Foreign body in the superior mediastinum following a fall on a box is uncommon. We present a 27 years old woman with history of fall on a box containing embroidery needles 3 years ago. Chest Xray and fluoroscopy revealed two needles; one at the left parasternal subcutaneous plane was removed and advised removal of the second needle at the superior mediastinum. She defaulted and came after a recent trivial chest injury. After confirmation, by thoracotomy, a rusted needle (of 1 in. size) embedded between the trachea and superior vena cava was removed. The longer asymptomatic period and the migration of the needle from anterior to posterior chest without injuring vital structures is a rarity.
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