Pulmonary embolism by a foreign body that migrated in the inferior vena cava during lumbar spine surgery.

To cite: Naito N, Abe M, Fukasawa M, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014205423 DESCRIPTION A 72-year-old man was referred to our department for evaluation and treatment of pulmonary embolism by a foreign body. He underwent lumbar spine surgery for spinal canal stenosis. The surgeons noticed a piece of rubber catheter used to cover a tip of surgical suction was missing during procedures. Lumbar spinal X-ray taken in the operation room revealed the foreign body just anterior to the lumbar spine. The piece of catheter was thought to have migrated in the inferior vena cava through the lumbar vein during blood suction. An enhanced chest multidetector CT (MDCT) taken just after the surgery showed the catheter lodged in the anterior basal branch of the left pulmonary artery (figure 1). Even though the patient’s haemodynamic condition was stable and there were no signs of complete occlusion of the vessel, urgent intervention was indicated considering a risk of secondary complications such as blood clot formation. The removal was achieved with pulmonary arteriotomy through left lateral thoracotomy (figures 2 and 3). The postoperative course was uneventful with no evidence of pulmonary artery stenosis or thrombosis. Foreign body pulmonary embolism can cause clot formation, secondary infection, pulmonary infarction and erosion to a bronchus. 2 Therefore, removal of foreign bodies should be considered to avoid secondary complications. Although endovascular technique is standard treatment, we chose the surgical retrieval because the foreign body was firmly stuck and there was no space to bring an