Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report

Rik De Decker; Yifan Joshua Li; Dirk von Delft; Heidi Meyer; Alfred Mureko

doi:10.1093/ehjcr/ytz106

Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report

Eur Heart J Case Rep. 2019 Jul 6;3(3):ytz106. doi: 10.1093/ehjcr/ytz106. eCollection 2019 Sep.

Authors

Rik De Decker¹, Yifan Joshua Li¹, Dirk von Delft², Heidi Meyer³, Alfred Mureko⁴

Affiliations

¹ Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, South Africa.
² Division of Paediatric Surgery, Department of Paediatrics and Child Health, University of Cape Town, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, South Africa.
³ Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory, Cape Town, South Africa.
⁴ Division of Cardiothoracic Surgery, Department of Surgery, University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory, Cape Town, South Africa.

Abstract

Background: Paediatric penetrating cardiac injury is extremely rare, precluding published management guidelines, therefore warranting a case-by-case approach with learning points gleaned from each case.

Case summary: A 7-year-old boy presented to a rural hospital with a stab wound to the chest by a Withaak (Vachellia tortilis) thorn. The patient was haemodynamically stable on presentation, but a 2 cm subcutaneous, pulsatile mass was present at the cardiac apex. Echocardiography revealed a foreign body penetrating from the apex into the heart, with evidence for a fistula between a cardiac chamber and the pulsatile mass. Angiography confirmed the existence of the fistula between the right ventricle (RV) and the pulsatile mass. A controlled extraction under general anaesthaesia via median sternotomy was performed in-theatre, with blood products and cardiac bypass on standby. The patient recovered without complications and was discharged after 4 days.

Discussion: Our case illustrates the limitations of echocardiography in identifying the precise anatomical definition of penetrating cardiac injuries. Angiography is therefore indicated in such cases. The injury to the RV and the haemostatic effects of the in situ thorn were favourable prognostic factors. We believe that the mortality risk reduction of extraction under full control warrants the minor morbidity of a median sternotomy.

Keywords: Angiography; Case report; Echocardiography; Median sternotomy; Paediatrics; Penetrating cardiac injury.

Publication types

Case Reports