B Jayakrishnan, FRCP 1* , Boris Itkin, MD 2 Anitha Jose, BSc3, Sami M Bennji, FCP(SA)4
1Senior Consultant, Division of Pulmonology, Head & Neck and Thoracic Program, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman
2Senior Consultant Oncologist, Rare Tumours Program, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman
3Staff Nurse, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman
4Consultant, Division of Pulmonology, Head & Neck and Thoracic Program, Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman
Keywords: Artifact, Chest X-ray
BACKGROUND
A 72-year-old man with advanced right thigh synovial sarcoma and pulmonary metastasis presented with bilateral pleural effusion in March 2024. Upon admission he underwent left-sided pleural drainage. A few days later, an 8F pigtail catheter was inserted on the right side, which successfully drained approximately 1500 ml of slightly blood-stained pleural fluid (Figure 1). However, on the same night, the catheter was inadvertently dislodged by the patient. A tight-fitting plaster was promptly applied, and he remained symptom-free. A follow up chest radiograph showed a clear linear radiopaque shadow measuring around 9.4 cm with the tip visible well inside the right chest (Figure 2). This shadow was puzzling as the pleural drain had been completely removed. There was no palpable swelling, wires, or tubes under the skin. Upon closer examination, it was discovered that the gauze used (Bromed Gauze Lap sponges, Brosco International Inc, Mesquite, USA) had a linear radiopaque marker (Figure 3). A repeat radiograph did not show this opacity. This radiopaque marker on the gauze resembled a metallic foreign object in the thorax, causing anxiety and confusion among the medical staff and the patient. Patient remained well without worsening of the effusion for two months but succumbed to his illness subsequently.
