Fig. 1: Initial chest film showing detached catheter fragment straddling the left upper and lower pulmonary arteries (white arrows).

Fig. 2: Attempt to snare the inferior aspect of the catheter fragment in the descending left pulmonary artery. The tip of the fragment was impacted in the vessel (black arrow)making it impossible to engage the fragment in the snare. The snare was manipulated to the superior tip of the fragment, but it too was impacted and a similar problem was encountered.

Fig. 3: A 6 Fr pigtail catheter is formed around the mid-point of the fragment and fixed using a deflector wire. The pigtail catheter was then withdrawn over the fragment freeing its superior end and repositioning it into the left main pulmonary artery.

Fig. 4: The tip of the fragment in the left pulmonary artery is captured with a 10 mm Amplatz snare (white arrow).

Fig. 5: The snare has been repositioning to the mid portion of the catheter fragment and the snare and fragment have been brought down into the iliac vein. A guide wire has been inserted through the sheath along side the snare and advanced into the IVC. Note size mismatch between the doubled-over catheter and the 8 Fr sheath.

Fig. 6: The sheath, snare and catheter fragment are removed as a unit leaving the safety wire to preserve access. After a quick fluoroscopic survey to assure no further access was necessary, the guide wire was removed and hemostasis secured by manual compression.