While digging road pavement, a 42-year-old road worker suffered sudden chest pain followed by loss of consciousness.
When the patient was examined in the emergency department, a 2-cm entry wound was evident just below the right nipple. Diffuse muffling of heart sounds coupled with a consistent reduction of the QRS complexes in each ECG lead confirmed the diagnosis of cardiac tamponade. A chest radiograph (Figure 1⇓) clearly showed the presence of a triangular foreign body resembling a metallic jackhammer tip fragment located inside the pericardial cavity. An echocardiogram and a chest CT scan (Figures 2⇓ and 3⇓) were particularly helpful in defining the exact position of the fragment and the extent of tissue damage.
The metallic tip entered the right side of the chest, penetrating the right free ventricular wall and ending its path in the interventricular septum, close to the apex.
Surgical treatment consisted of a right thoracotomy followed by drainage of the hemopericardium and repair of the ventricular wall. The jackhammer splinter was left in place.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 2000 by American Heart Association