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Case report of a mysterious myocardial mass: an aetiological conundrum
Jack Stewart1, Aigul Baltabaeva1, Ian Beeton1
1Ashford & St Peter's NHS Trust, St Peter's Hospital, Chertsey, Surrey KT16 0RN, UK.
Insights
A metallic surgical clip migrated to the heart, causing atypical chest pain in an elderly man. This rare case highlights a novel cause of iatrogenic cardiac injury from hernia repair clips.
Area of Science:
- Cardiology
- Medical Imaging
- Surgical Complications
Background:
- Atypical chest pain presents a diagnostic challenge, often necessitating cardiac investigations.
- Ruling out cardiac disease is crucial, but investigations may not reveal the underlying cause.
Observation:
- An 80-year-old male experienced recurrent chest pain despite normal cardiac evaluations including coronary angiography and echocardiography.
- Cardiac MRI revealed a right ventricular mass, later identified as a metallic object by CT scan.
Findings:
- A metallic foreign body was discovered within the right ventricular wall.
- The object's presence was unexplained by the patient's history, with clip migration from prior inguinal hernia repair being the suspected etiology.
Implications:
- This case represents a novel instance of iatrogenic injury due to surgical clip migration to the myocardium.
- It underscores the importance of considering unusual complications in patients with unexplained symptoms post-surgery.
Introduction:
Atypical chest pain is frequently an aetiological conundrum, and missing a diagnosis of underlying cardiac disease can have detrimental consequences. The investigation of this may rule out cardiac disease but often provides no clear answers to the underlying pathology.
Case Presentation:
An 80-year-old man with a background of bilateral inguinal hernia repairs but no cardiac disease presented to his general practitioner with intermittent chest pain of approximately 15 min duration, felt inside his chest under his right nipple. His episodes of chest discomfort had increased in frequency, occurring both at rest and upon exertion. He was seen by the cardiology team at his local hospital and reassured following normal coronary angiography and outpatient echocardiography. The pain persisted, so cardiac magnetic resonance imaging (MRI) was arranged to exclude the underlying myocardial disease. This demonstrated a mass within the right ventricular free wall, which MRI was unable to characterize. Follow-up cardiac computed tomography showed this to be a metallic object within the right ventricular wall, but despite thorough examination of his medical and social history, there remains no obvious explanation to its aetiology other than potentially due to clip migration from his hernia repair.
Discussion:
Metallic foreign bodies within the myocardium are described in case reports but almost entirely in the setting of intentional self-injury. There is no previous case evidence of migration of distal surgical clips to the heart, but there appears to be no other clear aetiology for this gentleman's pathology, thus representing a novel description of iatrogenic injury.
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