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Postmortem Identification of a Foreign Body in the Heart: A Case Report
Kamil Şahin1,2, Adem Tartıcı3, Bora Özdemir3
1Council of Forensic Medicine, Ministry of Justice, Bahçelievler, Istanbul, Turkey. drkamil_sahin@hotmail.com.
Insights
A pediatric patient tragically died when a broken angiocath tip migrated to the right ventricle, piercing the heart wall. This rare event highlights the critical need for healthcare professionals to verify catheter integrity after removal.
Area of Science:
- Cardiology
- Pediatric Medicine
- Medical Device Complications
Background:
- Foreign bodies in the heart are rare, particularly in pediatric patients.
- Angiography catheter breakage can lead to severe injury or death.
- Previous reports primarily involve adult patients.
Purpose of the Study:
- To report a unique case of a pediatric patient's death due to a fractured angiocath tip.
- To raise awareness among healthcare professionals about this rare complication.
- To emphasize the importance of post-removal catheter integrity checks.
Main Methods:
- Case presentation of a 4.5-month-old female.
- Review of medical history including peripheral venous access with angiocatheters.
- Autopsy findings detailing the migrated catheter tip and cardiac perforation.
Main Results:
- A 1.5 cm angiocath tip was found to have penetrated the right ventricular wall.
- The patient experienced bradycardia and arrhythmia prior to death.
- Death was attributed to complications from the catheter tip embolism and cardiac perforation.
Conclusions:
- Healthcare providers must meticulously check the integrity of peripheral catheters upon removal.
- Documenting catheter integrity can prevent catastrophic events like this.
- This case underscores the potential risks associated with peripheral vascular access devices in infants.
Abstract:
The presence of a foreign body in the heart have been reported, mostly in adults. Deaths and injuries can result from the breakage or rupture of angiography catheters. We present a case in which an angiocath tip was identified in the right ventricle of a pediatric patient, and the patient died as a result thereof. As no similar cases have been reported, we would like to draw attention to this subject. A 4.5-month-old female patient who was hospitalized 3 times during her life had a history of peripheral venous access establishment in the extremities with angiocatheters. During these hospital admissions, a central catheter was not inserted, and no additional problems were identified. Emergency personnel responded and found the patient at home, experiencing bradycardia and arrhythmia. She was resuscitated and taken to the hospital, where she died. The autopsy revealed, the tip of a 1.5 cm long, 1 mm wide lumen catheter had penetrated the right ventricular wall (Fig. 1) (Fig. 2), thus her death was attributed to complications that developed as a result of the peripheral vascular access catheter tip breaking and migrating to the right ventricle. Although the patient did not have an ECG, physical examination by the emergency ambulance personnel revealed an irregular and bradycardic heartbeat, suggesting that the child may have developed arrhythmia and atrioventricular conduction block. Health care professionals must check upon removal of peripheral intravenous access, and record whether the integrity of the peripheral catheter tip was compromised to prevent similar events in future. Fig. 1 Angiocath tip piercing the right ventricular wall and exiting the heart Fig. 2 a A 1.5 cm long, b 1 mm wide lumen catheter tip penetrating the right ventricular wall.
