PMC4389472_01
A: Fragment lodged in the heart shadow (arrow). B: Myocardial thinning in the
ventricular apex (asterisk). C: Trajectory of the fragment, note the possible
points of entry and exit in the ventricle. D: Three-dimensional reconstruction of
the trajectory and the fragment
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Chest radiography showed a solid fragment lodged in the heart projection (Figure 1A), and computed tomography showed possible heart damage due to myocardial tapering in ventricular apex (Figure 1B) and presence of a small volume pneumoperitoneum. According to computed tomography images and reconstruction of the trajectory, the shrapnel transfixed the ventricular apex and lodged itself in the lower lobe of the left lung (Figure 1C and D).
A: Possible fibrous formation in the site of wound repair is seen (asterisk). B:
Threedimensional view of the chest and heart. C and D: pledgets used in wound
repair in the myocardial apex (arrows)
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At follow-up, routine exams showed no changes: echocardiography with preserved ventricular function, normal left ventricular segmental contractility, heart valves with good opening and mobility, atrial and ventricular septal integrity, and an ejection fraction of 66%; ergometric test without evidence of ischemia; and chest CT angiography with only remnants of a repaired myocardial injury (Figure 2).