**Introduction/Hypothesis:**
While foreign bodies in the heart or its vasculature are uncommon, iatrogenic and post-traumatic causes account for the majority of foreign bodies described in the literature. Plain chest radiography, echocardiography, and computed tomography (CT) are common and accessible imaging modalities used to evaluate such foreign bodies. We describe an interesting case of a foreign body of unknown type and etiology in the pulmonary artery evaluated with transesophageal echocardiography (TEE) and cardiac CT.

**Methods**
A 58-year-old man, with complaint of chest pain, and known history of remote gastric sleeve surgery, previous knee surgeries, and chronic obstructive lung disease presented for evaluation of a foreign body detected on cardiac CT done for evaluation of chest pain. He did not have a known history of peripherally inserted central catheters, port-a-cath, or Swan Ganz catheters. His cardiac CT showed a linear looping filling defect within the bilateral lobar pulmonary arteries extending into lower lobe pulmonary branches (non-contrast CT image uploaded with the abstract). This was thought to be an embolized wire or a fractured catheter. This foreign body was not observed on a plain chest radiograph.

**Results**
TEE assessment showed an echo-bright foreign body, with railroad-track like appearance in the pulmonary artery, which moved with the respiratory cycle. This object extended from the right pulmonary artery to the proximal left pulmonary artery and did not have the appearance of wire, rather ‘railroad’ parallel linear echodensities the demonstrates some independent motion most consistent with a catheter. 2-D and 3-D imaging (clips uploaded with the abstract) by TEE did not demonstrate any thrombi on the foreign body. The object may be tethered to the wall of the pulmonary artery. Assessment of the right heart structures did not reveal any obvious damage to the tricuspid or pulmonary valves. There was no significant valvular regurgitation. The right ventricle size and systolic function were normal.

**Conclusion**
Based on the patient's clinical presentation, absence of related symptoms (chest pain not felt to be related to the catheter), and imaging characteristics of the foreign body on TEE and chest CT, it was decided to manage the patient conservatively. TEE utilizing 2-D and 3-D imaging reconstruction provides important complimentary information to CT in assessing foreign bodies in the heart and their impact on surrounding structures. TEE can assist surgeons and interventionalists in their decision-making process for monitoring or removing foreign bodies.



Assessment of a mysterious foreign body in the pulmonary artery

This course will explore basic and cutting-edge imaging techniques to improve patient care and hone individual skills in performance and interpretation of echocardiography, nuclear cardiology, cardiac computed tomography, and cardiovascular magnetic resonance imaging. Days will reinforce how cardiovascular imaging may improve comprehension in ischemic heart disease, structural heart disease, cardiomyopathies, and heart failure. Experts will utilize novel techniques to reinforce key topics including taped interventional cases and a strong emphasis on case presentations.