A rare window for conservative extraction: learning from an asymptomatic thoracic nail gun injury

Penetrating thoracic injuries involving retained foreign bodies (RFBs) present a significant clinical challenge. While removal is generally indicated to prevent complications, invasive surgical approaches carry inherent risks. We present the case of a 60-year-old male who sustained an accidental nail gun injury to his left chest. Imaging revealed a 10 cm nail lodged in the lung, 3 mm from a branch of the pulmonary artery. Despite the proximity to a major vessel, the patient's haemodynamic stability permitted a conservative approach. Under local anaesthesia and mild sedation, a prophylactic chest drain was inserted, and the nail was successfully extracted along its entry path. The patient recovered without incident and was discharged the following day. This case highlights that in select, stable patients, a carefully planned conservative extraction can be a safe and effective alternative to more invasive procedures like thoracotomy or video-assisted thoracic surgery, minimizing patient morbidity.