Cardiac gunshot injury: child with stable presentation and asymptomatic short-term follow-up

A 2-year-old female child was brought to the emergency department after she was accidentally shot by her father, while cleaning his air rifle loaded with the pointed type 0.22 (5.5 mm) caliber pellet. The pellet hit the front of chest from a distance of about 10-15 m. On physical examination, it was found that there was entrance wound in right lower parasternal area but no exit wound. She was hemodynamically stable with normal auscultatory findings. Chest roentgenogram (Fig. 1) demonstrated a bullet overlying cardiac silhouette with no other findings. Two-dimensional transthoracic echocardiography (Figs, 2, 3, and movie clip 1) showed an echogenic density in the interventricular septum just beneath the insertion of tricuspid and mitral leaflets. The atrioventricular valves appear normal with no regurgitation. The biventricular function also appeared normal with no regional wall motion abnormalities. There was no pericardial effusion present. The echogenicity is most likely the pellet that punctured the chest wall and continued inward to lodge in the interventricular septum. Computed tomographic scan of the chest showed an intracardiac foreign body without other abnormalities. Up to 11 months, repeated scans have shown no changes. She will continue to receive ongoing follow-up to assess for late complications (migration, erosion, conduction, disturbance, etc.) To the best of our knowledge, she may be the youngest living patient having cardiac trauma with clinically stable presentation and asymptomatic short-term follow-up.