Case report
A 53 years old female presented to us with sudden onset excruciating pain in the left upper arm and shoulder for the last 1-2 days which worsened on the movement of the arm. The patient also reported having a strange foreign body like sensation which also got aggravated with the movement of her left arm. She was a known case of dilated cardiomyopathy (DCMP), severe left ventricular dysfunction with ejection fraction (EF) 20%, for which she underwent cardiac resynchronisation therapy (CRT-D) three years back. Subsequently, the patient underwent lead replacement at another centre for the non-functional left ventricular lead about 6 months ago. The right atrial (RA) lead was also found to be non-functional which was replaced with subclavian vein puncture and screwed. Apart from the two procedures for CRT-D, the patient did not give the history of any other interventional procedures.
On examination, a wire tip like foreign material was palpable in the left upper arm which became more prominent on elevation and abduction of the arm. Therefore, she was subjected to undergo a chest x-ray which showed wire-like opacity extending from the pocket of the CRT-D device to left upper arm [Fig.1]. Computed tomography (CT) of thorax with contrast was done which confirmed the presence of the foreign body in the left upper arm [Fig.2], and upper limb vessels showed normal contrast opacification. Fluoroscopy showed the wire-like foreign body extending from the pocket of CRT-D to left-arm [Fig.3]. Surgical exploration was planned with an intent to remove this wire. A longitudinal incision was applied over the left upper arm over the palpable foreign body. The wire was impacted in the deltoid muscle and reached up to subcutaneous tissue, which was dissected and retrieved completely. There was no neurovascular injury noted. The retrieved wire resembled a coronary guidewire with coating and radiopacity at the distal tip which must have been used to deploy the pacemaker lead during the last procedure. The CRT-D device was programmed and checked for all parameters and was found to be properly functional. Postoperative recovery was uneventful and the patient was discharged on the second postoperative day. After 2 weeks of follow up, the patient was asymptomatic and had full recovery of the surgical wound.