The long journey of a retained guidewire, from vein to aorta leading to cardiac tamponade: a case report.

Background: Complete loss of a guidewire during central venous catheterization is a rare but potentially life-threatening complication and is considered a preventable 'never event.' Retained guidewires mostly recognized during or shortly after the procedure, some may be stay in vascular system for a long time without detection and are associated with wide range of complications including vascular and cardiac chamber perforation. The decision to remove the guidewire through surgical or percutaneous technique should follow an individualized approach based on its location, associated complications, and the patient's clinical condition. Case summary: A 61-year-old male presented with sharp chest and epigastric pain, initially raising suspicion of acute coronary syndrome. Chest X-ray and initial echocardiogram were unremarkable. Electrocardiogram findings and serial troponin measurements were inconclusive. During follow-up, the patient developed fever, elevated acute phase reactants, and abdominal tenderness. Given the atypical clinical presentation, emergent coronary angiography was deferred. Abdominal ultrasound showed no acute intra-abdominal pathology. Due to persistent fever and worsening abdominal symptoms, a computed tomography scan was obtained revealing a linear radiopaque object extending from the right femoral vein, perforating right atrium and ascending aorta with associated haemorrhagic pericardial effusion. Emergent surgery was performed, and guidewire was successfully removed. Retrospective imaging showed its unnoticed presence for almost nine years. Discussion: Although guidewire retention is well-documented, delayed diagnosis with major vascular injury is exceedingly rare. Existing literature highlights inadequate supervision and procedural distractions as leading contributors to guidewire retention. This case underscores the long-term risk and severe consequences of retained guidewire.