Clinical Images

Foreign-body Myopericarditis

Authors: Daniel Heikali, MD, John Moriarty, MD, and Olcay Aksoy, MD

            A 26-year-old man with history of cryptogenic cirrhosis for which he had undergone orthotopic liver transplantation (OLT) presented with chest pain and fever one day after undergoing transjugular liver biopsy. ECG revealed ST-elevations and PR-depressions in I, II, aVL, aVF, and V2-V6. The cardiac troponin I peaked at 1.5 ng/ml (reference range, <0.1 ng/ml). Computed tomography (CT) of the chest revealed a linear radio-opaque structure within the right ventricle appearing to extend into the myocardium, concerning for a retained foreign body (Fig. 1A and 1B). Fluoroscopy confirmed the presence of a linear foreign body (Fig. 1C), which was removed using an endovascular snare. The foreign body measured 9.3 x 0.1cm and consisted of a gray rubbery segment of tubing, which appeared to be a sheared fragment of a micropuncture sheath (Fig. 1D). The patient’s chest pain improved rapidly after removal of the foreign body. 

MCQ: Which of the following is the most likely diagnosis?

A. Spontaneous coronary artery dissection 

B. Foreign-body myopericarditis 

C. Thrombosis of an anomalous coronary artery 

D. Infectious native-valve endocarditis

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References:

1.         Actis Dato GM, Arslanian A, Di Marzio P, et al. Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature. J Thorac Cardiovasc Surg. 2003 Aug;126(2):408-14. Review.

2.         Saw J, Mancini GB, Humphries KH. Contemporary Review on Spontaneous Coronary Artery Dissection. J Am Coll Cardiol. 2016 Jul 19;68(3):297-312. doi:10.1016/j.jacc.2016.05.034. Review.

3.         Hauser M. Congenital anomalies of the coronary arteries. Heart. 2005 Sep;91(9):1240-5. Review

Brief Bio:

Daniel Heikali is a resident physician in the Department of Internal Medicine at Ronald Reagan UCLA Medical Center in Los Angeles, CA.

John Moriarty is an attending physician in the Department of Radiology, as well as the Division of Cardiology, at Ronald Reagan UCLA Medical Center.

Olcay Aksoy is an attending physician in the Division of Cardiology at Ronald Reagan UCLA Medical Center.