Metallic foreign body deep in the prevertebral space after an endomyocardial biopsy: a case report

INTRODUCTION: Although inspirated or ingested foreign bodies constitute a common otolaryngologic emergency, the removal of a solitary retained foreign body from the neck has seldom been described in the literature. The ingestion of foreign bodies commonly results in perforated viscose or extraluminal migration to adjacent structures quite a long period of time after the fact. To the best of our knowledge, this is the first English language description of an endomyocardial biopsy complicated by a retained foreign body deep in the prevertebral space of the patient’s neck. We report such a case and share our experience in treating it. CASE PRESENTATION: A 68-year-old Asian man suffering right-sided heart failure underwent an endomyocardial biopsy via his right internal jugular vein. After undergoing the procedure, he was found to have retained a metallic cup tip which had become lodged in his neck. A surgeon then performed neck exploration and the foreign body was removed without adverse effect. CONCLUSIONS: Decision making as to whether to remove the foreign body or not remains controversial. However, the later incidence of adhesive fibrosis or, even worse, of a catastrophic abscess or adjacent vascular injury might occur if the foreign body was not removed. Early exploration is suggested, if the patient’s condition makes this feasible.