A piece of chainlink fence in the heart

A 63-year-old man was mowing the grass along a chainlink fence when he felt a brief stab of intense pain in the middle of his chest. Hours later, precordial pain suddenly arose. On his arrival at our emergency department, a small, bleeding lesion was evident near the right edge of the sternum (Fig. 1). Electrocardiographic (ECG) results were normal, as were cardiac enzyme levels. Chest radiographs revealed a metallic foreign body over the cardiac silhouette (Fig. 2). Transthoracic echocardiography (TTE) showed a hyperechoic fixed mass (1.5 cm) between the interventricular septum and the posterior-inferior left ventricular wall (Fig. 3). Mild pericardial effusion was present. Although very near the mass, the mitral valve apparatus appeared neither damaged nor functionally altered, and no segmental wall-motion abnormalities were seen. On contrast-enhanced computed tomography (CT), the fragment seen was near the apex (Fig. 4A); on volume-rendered 3-dimensional reconstruction, it appeared to be almost completely embedded within the left ventricular wall (Fig. 4B). Because the patient was clinically and hemodynamically stable, he did not undergo urgent surgery; he was admitted for follow-up. Blood cultures were obtained, and therapy with broad-spectrum antibiotics was started. At the 6-month follow-up examination, the patient was asymptomatic. The Holter ECG was unremarkable, without any arrhythmic event during the 24-hour recording. The TTE and CT scans were substantially unchanged; the foreign body lay in the same position.