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A 36-year-old man was admitted to the Emergency Department with a penetrating right chest wound after an accidental explosion. He was hemodynamically stable (blood pressure 125/80, heart rate 90 bpm, sinus rhythm, pulse oximetry 98%). Physical examination found a small puncture wound in the 4th intercostal space (Fig. 1a). A computed tomography of the chest found bilateral small amount of pleural effusion, and surprisingly a high dense shadow in the inter-ventricular septum (Fig. 1b). Bedside transthoracic echocardiography further confirmed a 3 mm high-echo foreign body in the inter-ventricular septum (Fig. 1c). No signs of valvular regurgitation, ventricular septal defect and accumulation of pericardial fluid were detected. The patient refused any invasive interventions and was treated with prophylactic antibiotics. He remained well and was discharged with cautious follow-up given his risk of late intracardiac structural deformation and infection. Six-month follow-up imaging including chest X-ray (Fig. 1d) and echo revealed vanishing of his pleural effusion and no abnormalities with respect to cardiac structures. Although the presentation of a patient who has suffered a penetrating cardiac injury varies considerably, it is rare lucky of our case that no prompt and late cardiac complications was identified. However, additional long-term follow-up of this patient is required.
The authors have none to declare.
This study was supported by grant from the National Natural Science Foundation of China (No. 81300155).