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Videothoracoscopic approach to the extraction of a cardiac retainer missile
Carlos Andres Muñoz1, Jairo González Quitian2, Alberto García1
1Department of Trauma and Emergency Surgery, Hospital Universitario del Valle - Fundación Valle del Lili, Cali, Colombia.
Insights
Foreign bodies in the heart are rare after penetrating trauma. This case details the successful removal of a projectile from the pericardial sac using video-assisted thoracoscopic surgery (VATS) in a stable patient.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Medical Imaging
Background:
- Foreign body (FB) retention in the heart or pericardium following penetrating trauma is uncommon.
- Management strategies for retained cardiac FBs in hemodynamically stable patients remain controversial.
Observation:
- A 19-year-old male presented with two gunshot wounds to the lumbar region.
- Imaging revealed a foreign body near the right heart chamber, left atrial wall, and right ventricle.
- The patient was hemodynamically stable upon admission.
Findings:
- Diagnostic imaging included chest x-ray (CXR), thoracoabdominal computed tomography (CT), and transesophageal echocardiogram (TEE).
- A missile was successfully located within the pericardial sac.
- Surgical intervention was performed using video-assisted thoracoscopic surgery (VATS).
Implications:
- This case highlights the successful application of VATS for retained cardiac projectiles.
- It underscores the importance of comprehensive imaging in diagnosing retained FB injuries.
- It contributes to the limited literature on managing stable patients with cardiac FB trauma.
Abstract:
The presence of foreign bodies (FB) retained in the heart or pericardium secondary to penetrating trauma in stable patients is a very rare event and its management is controversial. We present the case of a 19-year-old patient who was admitted to our trauma center hemodynamically stable because of two gunshot wounds in the lumbar region. A chest x-ray (CXR) revealed a blurred foreign body over the right heart chamber, thoracoabdominal computed tomography (CT) scan showed a free projectile over the left atrial wall, and transesophageal echocardiogram (TEE) showed a hyperrefringent pericardial sac image near the right ventricle. Finally, the patient went to surgery where a missile was removed from the pericardial sac by video-assisted thoracoscopic surgery (VATS).
