An Unusual Radio-Opaque Shadow in the Chest Radiograph After Coronary Artery Bypass Surgery

Abstract

Fig 1. The chest radiograph showing the “foreign body” (arrow). A50-YEAR-OLD, 175-cm, 140-lb man requiring a triple-vessel coronary artery bypass was admitted to the authors’ hospital. The preoperative chest radiograph was normal. Per institutional protocol, a femoral arterial catheter and a pulmonary artery catheter (PAC) were inserted under local anesthesia. During the insertion of the PAC, it was noted that the catheter had to be advanced beyond 50 cm to achieve a wedge position. During surgery, the left anterior descending coronary artery and the first and second obtuse marginal coronary arteries were grafted by the off-pump method. At the end of the surgical procedure, the count of equipment, needles, and gauze pieces were correct. The patient was transferred to the intensive care unit for postoperative management. A routine postoperative chest radiograph revealed a crescent-shaped “foreign body” superimposed on the cardiac shadow in the region of the main pulmonary artery (Fig 1). Initially, it was suspected that one of the intracoronary shunts used was left behind inadvertently in the chest, but the instrument count was correct. The decision whether to re-explore to retrieve the “foreign body” had to be made. What is the diagnosis?