulmonary artery, confirming bronchial perforation. The foreign body was removed without complication by direct visualisation with rigid bronchoscopy.

Intrapulmonal dislocation of a totally implantable venous access device

“…In this position a mechanical irritation leading to a chronic decubitus of the vessel wall with consequent perforation into the lung is possible. A similar event of an intrabronchial migration has been reported with a broken intraatrial pacing device [9]. However, these pacing catheter tips contain metallic material and therefore are more rigid than silicone port catheters, favouring a spontaneous perforation of these devices.…”

Extraction of the Inner Coil of a Pacemaker Lead Slid into the Pulmonary Artery

“…The pulmonary artery is a well‐known embolizing site of pacemaker lead fragments, 2,3 even during lead extraction 4,5 . This case differs from others in that the inner coil (conductor + insulator) slid outside the outer coil while remaining anchored to the auricle by the distal tip.…”

“…Additionally, intravascular embolization is often observed, especially with shortcut, abandoned leads. Pulmonary circulation and inferior vena cava are the most frequent migration sites of the lead fragments 2–5 …”