Intrathoracic migration of a Kirschner wire
A 49-year-old woman admitted to our hospital complaining of breathing-dependent chest pain and dyspnea with progressive onset lasting for 2 h. The pain was acute at onset, sharp in nature, worse on deep inspiration, did not radiate and was not reproducible with palpation. A day before presenting to us, she was admitted to another emergency unit with an acute pain in the right abdomen. Her symptoms had been interpreted as dyspepsia and she was discharged from the hospital with simple treatment.\nThe most remarkable of her past medical history was that she had been undergone total hip replacement 8 years ago at another institution. Previous pelvic radiograms of that period were not available.\nOn presentation, the patient was in mild respiratory distress with a respiratory rate of 30 breaths per min, heart rate of 90 bpm and oxygen saturation measured via pulse oximetry of 93% on room air. A respiratory examination revealed that right-sided findings of reduced chest expansion, diminished breath sounds and dullness in the lower right chest were found.\nLaboratory investigations were within normal limits. The ECG was unremarkable. Chest X-ray showed the presence of a metallic image ∼5–6 cm long, located in the right hemithorax. There was a large hemothorax but no pneumothorax (Fig. ). The investigation was complemented by a chest computed tomography (CT) that confirmed the presence of a metallic wire in the right pleural space.\nTaking into account the hemodynamic state of the patient, her physical examination, the laboratory results and the CT-scan findings, we decided to perform an urgent surgical removal of the K wire under general anesthesia.\nShe was placed in a left lateral decubitus position and a posterolateral thoracotomy in the fifth right intercostal space was used. The wire was removed without complications. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. As a precaution, a 28-F chest tube was placed. There was no air leak or bleeding postoperatively and the tube was removed on the second postoperative day. The postoperative outcome was favorable and the patient was discharged on postoperative Day 4 with a normal chest radiogram (Fig. ).