Q J Med 2014; 107:589 doi:10.1093/qjmed/hct237
Advance Access Publication 25 November 2013
Clinical picture Nail gun attempted suicide and traumatic ventricular perforations A 57-year-old male walked into the emergency department within 24 h of shooting himself with a nail gun as a suicide attempt. He was hemodynamically stable and reported chest pain. Although initial portable anteroposterior chest radiograph revealed three linear metallic densities projecting over the cardiac silhouette, a lateral chest radiograph (Figure 1) clearly identified three nails located in the left ventricular region. A median sternotomy was performed, and intraoperatively it was discovered that two nails had passed through the left ventricle and perforated the free wall on the diaphragmatic surface whereas the third nail had passed through the septum causing a traumatic ventricular septal defect. The nails were removed and the left ventricular perforations and traumatic septal defect were closed. The patient had an uneventful postoperative course and was transferred to an inpatient psychiatric unit once medically stable. Photographs and text from: B.C. Prokesch, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; J.E. Mangino, The Ohio State University Wexner Medical Center, 410 West 10th Ave., N-1150 Doan Hall, Columbus, OH 43210, USA. email:
[email protected]
Figure 1. Lateral chest radiograph showing three nails and three external electrocardiogram leads.
Conflict of interest: None declared.
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