Needle in the heart: a rare case of cardiac tamponade caused by a migrated foreign body and mimicking ST segment elevation myocardial infarction

Abstract

Background Pericardial tamponade is a serious condition which may eventually lead to severe haemodynamic disturbances and cardiac arrest. It is most often caused by the accumulation of fluid inside the pericardium, as a result of different aetiological factors such as pericarditis, neoplastic diseases, lymphatic dysfunctions, or idiopathic pericardial disease. Pericardial tamponade can develop after cardiac surgical procedures or as a complication of myocardial infarction. Collection of blood inside the pericardial sack can be the result of pericardial or cardiac trauma. It is exceedingly rare for the injury to be caused by a migrating foreign body. Although a typical picture of pericardial tamponade has been previously described, the disorder may clinically resemble an acute myocardial infarction. Case presentation We report the case of a 58-year-old female patient complaining of new onset thoracic pain and shortness of breath. Electrocardiographic examination results were suggestive of an acute inferior myocardial infarction. However, echocardiography revealed significant pericardial tamponade. The cause was found to be a needle which remained inside the pelvis following a previous cesarean delivery, which the patient had undergone 18 years prior. In emergency setting, the needle was removed and the pericardial tamponade was resolved. Due to the prompt and efficient management, the patient had an uneventful postoperative recovery and presented no recurrence at the follow-up examinations. Conclusions The migration of foreign bodies through tissues is exceedingly rare. If present, it may cause life-threatening complications. Since the aetiology of pericardial tamponade is vast, a thorough assessment is highly important. Therefore, echocardiography is the imaging modality of choice. We wish to highlight the possibility of migrating foreign bodies as probable cause for pericardial tamponade, as well as the importance of echocardiographic methods in the fast-track evaluation of such critical conditions.

Migrating Foreign Body in the Heart

“…Second, the patient was taken to the operating room twice with two different surgical services, vascular and cardiothoracic surgery, for attempted needle removal. Third, a needle being dislodged is not very common in contrast to the more common objects although it has been reported [2,3]. For example, inferior vena cava (IVC) filters or vascular stents are more commonly migrated in comparison to needles [4].…”

Removal of sewing needles from interventricular septum under the guidance of multiple imaging modalities

“…In such cases, the inability of victims to cooperate makes the taking of medical history difficult, 2 causing problems in diagnosis at the initial stage and thus delaying timely treatment. 6 It is crucial to diagnose quickly and precisely, using multiply imaging modalities, especially in patients who are unconscious.…”

“…Penetration of the heart or left chest wall by sewing needles is extremely rare, and some of these incidents have been self‐inflicted injuries resulting from depression or drug abuse. In such cases, the inability of victims to cooperate makes the taking of medical history difficult, 2 causing problems in diagnosis at the initial stage and thus delaying timely treatment 6 . It is crucial to diagnose quickly and precisely, using multiply imaging modalities, especially in patients who are unconscious.…”

Child abuse with multiple sharp foreign bodies penetrating the chest wall causing hemothorax and cardiac tamponade in two separate occasions: Case report

“…Its management is controversial. [1][2][3][4][5][6][7] Case report A 14-year-old cerebral palsy male presented left-sided chest pain and shortness of breath. CXR and computed tomography (CT) chest showed left-sided hemothorax and multiple metallic foreign bodies in the chest wall managed by a small limited incision, removal of the foreign bodies and chest tube (Figures 1 and 2) (Video 1).…”