Foreign body granuloma from retained temporary epicardial pacing wire disguised as a painful, nonhealing cutaneous nodule.

Abstract

A 76-year-old woman with a significant cardiac surgery and breast cancer history presented to the dermatology clinic with a three-year history of an enlarging, tender, nonhealing cutaneous nodule on her upper abdomen. A shave biopsy was attempted given concern for nonmelanoma skin cancer or cutaneous metastasis. The biopsy was halted after a white wire was visualized. Retrospective computed tomography (CT) imaging review revealed a hyperdense linear structure becoming superficial at the location of the nodule seen on examination. Discussion with a cardiothoracic surgeon revealed this wire was likely a retained temporary epicardial pacing wire that was placed at the time of the patient's cardiac surgery three years prior. The decision was made to excise the lesion to fully remove the wire. Given intraoperative resistance with traction, the wire was partially removed by cutting it flush to the skin's surface. The patient healed appropriately with complete resolution of her symptoms. This case is unique because the wire was fully visualized on the CT scan, and it was unable to be fully removed.