Incidental Finding of a Left-over Guide-Wire on a Positron Emission Tomography.

Abstract

The Seldinger technique is commonly used to cannulate vessels for radiographical procedures [1]. Loss of a guide-wire into the circulation is a rare and preventable complication [2]. It is often noticed by chance during routine radiographs [2]. However, there is a lack of reported cases of incidental findings of leftover guide-wire on a PET scan. An intravascular foreign body should be retrieved as soon as the diagnosis is made, to prevent complications such as embolisation or vascular damage by fractured wires [1]. Interventional radiology is the method of choice for retrieval [2]. We report a rare case of the coincidental finding of a lost guide-wire on a PET scan. A 37-year-old man presented with psychotic episodes, thigh weakness, weight gain, increased appetite and leg cramps. He was subsequently diagnosed with Cushing Syndrome secondary to ectopic adrenocorticotropic secretion from a right lung tumour. He subsequently underwent a staging positron emission tomography (PET) scan (Fig. 1a). The lung tumour had no uptake on PET but had increased activity uptake on octeotride scanning (Fig. 1b, marked in red). These appearances were suggestive of with carcinoid tumour. The PET scan also revealed an incidental finding of a leftover guide-wire used during peripheral inserted central catheter (PICC) recently (Fig. 1a, arrows).The wire extended from right atrium to inferior vena cava. It also showed a high uptake in the adrenal glands, indicating hyperplasia, which was most likely due to adrenocorticotropic hormone stimulation (Fig. 1a, labelled A). He underwent a percutaneous wire retrieval via the right femoral vein in a cardiac catheterisation laboratory and was transferred to a thoracic surgical unit for lung tumour resection. Fig. 1 a PET shows the guide-wire (arrows) and high uptake of adrenal glands (A). b Lung tumour with increased activity uptake on octeotride scanning (marked in red), suggesting carcinoid tumour