(1146) A Rare Complication of Temporary Epicardial Pacing Wires Causing Granulomatous Lung Disease

Introduction: Granulomas are created from localized inflammatory reactions. Foreign body reactions are rare causes of granuloma formation leading to granulomatous lung disease. Temporary epicardial pacing wires (TEPW), when placed for postcardiac surgery, are cut when no longer indicated and retract into the body. Migration of these wires is a rare complication and there are no documented cases of wire migration to the lungs or causing granulomatous lung disease. In this case, we discuss a patient who developed granulomatous lung disease after migration of epicardial wires from a foreign body reaction within the lungs.

Description: A 66-year-old male, lifetime non-smoker, presented to the pulmonary office for evaluation of a growing lung nodule in his right middle/upper lobe. He underwent a minimally invasive mitral valve repair in 2008 with TEPWs placed and subsequently cut after surgery. An episode of chest pain in 2017 lead to an incidentally found irregular right middle/right upper lobe density, adjacent to the right atrium, close to the atrial portion of the pacing wire. Serial CTs going forward showed the mass increasing in size. He had a PET scan which was FDG avid with a SUV of 3.8 and no other hypermetabolic lesions. He then had a CT guided biopsy done of the mass in 2023. Pathology showed alveolar lung tissue with chronic interstitial inflammation and small non-necrotizing granulomas without evidence of malignancy. These findings suggest that the nodule was likely a local inflammatory response related to the pacing wire. The patient was recommended surgical resection versus radiographic/clinical monitoring and supervision.

Discussion: Granulomatous lung disease has a wide differential of causes including foreign body reactions. Complications of postcardiac surgery TEPWs include tamponade and ventricular perforation and for this reason, epicardial wires are cut to retract back under the skin instead of removed. Migration of TEPWs is rare and has only been reported in the aorta, left heart, and abdominal cavity. Here we present the first case of a TEPW causing both a foreign body granulomatous reaction from migration into the lung. The diagnosis was confirmed with biopsy. This case shows the importance of possible complications of TEPWs and it leading to granulomatous lung diseases.