The curious case of a migrating needle on the chest wall

Naveen Chander

Consultant Cardiothoracic and Vascular Surgeon, Kauvery Hospital, Salem, India

Correspondence: [email protected]

Case Presentation

The patient, a 26 years aged male, married, working in a store, presented to a hospital with chest pain, for the past 3 days. ECG showed ST changes. CT scan imaging showed the presence of needles in the anterior chest wall, lateral chest wall, and mild pericardial effusion.

A diagnosis of Acute Pericarditis due to needle stick injury was made and referred to our hospital.

On arrival, the patient complained of chest pain which was more on inspiration. He was tachypneic, sweating, and was not able to lie down flat in the bed.

Allegedly, he had presented to a hospital a year back, with chest pain. Imaging had shown three sharp objects in the chest wall. The one which was medial to the nipple, in the subcutaneous plane, was removed.

But the patient or the relatives did not divulge any details about how the needles got there!

No history of smoking/alcohol/substance abuse/suicidal tendency/medication for psychiatric illness.

Family history: Married for the second time, first ended with mutual divorce. No offspring.

On examination

Conscious/oriented/tachypneic

JVP elevated, sweating was excessive, Peripheries were cold.

Tachycardia of about 144/ min, Respiration Rate 47/min, SpO2 98% (8 L O2), on room air 88%, BP 120/70 mmhg.

CVS: no murmurs, RS: bilateral crepitations.

Chest wall examination:

No laceration/bruise, no discoloration or contusion

Three scars present:

  1. Curvilinear scar, of about 5 cm medial along the circumference of Lt areola and nipple
  2. Horizontal scar of about 2 cm lateral to the left sternal border, below the nipple
  3. 1 cm horizontal lateral to the second scar.

ECG showed diffuse ST-T changes, echo revealed – concentric left ventricular hypertrophy, massive pericardial effusion with strands, and normal LV function.

CT chest – sharp object piercing

Treatment

Taken up for emergency cardiac exploration and tamponade release.

Procedure

Emergency midline sternotomy, pericardium opened, 250 ml of tamponade released. A needle of about 5 cm which had pierced the Right Ventricle was removed intact. Puncture site closed with pledgeted 5.0 proline suture. Thorough hemostasis was achieved, closed with chest tubes in both pleura cavities.

Once the life-threatening sharp object was removed with the help of the C-arm the second needle which was about 5 cm (charred) was removed in total with a horizontal skin crease incision 2 cm above and lateral to the left nipple.

Pt was shifted to CTVS ICU in a hemodynamically stable condition. The postoperative course was uneventful. The patient improved well and was discharged on the 6th post-operative day.

CTVS-ICU
Pictures-were-taken-in-a-private-hospital-which-was-the-day-prior-to-the-admission-to-Kauvery-Hospital

Fig. 1. Pictures were taken in a private hospital, which was the day prior to the admission to Kauvery Hospital.

CTVS-ICU-1
CTVS-ICU-2

Fig. 2. Pictures were taken on the day of admission and emergency surgery in Kauvery Hospital, Salem.

Dr.-C.-Naveen-Chander

Dr. C. Naveen Chander

Consultant Cardiothoracic and Vascular Surgeon

Journals

Kauvery Hospital
Find Doctor
Book Appointment