Don’t get your wires crossed: epicardial wire-induced lung granuloma

Temporary epicardial pacing wires are routinely employed in patients undergoing cardiac surgery and are usually removed prior to hospital discharge. Complications related to retained wires may result in severe and life-threatening conditions, commonly due to wire migration into distant organs. Intrapulmonary retrieval of those wires has been rarely described and its management is challenging. Here, we report the case of a patient with a history of open-heart surgery, who underwent a chest computed tomography discovering a suspicious pulmonary nodule. Further follow-up imaging disclosed an additional migrating ground glass opacity in the same pulmonary lobe. Surgical resection of the right lung was performed, revealing an intraparenchymal retained pacing wire causing foreign-body inflammation and a solid nodule, which was later confirmed to be malignant. The post-operative period was uneventful and the patient fully recovered from surgery. Despite its rarity, intrapulmonary wire retention should be considered for the differential diagnosis of ground glass opacities in patients with a history of open-heart surgery. The management of these challenging cases should be carefully planned in a multidisciplinary team.