Circulation. 2006;114:e515-e516
doi: 10.1161/CIRCULATIONAHA.106.615062
(Circulation. 2006;114:e515-e516.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Directly to the Heart
Jonathan DeBlois, MD;
Sebastien Bergeron, MD;
Marie-Helene LeBlanc, MD;
Mario Senechal, MD;
Jocelyn Gregoire, MD;
Marie Arsenault, MD
From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada.
Correspondence to Marie Arsenault, MD, Hopital Laval, 2725 chemin Ste-Foy, Quebec, Canada G1V 4G5. E-mail marie.arsenault{at}crhl.ulaval.ca
A 24-year-old male was intentionally shot with a 0.410-caliber rifle to the anterior chest from a distance of about 10 m. The patient did not lose consciousness and was able to seek medical assistance on his own. On presentation, the patient had normal vital signs. A chest x-ray (Figure 1) and thoracoabdominal computed tomographic scan (Figures 2 and 3
) were immediately performed and showed multiple metallic foreign bodies, most of them in the anterior chest wall, many in the lung parenchyma, and some within the mediastinum. One pellet was located between the aorta and the superior vena cava. Another was adjacent to the esophagus, at the level of T3, where a small pneumomediastinum was also identified. Most importantly, 2 bullets were also visible within the heart. An echocardiogram was performed that demonstrated the exact localization of one of these bullets in the posterior wall of the heart near the base of the posterolateral papillary muscle (Figures 4 and 5). The patient also underwent an esophagoscopy and a bronchoscopy, both of which were normal. A right pleural effusion was drained with a chest tube. The patient remained stable without any cardiac symptoms or arrhythmias. Against medical advice, he left the hospital 3 days after his admission and was lost at follow-up.
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Figure 2. Computed tomographic scan of the chest demonstrating a pellet (black arrow) just behind the ascending aorta and adjacent to the base of the left atria.
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Figure 3. Computed tomographic scan image of the chest showing the pellet (black arrow), which was later localized with the echocardiogram. Also identifiable are the small right hemothorax and 2 other pellets in the parietal chest.
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Figure 4. Apical 2-chamber view showing a metallic foreign body (white arrow) that moved with the posteroinferior left ventricular wall. The pellet appeared to be caught near the base of the posterior papillary muscle. LV indicates left ventricle; LA, left atrium.
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Figure 5. An off-axis posterior apical four-chamber view showing the projectile (white arrow). RV indicates right ventricle; RA indicates right atrium; LV indicates left ventricle.
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Acknowledgments
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Disclosures
None.
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Footnotes
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The online-only Data Supplement is available with this article
at http://circ.ahajournals.org/cgi/content/full/114/13/e515/DC1.
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