Bedside ultrasound diagnosis of intracardiac paperclip

Abstract

Penetrating cardiac injuries are rarely reported in the literature. Foreign bodies are rarely seen in the heart and most patients with penetrating cardiac injuries die from hemorragic or pericardial tamponade before arriving at the hospital. Bedside ultrasonography is a highly valuable and readily learned tool that has expanded rapidly since its introduction more than 20 years ago. Our case was a 23-year-old convict brought to the emergency department (ED) with a history of continuous chest pain in the upper area of the left side of the chest for one week. Focused Cardiac Sonography (FOCUS) which was performed by emergency physician showed a strong echogenic linear structure with comet tail artifact, free floating in the mid-segment of the left ventricule. Exact localizations of the paperclips within the chest was obtained with multidetector computed tomography and one of them was seen in the left ventricular cavity. FOCUS plays a crucial role in these patients by diagnosing the injury and detecting the complications in emergency department.

Unsuccessful suicidal attempts by sewing needle introducing to chest: Removing 17 ones from the right ventricle and breast tissue in two stages; case report and literature review

“… Packed red cell transfusion One transfixing the posterior wall of the left cardiac ventricle extruding from the middle of a sub-epicardial haemorrhage in the upper third of the diaphragmatic surface of the heart, close to the atrioventricular grooves. ND cardiac arrest and death 15 h after entry Sarmento-Leite et al 2000 [ 16 ] 62/F Mild, oppressive chest pain 1 Sinus rhythm with nonspecific ST-T segment abnormalities Trans-venous removal of the foreign object under fluoroscopic guidance RV MDD Improvement Kim et al 2001 [ 17 ] 34/F Anterior chest pain 1 ND Removing by cardiopulmonary bypass Right cardiac chamber ND ND Beşirli et al 2002 [ 18 ] 13/F Self-reporting 1 NSR Mid-sternotomy, aortic and right atrial cannulations LV myocardium protruding slightly into the pericardial space MDD Improvement Nishida et al 2005 [ 19 ] 72/F Edema of the face and legs 1 Sinus tachycardia Removing by cardiopulmonary bypass Embedded in the LV musculature, the tip of the needle was penetrating the RV ND Improvement Gungor et al 2008 [ 20 ] 32/M Nonspecific chest pain 1 NSR Mid-sternotomy, aortic and right atrial cannulations RV placed from apex to tricuspid valve Anxiety and depression Improvement Badano et al 2009 [ 21 ] 48/F Chest pain 6 ND ND Two of them were intra-cardiac One of the needles transfixing the interventricular septum and reaching the posterior wall of the LV Schizophrenia ND Mick et al 2010 [ 22 ] 61/F Chest pain and shortness of breath 4 ...…”

“…The most common symptoms in the reviewed cases were simply types of chest pain [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ] followed by dyspnea [ 14 , 19 , [28] , [29] , [30] ] ( Table 2 ). In our case, the patient initially had introduced four sewing needles into her chest, one of them reaching the RV, leading her to tamponade and hemodynamic instability.…”

Migration of a Needle From the Chest Wall Into the Right Ventricle in a 10-Year-Old Child

“…Bullets, catheter fragments, paper clips, and portions of circular saws have been reported as foreign bodies found within the heart. 2,3 Several articles report extraction of sewing needles from the myocardium or cardiac chambers. 4 -6 In most cases, the history of injury and one or two imaging modalities can confirm the diagnosis, although in pediatric patients the mechanism of injury may be difficult to determine.…”