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.