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Pre-participation sports examination (PPE) is a frequent reason for consultation. However, the exact role of cardiovascular magnetic resonance (CMR) in PPE remains undefined. The additive value of CMR in adolescent athletes with ventricular rhythm disturbances (VRDs) was investigated. We prospectively recruited and evaluated with CMR 50 consecutive, asymptomatic young athletes referred to our tertiary center after identification of VRDs on electrocardiogram (ECG) with otherwise normal standard PPE and echocardiography, and 20 age-and sex-matched healthy volunteer athletes who underwent the same evaluations. The primary outcome was case-control status and the secondary outcome was the discrimination between athletes with VRDs with and without non-sustained ventricular tachycardia (VT). CMR identified arrhythmogenic substrates in all athletes with VRDs. The predominant condition was myocarditis and arrhythmogenic right ventricular cardiomyopathy in patients with and without VT, respectively. Based on penalized regression analysis, late gadolinium enhancement (LGE), early gadolinium enhancement (EGE), extracellular volume fraction (ECV), and T2-mapping, best distinguished between case-control status. The aforementioned indices predicted case-control status independent of age and sex: EGE [Odds ratio (95% confidence interval): 6.89 (2.19-21.62) per 0.5-unit, P<0.001], LGE (perfect prediction), ECV [1.66 (1.25-2.22), P<0.001] and T2 mapping [1.40 (1.13-1.72), P=0.002], among other independent CMR-derived predictors. Only indexed ventricular volumes independently discriminated between VRD patients with and without VT. In this study, asymptomatic young athletes with VRDs and normal PPE/echocardiography were optimally discriminated from healthy control athletes by CMR-derived indices, and CMR allowed for the identification of arrhythmogenic substrates in all cases.

A 3-year-old boy was admitted in our department from another hospital with loss of consciousness and with the diagnosis of "pericardial effusion-cardiac tamponade." The boy had a history of chest injury before 1 week while playing by falling over a short palm tree (Yucca elephantipes). His trauma was dealt by his mother with a local antiseptic and was forgotten thereafter.At his admission, there were no obvious signs of external thoracic trauma, and the submission echo did not describe the pin, which was considered as an artifact (Fig. 1). This misinterpretation resulted in recurrent episodes of tamponade, which were initially treated by relieving pericardiocenteses and transfusion of autologous red blood cells. Finally, the lack of diagnosis led the patient to the operating room.During operation, a 3.4-cm long leaf pin was found to penetrate the thoracic wall causing injury of the right atrium ( Figs. 2 and 3). The pin was removed, and the atrium was closed with a single suture without using cardiopulmonary bypass. The boy recovered uneventfully, and 2 years later, he is free of symptoms.Foreign bodies reach the heart either directly through chest wall penetration, by migration from adjacent tissues, or through the blood stream from remote anatomic areas. They either remain asymptomatic or get complicated by hemorrhage, cardiac tamponade, peripheral embolization, arrhythmias, valve incompetence, endocarditis, and heart failure. A majority of posttraumatic foreign bodies in the heart are commonly high-velocity penetrating metallic objects, such as bullets, but few consist of other material such as wood or glass that are characteristically sharp ended.To the best of our knowledge, no similar cases have been described in the literature.

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