A 20-year-old man presented with severe dyspnea after a thoracic firearm injury. Many pellets distributed in the thoracic wall and an enlarged cardiac silhouette was detected on chest X-ray. Electrocardiogram demonstrated regular sinus rhythm with low voltage. Transthoracic echocardiography (TTE) revealed pericardial effusion causing cardiac tamponade and the presence of a swinging retained pellet in the pericardium and the absence of intra and extracardiac shunt (Figure 1 and 2). The patient was transferred to the operating room and examination of the heart showed intrapericardial localization of the pellet and erosion of the left side of the myocardium without any coronary artery and other cardiac injures (Figure 3). Primary suture of erosion was performed with patch on beating heart successfully. After operation TTE was performed again and revealed no abnormalities. This case highlights the role of TTE in emergency room to exclude or confirm the potential cardiac injury and importance of rapid diagnosis and operation should be emphasized to reduce mortality due to cardiac tamponade [1, 2].
|Journal Section||Letters to the Editor|
|Publication Date||September 27, 2011|
|Published in Issue||Year 2011, Volume 33Issue 3|