Directly to the Heart

Abstract

HomeCirculationVol. 114, No. 13Directly to the Heart Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBDirectly to the Heart Jonathan DeBlois, MD, Sebastien Bergeron, MD, Marie-Helene LeBlanc, MD, Mario Senechal, MD, Jocelyn Gregoire, MD and Marie Arsenault, MD Jonathan DeBloisJonathan DeBlois From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Sebastien BergeronSebastien Bergeron From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Marie-Helene LeBlancMarie-Helene LeBlanc From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Mario SenechalMario Senechal From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Jocelyn GregoireJocelyn Gregoire From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author and Marie ArsenaultMarie Arsenault From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author Originally published26 Sep 2006https://doi.org/10.1161/CIRCULATIONAHA.106.615062Circulation. 2006;114:e515–e516A 24-year-old male was intentionally shot with a 0.410-caliber rifle to the anterior chest from a distance of about 10 m. The patient did not lose consciousness and was able to seek medical assistance on his own. On presentation, the patient had normal vital signs. A chest x-ray (Figure 1) and thoracoabdominal computed tomographic scan (Figures 2 and 3) were immediately performed and showed multiple metallic foreign bodies, most of them in the anterior chest wall, many in the lung parenchyma, and some within the mediastinum. One pellet was located between the aorta and the superior vena cava. Another was adjacent to the esophagus, at the level of T3, where a small pneumomediastinum was also identified. Most importantly, 2 bullets were also visible within the heart. An echocardiogram was performed that demonstrated the exact localization of one of these bullets in the posterior wall of the heart near the base of the posterolateral papillary muscle (Figures 4 and 5). The patient also underwent an esophagoscopy and a bronchoscopy, both of which were normal. A right pleural effusion was drained with a chest tube. The patient remained stable without any cardiac symptoms or arrhythmias. Against medical advice, he left the hospital 3 days after his admission and was lost at follow-up. Download figureDownload PowerPointFigure 1. Chest x-ray showing the multiple foreign bodies resulting from the gunshot.Download figureDownload PowerPointFigure 2. Computed tomographic scan of the chest demonstrating a pellet (black arrow) just behind the ascending aorta and adjacent to the base of the left atria.Download figureDownload PowerPointFigure 3. Computed tomographic scan image of the chest showing the pellet (black arrow), which was later localized with the echocardiogram. Also identifiable are the small right hemothorax and 2 other pellets in the parietal chest.Download figureDownload PowerPointFigure 4. Apical 2-chamber view showing a metallic foreign body (white arrow) that moved with the posteroinferior left ventricular wall. The pellet appeared to be caught near the base of the posterior papillary muscle. LV indicates left ventricle; LA, left atrium.Download figureDownload PowerPointFigure 5. An off-axis posterior apical four-chamber view showing the projectile (white arrow). RV indicates right ventricle; RA indicates right atrium; LV indicates left ventricle.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/114/13/e515/DC1.DisclosuresNone.FootnotesCorrespondence to Marie Arsenault, MD, Hopital Laval, 2725 chemin Ste-Foy, Quebec, Canada G1V 4G5. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zurick A and Morse M (2016) A Shot to the Heart, Journal of Nuclear Cardiology, 10.1007/s12350-016-0485-4, 24:1, (325-328), Online publication date: 1-Feb-2017. Janssens S (2010) Stem Cells in the Treatment of Heart Disease, Annual Review of Medicine, 10.1146/annurev.med.051508.215152, 61:1, (287-300), Online publication date: 1-Feb-2010. Lundy J, Johnson E, Seery J, Pham T, Frizzi J and Chasen A (2009) Conservative Management of Retained Cardiac Missiles: Case Report and Literature Review, Journal of Surgical Education, 10.1016/j.jsurg.2009.04.002, 66:4, (228-235), Online publication date: 1-Jul-2009. September 26, 2006Vol 114, Issue 13 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.615062PMID: 17000915 Originally publishedSeptember 26, 2006 PDF download Advertisement SubjectsComputerized Tomography (CT)Echocardiography