Needle in the heart: a rare case of cardiac tamponade caused by a migrated foreign body and mimicking ST segment elevation myocardial infarction

Abstract

Background: Pericardial tamponade is a serious condition which may eventually lead to severe haemodynamic disturbances and cardiac arrest. It is most often caused by the accumulation of fluid inside the pericardium, as a result of different aetiological factors such as pericarditis, neoplastic diseases, lymphatic dysfunctions, or idiopathic pericardial disease. Pericardial tamponade can develop after cardiac surgical procedures or as a complication of myocardial infarction. Collection of blood inside the pericardial sack can be the result of pericardial or cardiac trauma. It is exceedingly rare for the injury to be caused by a migrating foreign body. Although a typical picture of pericardial tamponade has been previously described, the disorder may clinically resemble an acute myocardial infarction.

Case presentation: We report the case of a 58-year-old female patient complaining of new onset thoracic pain and shortness of breath. Electrocardiographic examination results were suggestive of an acute inferior myocardial infarction. However, echocardiography revealed significant pericardial tamponade. The cause was found to be a needle which remained inside the pelvis following a previous cesarean delivery, which the patient had undergone 18 years prior. In emergency setting, the needle was removed and the pericardial tamponade was resolved. Due to the prompt and efficient management, the patient had an uneventful postoperative recovery and presented no recurrence at the follow-up examinations.

Conclusions: The migration of foreign bodies through tissues is exceedingly rare. If present, it may cause life-threatening complications. Since the aetiology of pericardial tamponade is vast, a thorough assessment is highly important. Therefore, echocardiography is the imaging modality of choice. We wish to highlight the possibility of migrating foreign bodies as probable cause for pericardial tamponade, as well as the importance of echocardiographic methods in the fast-track evaluation of such critical conditions.

Keywords: Cardiac tamponade; Case report; Foreign body migration; STEMI.

Fig. 1

Electrocardiogram revealing sinus tachycardia (110 bpm), Q waves and minimal acute ST segment elevation with concordant T waves in the inferior leads

Fig. 2

Cardiac catheterization: The silhouette of a needle-like object can be identified (orange arrows). It appears to be implanted into the heart, due to its rhythmic movements with the cardiac contractions

Fig. 3

Echocardiographic imaging revealing the presence of significant pericardial collection

Fig. 4

Intraoperative aspect after gaining access inside the pericardial space: the needle can be seen on the anterior surface of the heart (yellow arrow), being implanted into the cardiac wall and puncturing an epicardial artery, thus causing the intrapericardial bleeding

Fig. 5

The needle after its surgical removal. The 3 ml syringe was used for size comparison