Hepatic foreign body - a sewing needle - in a child

We report a case of a 1-year-old boy with a needle-like foreign body embedded in the liver. The foreign body was incidentally found in the right hypochondrium on routine chest X-ray during a periodic medical examination. He was asymptomatic and there was neither a history of swallowing a needle nor a puncture wound on his body. The results of blood tests and physical examination were entirely within normal limits. Computed tomography scan showed that the needle was completely buried in the liver. At laparotomy, some fibrous tissue and a scar were recognized between the surface of the left lobe of the liver and the parietal peritoneum of the upper abdominal wall. The end of the sewing needle was manually squeezed out and extracted from the liver. From this operative finding, it was assumed that the needle had penetrated the liver through his skin. His postoperative course was uneventful and he was discharged on postoperative day 8.     

An operated case of traumatic intrapulmonary foreign body persisting for 45 years]

A case with a bronchial foreign body which had an uncommon way of entry through a wound in the chest wall was described. A 70-year-old man was admitted to our hospital because of productive cough and weight loss. He had been injured by a fragment of a hand grenade which penetrated his anterior chest wall at the front in China 45 years ago. A chest x-ray film revealed a metallic foreign body, measuring 1.3 by 0.9 cm, in the upper lobe of the right lung. Computed tomography of the chest and bronchoscopy demonstrated a steel fragment lodging beside and in the right upper lobe bronchus. Right upper lobectomy was performed, and the patient remains well without any thoracic symptoms one and a half years after the operation. Problems in the treatment of traumatic intrapulmonary foreign bodies were discussed.     

Massive hemoptysis after aspiration of a toothpick

A 42-year-old man presented with massive hemoptysis. His past medical history was significant for a bayonet injury to the left chest several years ago. A chest computed tomographic scan showed a radio-opaque foreign body in the left lower lobe. A left thoracotomy was performed because of unrelenting hemoptysis in association with a foreign body that could not be retrieved by bronchoscopy. At surgery, a toothpick covered with blood was retrieved from the left lower lobe bronchus. A left lower lobectomy was performed because a lung abscess was present. Postoperatively, the patient confirmed that 1 year prior he had fallen asleep with a toothpick in his mouth while intoxicated.     

Bullet embolus to the heart after gunshot wound to the neck: a case report

A 43-year-old woman presented with gunshot wounds to the neck, chest, and left thigh. Computed tomography of the neck and chest with intravenous contrast revealed a left common carotid pseudoaneurysm and a foreign body in the right atrium. Preoperative chest x-ray and CT scan confirmed a metallic foreign body in the right heart. At median sternotomy, the intracardiac foreign body could not be located using fluoroscopy. The foreign body (bullet) was subsequently removed in the cardiac catheterization laboratory using a percutaneous transvenous basket extraction through a right femoral vein cutdown.     

Foreign body left bronchus with delayed complications: a case report

A 30 years old man presented with history of cough with expectoration, and fever off and on for the last many years with no history of haemoptysis. He was often treated by a course of antibiotics, expectorants and bronchodilators by the physicians. He was also given a course of Anti Tubercular Treatment (ATT) for the 6 months by some physician but without any relief. On a detailed interaction and history taking patient did give a doubtful history of aspiration of foreign body during his childhood, after which he began to develop repeated episodes of cough and fever. X-rays of the chest didn’t reveal any foreign body. Computed Tomography (CT) scan chest revealed left lower lobe bronchiectasis with collection in the left lower lobe basal segment with pleural collection around it. Surgical intervention was undertaken and left lower lobe lobectomy was done. A foreign body in the form of plastic whistle was removed from the bronchus.     

Delayed heart perforation after blunt trauma.

A 33-year-old patient was hospitalized after a blunt chest trauma with a left flail chest. Six hours after admission to the intensive care unit the patient suddenly developed hypotension and tachycardia. His left chest tube drained 1.5 l of blood within minutes. Immediate resuscitation and emergency sternotomy with left anterolateral extension was performed for pericardial tamponade secondary to left ventricular perforation due to a sharp rib fragment. Outcome was favourable and the patient was operated on for his flail chest by internal stabilization the next day.     

A successful repair of post-infarction left ventricular free wall rupture

Left ventricular free wall rupture secondary to acute myocardial infarction is almost invariably fatal. This report is the case presentation of a successful repair of left ventricular free wall rupture. A 55-year-old man, with a diagnosis of acute infero-lateral myocardial infarction, was transferred from another hospital to our CCU having recurrent chest pain on the fourth day after infarction. Shortly after admission, he lost his consciousness and fell into cardiogenic shock. Echocardiography showed a large pericardial fluid. He was immediately transferred to the operating room with the diagnosis of the heart rupture. After opening the pericardium containing 200 cc of blood, cardiac tamponade was relieved. The posterolateral portion of the left ventricle was found to be bluishly discolored, with a 8 mm-long tear of epicardium. Using cardiopulmonary bypass, the tear was closed with Teflon-reinforced sutures. The post-operative course was uneventful.     

Survival following fracture of strut from mitral prosthesis with disc translocation.

Mechanical complications of prosthetic valves are increasingly rare. The acute, catastrophic nature of the symptoms associated with massive transvalvular regurgitation preclude survival except with immediate operation. In the patient described herein, two weld fractures of a Bj?rk-Shiley mitral prosthetic strut led to displacement of the valve occluder into the left atrium. The patient survived reoperation, following which the strut was detected radiologically in the left ventricular free wall. A slow, limited recovery resulted from his 5 preoperative hours of deep shock and coma. No complication attributable to the retained ventricular foreign body has been identified.     

Ventricular septal defect with right pulmonary agenesis and left bronchial stenosis

We report a case of ventricular septal defect (VSD) with right pulmonary agenesis and left bronchial stenosis. Delivery of a male infant was uneventful. Birth weight was 3,050g. At 12 days of age, he presented himself with tachypnea and wheezing. Dextrocardia was noted on a chest X-ray. Computed tomography (CT) of the chest showed right pulmonary agenesis and severe narrowing of the left main bronchus. An echocardiogram showed VSD, patent ductus arteriosus (PDA) and pulmonary hypertension (PH). At 22 days of age, he was put on ventilator. At 1 month of age, pulmonary artery banding and division of PDA were performed through median sternotomy. At 5 months of age, weighing 5.0 kg, the VSD was closed with a Dacron patch through median sternotomy. At 6 months of age, tracheostomy was necessitated. At 1-year-old, he became free from ventilator.     

Thoracoscopic removal of a suture needle from the posterior pericardium after coronary artery bypass grafting

We demonstrate a minimally-invasive thoracoscopic approach [video-assisted thoracic surgery (VATS)] for removal of a retained pericardial suture needle after standard coronary artery bypass grafting (CABG) surgery. A 46-year-old male presented with unstable angina. His workup demonstrated significant coronary artery disease for which he underwent a six vessel CABG, including entering the left chest for preparation of the left internal mammary artery (LIMA). At seven weeks, a postoperative chest X-ray demonstrated a foreign body (suture needle) present in the cardiac silhouette. Further computed tomography (CT)-scan imaging confirmed the suture needle to be localized in the left inferior-posterior pericardium. The patient underwent a left VATS exploration for removal of the suture needle. The pericardial suture needle was successfully retrieved thoracoscopically. The chest tube was removed on the first postoperative day and the patient was discharged to home on the second postoperative day. The patient's postoperative course and recovery were uneventful. A minimally-invasive approach can be undertaken for the removal of a foreign body even after prior open chest surgery, avoiding the associated morbidity of a repeat sternotomy.     

Three cases of an intracranial wooden foreign body

Three cases of intracranial wooden foreign body are reported discussing the diagnostic and therapeutic problems. First case is a 50-year-old man. After drinking, he drove a bike and fell to the ground. On admission the wooden foreign body could not been detected in appearance. CT scan showed low density area similar to air in bilateral anterior horn of lateral ventricle. The patient was treated for traumatic pneumocephalus at first. Later, it proved that he was stabbed with a foreign body penetrating into the contralateral frontal lobe through the left nasal cavity. It was extracted by endonasal approach by otolaryngologist, fortunately without trouble. The foreign body was a branch of tree. The second case is an 18-year-old man. He was driving a car, and suffered injury. He was stabbed with a wooden stake penetrating into his left eye. Immediately, bifrontal craniotomy was performed and the stake was withdrawn carefully. Moreover bone fragments were removed. The third case is a 61-year-old man. When he cut the timber by chain saw, a piece of wood hit and stabbed his right eye directly. Immediately right front temporal craniotomy was performed. The piece of wood was withdrawn from the right eye, and pieces of glass, wood and bone fragments were evacuated. It is difficult to confirm intracranial foreign body accurately by means of only plain skull film and usual CT scans. It is necessary to utilize various function of CT scanner. For example, it is useful to know CT values or select measure mode with window width and level or make reconstruction image to sagittal or coronal section, and so on.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of asymptomatic intracardiac missiles using echocardiography

A child sustained a low-velocity airgun pellet injury to the left ventricle. No cardiovascular compromise was produced. The foreign body was localized by two-dimensional echocardiography to the left ventricular chamber near the mitral valve, and subsequently removed through a left atriotomy incision. In asymptomatic patients, missiles clearly embedded within a chamber wall may be observed; all others should be removed. Two-dimensional echocardiography is recommended for localization.     

Three-dimensional computed tomography imaging of an implantable cardioverter-defibrillator lead fragment in the left ventricle of a heart transplant followed by successful transarterial extraction with a snare catheter

We report on a 51-year old heart transplant recipient in whom a pacing lead fragment of his old implantable cardioverter-defibrillator (ICD) had been detected in the left ventricle following successful heart transplantation. The patient was transplanted after 5 weeks on high urgent status. A postoperative routine chest X-ray and a subsequent cardiac three-dimensional (3D) computed tomography scan showed a metallic foreign body bending during systole below the posterior mitral valve leaflet within the left ventricle of the heart transplant. Transarterial extraction therapy was planned and the femoral artery was cannulated in the usual fashion. An 8F snare catheter was directed into the left ventricle under fluoroscopic guidance. Successful extraction revealed a 3-cm, uncoated ICD fragment (diameter = 0.025 in.). Following extraction of the fragment echocardiography showed mild mitral regurgitation but no further adverse events occurred. The patient was discharged 2 days later. Transarterial fragment extraction using a snare catheter is a feasible, minimally invasive procedure in this clinical scenario. Careful inspection of all explanted hardware is strongly recommended to ensure that no portion of an ICD lead is left behind.     

Complication of the Use of a Radiofrequency Device in Arthroscopic Shoulder Surgery: Second-Degree Burn of the Shoulder Girdle

Radiofrequency ablation (RF) energy devices are increasingly being used in arthroscopic surgery. This is a case report of a 53-year-old man who had second-degree burns of the shoulder and chest wall as a result of fluid overheating due to RF. During an extensive arthroscopic bursal dissection of the left shoulder, the suction device on the RF wand and the valve was left open, allowing fluid to drip onto the chest and arm of the patient. Three days after his surgery, on his first postoperative visit, the dressings were removed, and the patient was noted to have severe blistering on the lateral aspect of his arm and on the anterolateral aspect of his left chest wall. One year after the surgery, he still had residual scarring that was only mildly intermittently pruritic. The use of RF during arthroscopic surgery is very useful clinically; however, it is important to have a strict understanding of the potential hazards the thermal energy can cause to the surrounding soft tissue.     

Subepicardial left ventricular aneurysm with an intraventricular narrow neck on the avascular apical area: Report of a case

A 48-year-old hiatus hernia patient with a history of an occasional epigastric burning sensation for the last 10 years presented with a new onset of chest pain in addition to the persistence of his other symptoms. An apical left ventricular aneurism was found on 64-slice computed tomographic angiography. Coronary angiography confirmed the diagnosis. No coronary lesion was found and the apical region of the left ventricle was avascular. He was operated on under the suspected preoperative possible diagnoses of left ventricular apical aneurysm, a pseudoaneurysm, or a diverticulum. Macroscopically, a subepicardial whitish aneurysmal region with a weakened wall was seen at the apical part of the left ventricle. The size of the lesion was 3 x 3 cm. The aneurysm did not have an extracardiac neck. When the aneurysm site was opened, a sclerotic aneurysm wall and a narrow neck below the incised sac was found; and the neck was communicating with the left ventricular cavity. The aneurysm site was resected and closed with a linear closure technique by using pledget-supported sutures. The termination of cardiopulmonary bypass was uneventful. The patient left the intensive care unit on the first postoperative day and was discharged from hospital on the 4th postoperative day. A subepicardial left ventricular aneurysm should therefore also be considered in the differential diagnosis of atypical chest pain.     

“Kneedle pain”: slipped upper femoral epiphysis in disguise

A 14-year-old boy presented to the outpatient fracture clinic with a foreign body in his left knee. He was complaining of chronic knee pain. An X-ray revealed a foreign body—a sewing needle. On closer examination, he was noted to be obese and pre-pubertal. He had decreased range of motion in his right hip. X-ray of hip revealed a Grade 2 Slipped upper femoral epiphysis. He proceeded to OT for pinning in situ right hip and removal of foreign body in the left knee. Clinical case, and case photos are discussed.     

Penetrating knife injury to the heart.

A 39-year-old man attempted to kill himself using a small knife to penetrate the left anterior chest wall because of trouble at work and with his girlfriend. On arrival at the emergency room, his consciousness was not clear and vital signs were unstable. The knife remained vertically located in the left anterior chest wall. A large left hemothorax was identified by chest X-ray, and moderate cardiac tamponade was detected by echocardiography. Left-sided chest drainage was performed by inserting a chest drainage tube, and about 2500 ml of hemorrhagic effusion was drained. An emergency operation was performed to relieve the cardiac tamponade and repair the penetrating cardiac injury. About an hour after arrival at the emergency room, a median sternotomy was performed in the operating room. The knife had injured the surface of the right ventricular outflow tract, the left lung, and the 3rd intercostal artery and vein. Cardiopulmonary bypass was immediately prepared for the repair of the cardiac injury. The wounds were successfully repaired with pledgeted sutures under cardiac beating. The postoperative course was uneventful with no sign of infection. The patient was discharged at 9 days after the operation. Here we have reported a case of successful surgical repair of a penetrating knife injury to the heart, which was managed by immediate resuscitation and emergency surgery.     

A case report of successful mitral valve replacement for congenital mitral stenosis associated with coarctation of the aorta and ventricular septal defect

A 5-month-old infant with coarctation of the aorta, ventricular septal defect and mitral stenosis known as "Shone's anomaly" is presented. He underwent the repair of coarctation of the aorta by means of the extended aortic arch anastomosis and banding of the pulmonary trunk at 1 month of age and the patch closure of ventricular septal defect and debanding of the pulmonary trunk at 3 months of age in our institution. About 2 months after second surgery, he had been admitted to our institution due to developing tachypnea and he needed the support of mechanical ventilation. The chest X-ray showed pulmonary congestion and the echocardiography revealed only one papillary muscle of mitral valve and pressure gradient about 30 mmHg through mitral valve. Mitral stenosis due to parachute mitral valve was suspected and he was subjected to an emergent surgery. Initially we performed mitral valve repair for parachute mitral valve but echocardiography during the surgery revealed moderate grade of mitral regurgitation and a hemodynamics was not satisfactory. Eventually mitral valve replacement was successfully done with Carbo-Medics mechanical valve (19 mm in diameter) in the position of left atrial wall because his mitral annulus was so small as 10 mm in diameter. The postoperative course was uneventful and the patient has been doing well.     

Impending Rupture of a Blunt Trauma-Induced Left Ventricular Aneurysm: Report of a Case

Most left ventricular true aneurysms that occur secondary to blunt trauma gradually become symptomatic as they enlarge, which validates conservative management as a reasonable initial course of action. We report a case of impending rupture of a left ventricular true aneurysm that showed rapid expansion within a few weeks. A 17-year-old youth was involved in a head-on collision into a car while riding a motorcycle. He underwent repair of a ruptured jejunum and internal fixation of a fractured femur; 28 days after the accident, he was transferred to another hospital for rehabilitation. His chest X-ray just before the transfer was normal. He was re-admitted to our hospital 58 days after the accident complaining of anterior chest pain and dyspnea. Echocardiography showed impending rupture of a left ventricular aneurysm. We performed emergency open repair of a left ventricular true aneurysm with a very thin wall. We report this case to show that even a true aneurysm of the left ventricle should be carefully monitored from the early stage, considering the possibility of rupture.     

Perforation of the aorta by a rib edge: an unusual complication after chest wall resection

Thoracic aortic perforation in the context of a minor trauma is extremely rare. In this article, we describe a case of an 80-year-old man who presented with an aortic perforation after a fall from his height during his hospitalization. The patient had previously undergone a left superior lobectomy, a partial chest wall resection, and reconstruction for a locally invasive lung cancer. He was directly transferred to the operating room, as he presented with hemodynamic instability. A 4-mm laceration in the descending thoracic aorta was identified and repaired. The postoperative course was uneventful. This case illustrates the importance of applying a solid fixation to the rib stumps when performing a chest wall resection, irrespective of the size of the wall defect.