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Corresponding author at: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Tel.: +91 11 26593287; fax: +91 11 26588663.
At the age of 11 years, a female patient had sustained a fracture of the right humerus.
She underwent open reduction and internal fixation with two straight Kirschner wires
(K-wires). Twenty years later, at the age of 31 years, she underwent a chest roentgenogram
for suspected respiratory symptoms when it was discovered that one of the K-wires
(arrow in Fig. 1) had migrated to the mediastinum. Contrast enhanced computed tomography scans (Figure 2, Figure 3) revealed that the K-wire (green arrow) had migrated to the posterior mediastinum
across the midline in the pre vertebral space posterior to the oesophagus and arch
of aorta (red arrow). Because the sharp edge had already crossed the midline and the
vital structures and the probability of further left lateral movement was high, it
was decided to keep the patient under yearly follow-up because the surgical removal
from the left hemithorax was anticipated to be technically easier and associated with
less morbidity than removing it from its current location in the posterior mediastinum.
Figure 1Chest X-ray AP view showing sharp linear radio opaque shadow (red arrow) in midline
with extension in bilateral hemithorax at the level of D4 vertebra. Rest of the structures
appear normal. (For interpretation of the references to colour in this figure legend,
the reader is referred to the web version of the article.)
Figure 2CECT chest, axial section, mediastinum window at the level of arch (red arrow) showed
high attenuation linear metallic structure (green arrow) in posterior mediastinum
in prevertebral space with extension in bilateral lung parenchyma. Mediastinal vascular
structures are normal. (For interpretation of the references to colour in this figure
legend, the reader is referred to the web version of the article.)
