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(Circulation. 1999;100:e18-e19.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Nail Gun Penetrating Injury of the Left Ventricle and Descending Aorta

Ming-Jiuh Wang, MD, PhD; I-Shiang Chen, MD; Shen-Kuo Tsai, MD, PhD

From the Department of Anesthesiology (M.-J.W., S.-K.T.) and Surgery (I.-S.C) of National Taiwan University Hospital, Taipei, Taiwan.

Correspondence to Ming-Jiuh Wang, MD, PhD, Associate Professor, Department of Anesthesiology, National Taiwan University Hospital, 7, Chung Shan South Rd, Taipei, Taiwan, 100. E-mail canon@ccms.ntu.edu.tw

	Introduction

 
A17-year-old boy was sent to the emergency service for an accidental nail-gun shot injury of the chest. His blood pressure was 90/60 mm Hg, heart rate was 110 bpm, and oxygen saturation was 87% before anesthetic induction in the operating room. Transesophageal echocardiography undertaken after induction with general anesthesia and endotracheal intubation showed that the left ventricle and descending aorta were penetrated by the nail. There was large amount of pericardial effusion with cardiac tamponade. Periaortic hematoma was evident by transesophageal echocardiography. Under partial cardiopulmonary bypass, the nail was removed, and the wounds of the left ventricular wall and descending aorta were repaired. The patient was discharged uneventfully 7 days after the accident.

View larger version (96K): [in this window] [in a new window]   Figure 1. Transesophageal echocardiography of descending aorta, short-axis view. A nail (large arrow) penetrating into descending aorta and large hematoma in front of aorta (small arrow) can be clearly seen.

View larger version (82K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiography of descending aorta, long-axis view. Penetrating nail (large arrow) and aortic blood flow with hematoma (small arrows) surrounding aorta can be clearly seen.

View larger version (99K): [in this window] [in a new window]   Figure 3. Transesophageal echocardiography of ventricles, short-axis view. Large amount of pericardial effusion is demonstrated. LV indicates left ventricle; RV, right ventricle.

View larger version (84K): [in this window] [in a new window]   Figure 4. Transesophageal echocardiography of ventricles, short-axis view. Right ventricle is compressed by pericardial effusion (large arrow), and a lacerated wound at apex of left ventricle and part of interventricular septum is shown (small arrow). LV indicates left ventricle; RV, right ventricle.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of . . . [Full Text of this Article]

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