Use of ultrasound for localization of a foreign object in the heart

Abstract

Ultrasound has been utilized intraoperatively for the localization, detection, and evaluation of various pathologic abnormalities in multiple organ systems.'~2 Use of sonography has been reported for localization of intracardiac foreign bodies pre~p e r a t i v e l y .~-~ However, there is only one known reported case where sonography was used intraoperatively for localization of a foreign body in the heart.6 The purpose of this case is to demonstrate an application of an underutilized technique for localization of intracardiac foreign bodies. CASE REPORTAn 8-year-old male was transferred from another facility two days postemergency thoracotomy for a gunshot wound to the heart. At the time of the original surgery, cardiac tamponade was relieved and a right ventricular perforation was repaired. An attempt to remove the lodged bullet fragment inside the myocardial wall was unsuccessful. The patient was then transferred to our institution for further management.Fluoroscopy demonstrated that the fragment was possibly lodged in the septum at the anterior aspect of the heart (Figure 1). After the patient, was stabilized, he was taken to surgery where attempts to remove the fragment were unsuccessful.A portable ATL (Advanced Technology Laboratory)" ultrasound scanner was brought to the operating room to assist in localizing the fragment. A 5-MHz medium focus transducer was used in a sterile fashion to localize the bullet fragment in the diaphragmatic aspect of the left *Advanced Technology Laboratory, Bellevue, WA. Report ventricle near the interventricular septum (Figure 2). This was confirmed by a repeat X-ray after the placement of surgical clips at the site localized by ultrasound. A small incision was made over the localized site and the bullet fragment was removed. Following completion of the surgery, the patient remained hospitalized for five days without complications and was discharged on the fifth day postoperation.