Diagnostic challenges and treatment options of a suspected pericardial metallic projectile foreign body in a dog

Abstract

Considering the high rate of complications that develop in human patients where the foreign bodies are not removed, veterinarians should be aware of risks associated with long standing pericardial foreign bodies even when no clinical signs are present. Guidelines from the human literature may be considered for investigation of, and treatment options for, cardiac and intracardiac metallic projectile foreign bodies in dogs.

The Diagnosis and Surgical Management of Intracardiac Quill Foreign Body in a Dog

“…Several methods have been successfully used to retrieve cardiac foreign bodies in dogs, including endovascular retrieval, thoracoscopic retrieval, removal via thoracotomy, and cardiopulmonary bypass with open heart surgery. 1,[3][4][5]8,16 In the present case, the CT exam did not reveal an intracardiac foreign body and, hence, more specific cardiac retrieval procedures were not considered. A median sternotomy is considered the gold standard for exploring the thoracic cavity in cases of spontaneous pneumothorax because of the ability to explore the left and right lung lobes.…”

“…Migration of sewing needles and wooden skewers from the gastrointestinal tract, intravascular migration of catheter fragments, metallic projectiles, and a single previous case of a quill migration have previously been described. 1,[3][4][5][6]8,16 Surgical intervention has been debated for small metallic projectile foreign bodies in both human and veterinary literature; however, early surgical intervention is recommended in people with acute injuries because complications, such as endocarditis, restrictive pericarditis, sepsis, and death, are reported at a rate of up to 71%. 4 In this case, the presenting complaint of bilateral pneumothorax was secondary to a migrating quill foreign body, which ultimately ended up penetrating into the right ventricular wall of the heart.…”

“…In veterinary literature, postoperative complications following removal of intracardiac foreign bodies are rare. 1,[3][4][5] The reported complications are often a result of the initial injury and disease caused by the foreign body rather than the development of disease secondary to the surgery or residual effects of the foreign body itself. 4,16 Although the concern for the development of postoperative endocarditis or pericarditis has been expressed, it has not been reported to date in veterinary literature.…”

“…1,[3][4][5] The reported complications are often a result of the initial injury and disease caused by the foreign body rather than the development of disease secondary to the surgery or residual effects of the foreign body itself. 4,16 Although the concern for the development of postoperative endocarditis or pericarditis has been expressed, it has not been reported to date in veterinary literature. 16 Conversely, patients who present with endocarditis, pericarditis, septicemia, or disseminated intravascular coagulation appear to have resolution of their clinical signs following removal of the foreign body.…”

“…These have included gastrointestinal migration of ingested sewing needles and barbeque skewers, Kirschner wire migration from previous fracture fixations, metallic projectile foreign bodies, and intravascular migration of catheter fragments. [1][2][3][4][5][6][7][8] Despite the propensity for porcupine quills to migrate, intracardiac quill foreign bodies are exceedingly rare in veterinary medicine.…”