A shot through the heart: a case report on retained bullet causing cardiac tamponade.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Case Reports Pub Date : 2024-12-06 eCollection Date: 2024-12-01 DOI:10.1093/ehjcr/ytae651
Rakesh Shah, Thomas Dacey, Joseph Sebastian, Kenton Zehr, Shaun Cardozo
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Abstract

Background: As a rare complication of penetrating chest trauma, one can occasionally find foreign bodies inside the pericardium. Even rarer is finding an intact bullet inside the pericardial cavity following the gunshot injury.

Case summary: A 17-year-old male presented to the emergency department as a Level 1 trauma for multiple gunshot wounds. Upon arrival, the patient was tachycardic but normotensive. Physical exam was notable for several penetrating wounds to the chest and right clavicle. The initial chest X-ray demonstrated a metallic foreign body consistent with a bullet overlying the cardiac silhouette. Approximately 24 h into the hospital course, ST-segment elevation was noted on telemetry. An electrocardiogram demonstrated sinus tachycardia with diffuse ST-segment elevation in all leads, consistent with acute pericarditis. Over the following several hours, the patient gradually developed tamponade physiology, prompting a more emergent median sternotomy.

Discussion: Although penetrating cardiac injury carries a high mortality rate, management of these patients and complications that may arise during their hospital course are rarely explained. The diagnosis of projectile chest trauma starts with history and physical examination. The primary diagnostic modalities are the X-ray, computed tomography scan of the chest, electrocardiogram, and echocardiogram. Management of a patient with cardiac gunshot depends largely on haemodynamic status. As in our case, a patient with haemodynamic instability is managed with emergency exploration and removal of the foreign body.

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背景:作为穿透性胸部创伤的一种罕见并发症,人们偶尔会在心包内发现异物。更罕见的是,枪伤后在心包腔内发现一颗完整的子弹。病例摘要:一名 17 岁的男性因多处枪伤被送到急诊科,属于一级创伤。到达时,患者心动过速,但血压正常。体格检查显示患者胸部和右锁骨有多处贯穿伤。最初的胸部 X 光片显示,心脏轮廓上方有一个与子弹一致的金属异物。住院约 24 小时后,遥测发现 ST 段抬高。心电图显示窦性心动过速,所有导联弥漫性ST段抬高,与急性心包炎一致。在随后的几个小时里,患者逐渐出现了心肌填塞的生理现象,因此需要进行更紧急的胸骨正中切开术:讨论:虽然穿透性心脏损伤的死亡率很高,但对这些患者的处理方法和住院期间可能出现的并发症却很少解释。胸部外伤的诊断始于病史和体格检查。主要诊断方法是 X 光、胸部计算机断层扫描、心电图和超声心动图。对心脏中弹患者的处理主要取决于血液动力学状态。就像我们的病例一样,对于血流动力学不稳定的患者,应进行紧急探查并取出异物。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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