case report

Surgical Removal of a Subcutaneous Cranial Site-Migrated Vascular Catheter: A Case Report

Alberto Franzin1, Raffaello Bellosta3, Lodoviga Giudice1, Danilo Aleo2, Marco Pavia4, M. Morassi4, Karol Migliorati1, Giorgio Spatola1, Oscar Vivaldi1

1Neurosurgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

2Neurosurgery, Dept. of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Italy

3Vascular Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

4Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

*Corresponding author: Dr. Alberto Franzin, Neurosurgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

Received Date: 19 October 2022

Accepted Date: 22 October 2022

Published Date: 25 October 2022

Citation: Franzin A, Bellosta R, Giudice L, Aleo D, Pavia M, et al. (2022) Surgical Removal of a Subcutaneous Cranial Site-Migrated Vascular Catheter: A Case Report. Ann Case Report. 7: 1006. DOI: https://doi.org/10.29011/2574-7754.101006

Abstract

A 62-year old patient was brought to our attention following a year-long appearance of a subcutaneous tumefaction in the left parietal cranial site. We identified the distal part of a metal density via caudo-cranial course, crossing from C4, to the left temporal and front cerebral parenchyma, reaching the subcutaneous tissue.

The asymptomatic patient presented with a medical history of mitral valvuloplasty with the subsequent replacement of the valve with a metal prosthesis and a TIA-like episode that occurred one year after surgery. The patient had undergone catheter removal surgery, measuring a total of 17cm, with no particular complications.

Keywords: Tumefaction; Cerebral parenchyma; Catheter removal

Case Report

History and examination

The case reports a 62-year-old hypertensive, dyslipidaemia patient who had undergone percutaneous mitral valve valvuloplasty in 2001, followed by a subsequent replacement of the mitral valve with metal prosthesis in July 2015 at a different hospital. In December 2016, the patient reported an episode of intense and sudden headache, followed by difficulties in speech and asymmetry of the buccal rhyme. Consequently, the patient went to his local emergency room where, after being subjected to various assessments, he was discharged with a diagnosis of TIA. From the summer of 2017, the patient reported the presence of a subcutaneous tumefaction in the left parietal cranial site that he had noticed after an accidental fall with no evident head injury. Given the persistence of the problem, the patient underwent an ultrasound on the site of the tumefaction in February 2018, which showed a poorly defined hypoechogenic formation, which had deepened into the skull. The patient was then referred to a specialist neurosurgical examination where he was advised to undergo a neuroimaging study.

In April 2018, the patient had a brain MRI that reported the presence of a linear hypo intense image in all sequences, originating in the left temporal region at the cortical site and reaching the ipsilateral frontal region in the subcutaneous soft tissues; there was also evidence of hyper intensity in the long TR sequences in the frontal region close to the aforementioned image, attributable to a probable gliotic nature.

In order to further investigate the findings, the patient had an CT scan that showed the presence of the proximal end of a one millimetre metal density wire which, with caudocranial course, crosses from C4 to the left petrous part of the temporal bone, then the left temporal and frontal cerebral parenchyma and the cranial theca, reaching the subcutaneous tissue and causing a focal tumefaction (Figure 1). The patient then turned to our hospital where, after a neurosurgical evaluation and in consideration of recent and remote clinical history and findings, the physicians suggested hospitalization for diagnostic follow-up and appropriate treatment.

Figure 1: Focal tumefaction.

Under our observation, the patient reported subjective mnesic impairments that he had had for a long period of time, but did not interfere with his personal and working life. He was subjected to a thorough neurological examination, which showed a short-term memory deficit with intact fasia, vigilant patient, collaborating and well-oriented. An electroencephalographic examination showed findings within the normal limits.

During hospitalization, the patient underwent a head and neck CT scan with and without contrast and CT angiography of the supraortic logs and of the intracranial vessels that reported the presence of spontaneously hyper dense filiform foreign body located in the left extra-vascular para pharyngeal site near the upper horn of the left thyroid cartilage (Figure 2); it runs cranially in the soft tissues, always with medial localization with respect to the vascular structures, until it reaches the left carotid canal of which it crosses the roof, arriving in the medium cranial fossa. In the intracranial site, the foreign body crosses the temporal-mesial brain parenchyma, the Silvian cistern and the left inferior frontal gyrus, reaches, crosses the cranial casing at the left parietal bone level (Figure 3), and ends in the soft epicranial tissues.

The left inferior frontal encephalic tissue disposed around the foreign body appears hypointense as for edema / gliosis of entities superimposable to the previous CT control.

Figure 2: Left extra-vascular para pharyngeal site near the upper horn of the left thyroid cartilage.