Case report
A 53 years old female presented to us with sudden onset excruciating
pain in the left upper arm and shoulder for the last 1-2 days which
worsened on the movement of the arm. The patient also reported having a
strange foreign body like sensation which also got aggravated with the
movement of her left arm. She was a known case of dilated cardiomyopathy
(DCMP), severe left ventricular dysfunction with ejection fraction (EF)
20%, for which she underwent cardiac resynchronisation therapy (CRT-D)
three years back. Subsequently, the patient underwent lead replacement
at another centre for the non-functional left ventricular lead about 6
months ago. The right atrial (RA) lead was also found to be
non-functional which was replaced with subclavian vein puncture and
screwed. Apart from the two procedures for CRT-D, the patient did not
give the history of any other interventional procedures.
On examination, a wire tip like foreign material was palpable in the
left upper arm which became more prominent on elevation and abduction of
the arm. Therefore, she was subjected to undergo a chest x-ray which
showed wire-like opacity extending from the pocket of the CRT-D device
to left upper arm [Fig.1]. Computed tomography (CT) of thorax with
contrast was done which confirmed the presence of the foreign body in
the left upper arm [Fig.2], and upper limb vessels showed normal
contrast opacification. Fluoroscopy showed the wire-like foreign body
extending from the pocket of CRT-D to left-arm [Fig.3]. Surgical
exploration was planned with an intent to remove this wire. A
longitudinal incision was applied over the left upper arm over the
palpable foreign body. The wire was impacted in the deltoid muscle and
reached up to subcutaneous tissue, which was dissected and retrieved
completely. There was no neurovascular injury noted. The retrieved wire
resembled a coronary guidewire with coating and radiopacity at the
distal tip which must have been used to deploy the pacemaker lead during
the last procedure. The CRT-D device was programmed and checked for all
parameters and was found to be properly functional. Postoperative
recovery was uneventful and the patient was discharged on the second
postoperative day. After 2 weeks of follow up, the patient was
asymptomatic and had full recovery of the surgical wound.