Self-inflicted thoracoabdominal nail-gun injury presenting as STEMI: diagnostic challenges in a time-critical care pathway

Figures

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  Figure 1. Fluoroscopic images in composite from coronary angiography demonstrating radiopaque nails overlying the cardiac silhouette.

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  Figure 2. Sequential chest radiographs both obtained post-angiography; (a) mobile supine chest radiograph obtained to evaluate for acute pulmonary oedema; a partially imaged radiopaque foreign body is present at the film periphery; (b) mobile supine chest radiograph to confirm central line placement demonstrating multiple radiopaque foreign bodies projecting over the lower thorax and upper abdomen.

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  Figure 3. Composite CT imaging (axial, coronal, and sagittal reconstructions) demonstrating nail-gun projectiles penetrating the inferior left ventricle with trajectories extending towards the stomach; associated findings included haemopericardium, left haemopneumothorax, haemoperitoneum, and bilateral pulmonary consolidation.

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  Figure 4. Four puncture wounds located within the cardiac box; triangle and circle mark level of xiphisternum and left nipple.

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  Figure 5. Three nails retrieved at sternotomy from the pericardium and heart; a fourth nail (not pictured) was retrieved separately at laparotomy.

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  Figure 6. Completed pledgeted repair of left ventricular injuries using 3–0 Prolene sutures.