Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>In liver stereotactic body radiotherapy, reduction of normal tissue irradiation requires daily image guidance. This is typically accomplished by imaging a surrogate to the tumor. The surrogate is often an implanted metal fiducial m...

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Main Authors: Hennessey Hooman, Valenti David, Cabrera Tatiana, Panet-Raymond Valerie, Roberge David
Format: Article
Language:English
Published: BMC 2009-11-01
Series:Journal of Medical Case Reports
Online Access:http://www.jmedicalcasereports.com/content/3/1/140
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spelling doaj-3eedfe6a91704bc8b001498291f3e89f2020-11-24T22:36:36ZengBMCJournal of Medical Case Reports1752-19472009-11-013114010.1186/1752-1947-3-140Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case reportHennessey HoomanValenti DavidCabrera TatianaPanet-Raymond ValerieRoberge David<p>Abstract</p> <p>Introduction</p> <p>In liver stereotactic body radiotherapy, reduction of normal tissue irradiation requires daily image guidance. This is typically accomplished by imaging a surrogate to the tumor. The surrogate is often an implanted metal fiducial marker. There are few reports addressing the specific risks of hepatic fiducial marker implantation. These risks are assumed to be similar to percutaneous liver biopsies which are associated with a 1-4% complication rate - almost always pain or bleeding. To the best of our knowledge, we present the first case of such a fiducial marker migrating to the heart.</p> <p>Case presentation</p> <p>An 81-year-old Caucasian man (5 years post-gastrectomy for a gastric adenocarcinoma) was referred post-second line palliative chemotherapy for radiotherapy of an isolated liver metastasis. It was decided to proceed with treatment and platinum fiducials were chosen for radiation targeting. Under local anesthesia, three Nester embolization coils (Cook Medical Inc., Bloomington, IN, USA) were implanted under computed tomography guidance. Before the placement of each coil, the location of the tip of the delivery needle was confirmed by computed tomography imaging. During the procedure, the third coil unexpectedly migrated through the hepatic vein to the inferior vena cava and lodged at the junction of the vena cava and the right atrium. The patient remained asymptomatic. He was immediately referred to angiography for extraction of the coil. Using fluoroscopic guidance, an EN Snare Retrieval System (Hatch Medical L.L.C., Snellville, GA, USA) was introduced through a jugular catheter; it successfully grasped the coil and the coil was removed. The patient was kept overnight for observation and no immediate or delayed complications were encountered due to the migration or retrieval of the coil. He subsequently went on to be treated using the remaining fiducials.</p> <p>Conclusion</p> <p>Implanted fiducial markers are increasingly used for stereotactic radiotherapy. There is sparse literature on the risks of such procedures. Although uncommon, the risk of migration does exist and therefore physicians (surgeons, oncologists and radiologists) and patients should be aware of this possibility.</p> http://www.jmedicalcasereports.com/content/3/1/140
collection DOAJ
language English
format Article
sources DOAJ
author Hennessey Hooman
Valenti David
Cabrera Tatiana
Panet-Raymond Valerie
Roberge David
spellingShingle Hennessey Hooman
Valenti David
Cabrera Tatiana
Panet-Raymond Valerie
Roberge David
Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
Journal of Medical Case Reports
author_facet Hennessey Hooman
Valenti David
Cabrera Tatiana
Panet-Raymond Valerie
Roberge David
author_sort Hennessey Hooman
title Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
title_short Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
title_full Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
title_fullStr Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
title_full_unstemmed Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
title_sort cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report
publisher BMC
series Journal of Medical Case Reports
issn 1752-1947
publishDate 2009-11-01
description <p>Abstract</p> <p>Introduction</p> <p>In liver stereotactic body radiotherapy, reduction of normal tissue irradiation requires daily image guidance. This is typically accomplished by imaging a surrogate to the tumor. The surrogate is often an implanted metal fiducial marker. There are few reports addressing the specific risks of hepatic fiducial marker implantation. These risks are assumed to be similar to percutaneous liver biopsies which are associated with a 1-4% complication rate - almost always pain or bleeding. To the best of our knowledge, we present the first case of such a fiducial marker migrating to the heart.</p> <p>Case presentation</p> <p>An 81-year-old Caucasian man (5 years post-gastrectomy for a gastric adenocarcinoma) was referred post-second line palliative chemotherapy for radiotherapy of an isolated liver metastasis. It was decided to proceed with treatment and platinum fiducials were chosen for radiation targeting. Under local anesthesia, three Nester embolization coils (Cook Medical Inc., Bloomington, IN, USA) were implanted under computed tomography guidance. Before the placement of each coil, the location of the tip of the delivery needle was confirmed by computed tomography imaging. During the procedure, the third coil unexpectedly migrated through the hepatic vein to the inferior vena cava and lodged at the junction of the vena cava and the right atrium. The patient remained asymptomatic. He was immediately referred to angiography for extraction of the coil. Using fluoroscopic guidance, an EN Snare Retrieval System (Hatch Medical L.L.C., Snellville, GA, USA) was introduced through a jugular catheter; it successfully grasped the coil and the coil was removed. The patient was kept overnight for observation and no immediate or delayed complications were encountered due to the migration or retrieval of the coil. He subsequently went on to be treated using the remaining fiducials.</p> <p>Conclusion</p> <p>Implanted fiducial markers are increasingly used for stereotactic radiotherapy. There is sparse literature on the risks of such procedures. Although uncommon, the risk of migration does exist and therefore physicians (surgeons, oncologists and radiologists) and patients should be aware of this possibility.</p>
url http://www.jmedicalcasereports.com/content/3/1/140
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