Millimeters from catastrophe: The pericardium as a lifesaving shield

We report a rare case of a 2-year-old child presenting 48 h after accidental penetrating chest trauma due to a fall from a motorcycle, with a retained foreign body lodged within the pericardial sac. Imaging revealed an opaque object overlying the cardiac silhouette. On median sternotomy, approximately 50 mL of pericardial blood was evacuated, and a piece of metallic debris was found resting beneath the left atrial appendage without injury to cardiac structures. The foreign body was successfully removed without cardiopulmonary bypass, and the child had an uneventful recovery. Retained foreign bodies in the pericardium following blunt-penetrating trauma in pediatrics are exceedingly rare and require a high index of suspicion and appropriate imaging. Surgical exploration remains the definitive treatment when pericardial injury or cardiac tamponade is suspected.