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Ann Thorac Surg 2004;78:e15-e15
© 2004 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

A nail in the heart

Hikmet Koçak, MDa, Necip Becit, MDa*, Yahya Ünlü, MDa

a Department of Cardiovascular Surgery, Atatürk University School of Medicine, Erzurum, Turkey

* Address reprint requests to Dr Becit, Universite Lojmanlari 8/7, 25240 Erzurum, Turkey
e-mail: necipbecit{at}hotmail.com

A 25-year-old carpenter was accidentally injured by a 5-cm nail while working with an automatic nail gun. The nail appeared 5 cm below Luis's angle. Lateral chest radiograph (Fig 1) and computed tomography (Fig 2) showed that the distal end of the nail perforated the entire sternum and the pericardium, entering the rightatrium. In Figure 1, the nail is seen as a white line. The operation was performed via partial sternotomy 2 cm below the nail entrance point. About 100 mL of hemorrhagic fluid had accumulated in the pericardial space. The nail tip was located in the base of the right atrial appendage, and had missed the right coronary artery by 5 mm. The nail was removed. The right atrium was repaired using 4-0 polypropylene sutures armed with pledgets. The postoperative course was uneventful and the patient was discharged after 6 days.



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Yahya Ünlü
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