Case
A 2-year-old girl was transferred to our hospital with a 5-day history
of epigastric and left-upper-quadrant pain, plus intermittent fever.
Transthoracic echocardiography revealed massive pericardial effusion and
tamponade causing right atrial diastolic compression and tachycardia.
Emergent pericardial drainage was performed, collecting 40ml of
hemorrhagic effusion; however, post-drainage chest radiography
(posteroanterior view) showed a radio-opaque foreign body within the
cardiac silhouette at the left lower border (Figure, A). Computed
tomography of the chest confirmed that a metal wire was lodged in the
posterior wall of the left ventricle through the left diaphragm (Figure,
B, C). Surgical removal was then executed under general anesthesia.
Endoscopic esophagogastroduodenoscopy revealed only a small punctate
area of erythema on the gastric mucosa of the fundus, but no fistula.
Following a median sternotomy, the surface of the heart was revealed to
be covered with reactive fibrous tissues which were carefully released.
The wire appeared to have migrated into the left ventricle through the
diaphragm and was successfully removed from the left ventricle with
forceps but without cardiopulmonary bypass (Figure, D). The wire was
2cm, non-rusted, sharp, and metallic (Figure, E). No bleeding from the
heart was noticed and primary closure of the diaphragmatic fistula was
carried out. The patient made an uneventful recovery and was discharged
in good condition.