A hook wire sliding into pulmonary artery and being extracted under DSA: a case report about a rare complication associated with lung nodule localization

BACKGROUND: CT-guided hook wire has been recognized to be a safe and effective percutaneous localizer to identify small pulmonary lesions with ground-glass opacity (GGO) component, while several association complications including pneumothorax, hemothorax, intrapulmonary hemorrhaging, aeroembolism and dislodgement have been reproted. However, sliding into pulmonary artery is an extremly rare comlication of hook wire localization. CASE PRESENTATION: A 61-year-old male suffered from multiple pulmonary nodules received right upper lobectomy and right lower lobe wedge resection by video-assisted thoracic surgery (VATS) 3 months ago. Since it might be difficult to identify the ground-glass opacity located in the right lower lobe, a CT-guided hook wire was placed before surgery. During the operation, the hook wire unexpectedly slided into left upper lobe pulmonary artery. With the help of vascular surgery department, the hook wire was extracted by interventional therapy under digital substraction angiography (DSA). The patient was eventually recovered and discharged. CONCLUSIONS: During localization procedure, the tip of hook wire should be far from pulmonary vessels. At the beginning of the operation, the hook wire might as well be removed first. Even if the hook wire was still required to be in the pulmonary parenchyma, it should be fixed to the pleural by a titanic clip or a hemolock clip.