Images in Clinical Medicine

Shot to the Heart

Lance E. Sullenberger, M.D., and Mary Jo Rohrer, M.D.

N Engl J Med 2003; 348:2634June 26, 2003

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Article

A 29-year-old soldier on active duty in the Army who was involved in the forward combat zone of Afghanistan required emergency evaluation for a shrapnel wound to the chest. Chest radiography (Panel A) showed a metallic fragment (arrows) within the cardiac silhouette. Off-axis transthoracic echocardiographic images (apical two-chamber view, Panel B) showed that the shrapnel (arrow) was located within the apex of the left ventricle (LV). The left ventricular wall motion was normal. The patient was asymptomatic. The fragment was left in place, and the patient was still asymptomatic three months later.

Lance E. Sullenberger, M.D.
Mary Jo Rohrer, M.D.
Walter Reed Army Medical Center, Washington, DC 20307