Images in Clinical Medicine

Kim Eagle, M.D., Editor

Nail in the Aorta

Joel M. Felner, M.D.

N Engl J Med 1996; 334:239January 25, 1996

• Slide

Article

Figure 1 A 32-year-old man who had attempted suicide with a nail gun directed at his heart just to the left of the sternum presented to the emergency room with cardiac tamponade. The chest x-ray film (Panel A) revealed a nail (arrow), apparently in the heart. A two-dimensional transesophageal echocardiogram in the transverse plane at the level of the aorta revealed that the nail (open arrow) was 1 cm distal to the aortic leaflets (Panel B). The nail penetrated the right ventricle (RV), just proximal to the pulmonic valve (PV), adhering the right ventricle to the aorta (AO). A horizontal image (not shown) showed that the nail was within 1 mm of the right coronary artery. The color Doppler image (not shown) identified a left-to-right communication from the aorta into the right ventricle. LA denotes left atrium, LV left ventricle, and AV aortic valve.

The patient underwent emergency surgery, and by studying the transesophageal echocardiogram the surgeon was able to pinpoint his incision. Panel C shows the nail (arrow) just before its removal. The nail, with adherent thrombus and pieces of the patient's shirt, was removed without complication, permitting the right ventricular wall to contract normally. The patient was sent home from the hospital one week postoperatively, doing well physically. His mental health was improved.

Kim Eagle, M.D.

Joel M. Felner, M.D.
Emory University School of Medicine, Atlanta, GA 30303

Citing Articles (4)

Citing Articles

1. 1

   L N??lke, P Naughton, C Shaw, J Hurley, A E. Wood. (2005) Accidental Nail Gun Injuries to the Heart. The Journal of Trauma: Injury, Infection, and Critical Care 58:1, 172-174
   CrossRef

2. 2

   James A. Vosswinkel, Thomas V. Bilfinger. (1999) Cardiac Nail Gun Injuries: Lessons Learned. The Journal of Trauma: Injury, Infection, and Critical Care 47:3, 588-590
   CrossRef

3. 3

   Dmitry Oleynikov, Philip Kladar, James Stringham, Richard G. Barton. (1998) Case Report of Pneumatic Staple Gun Injury to the Aorta. The Journal of Trauma: Injury, Infection, and Critical Care 45:5, 892-893
   CrossRef

4. 4

   Giampiero Alberico, Ines Bucci, Franco Ciarelli, Giorgio De Giorgio, Domenico D'Artista, Osvaldo Ciccarelli. (1997) An Unusual Case of Nail Gun Injury. The Journal of Trauma: Injury, Infection, and Critical Care 43:1, 153-156
   CrossRef