A case report of an unusual left atrial mass

Abstract

Background Cardiac foreign bodies (FBs) are rare findings that may present as cardiac masses initially. Here, we present an exceptional and rare case of a hypodermic needle FB that transmigrated to the left atrium and presented as a left atrial mass. Case summary A 28-year-old woman with multiple psychiatric disorders including intentional FB ingestion and self-inflicting injuries presented to the emergency room with abdominal pain, nausea, vomiting, diarrhoea, and chest pain that radiated to the left arm and face for 2 weeks. An echocardiogram was performed revealing a left atrial mass concerning for myxoma. During the surgical removal of the mass, a hypodermic needle was found attached to the roof of the left atrium surrounded by thrombotic and fibrotic tissue, which was confirmed by pathology. Discussion Cardiac FBs are caused generally by penetrating wounds from direct trauma. Fewer cases have been reported regarding cardiac FB caused by ingestion from migration of the object to the heart. Signs and symptoms for cardiac FB may mimic those of cardiac masses. Cardiac FBs often require surgical intervention to avoid complications.

Management of an accidental penetrating cardiac injury in a 4-year-old girl

“…Penetrating cardiac injuries can also occur as a result of intentional penetration or accidental direct penetration of foreign bodies into the heart [ 6 ]. The main pathophysiological determinant for most survivors is acute pericardial tamponade, which can lead to shock and hemodynamic instability [ 3 ].…”

“…Penetrating cardiac injuries are severe and life-threatening conditions that require prompt diagnosis and management [ 3 ]. These injuries can result from both blunt and penetrating trauma, such as stab wounds, gunshot wounds, or foreign body penetration [ 4 , 5 , 6 ]. The prognosis for penetrating cardiac injuries is generally poor, with high mortality rates reported in the literature [ 7 , 8 ].…”

Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines

“…Perforation, extraluminal migration, abscess, peritonitis, fistula, appendicitis, necrotizing fasciitis, liver, bladder, heart, and lung penetration, incarcerated umbilical hernia, common carotid artery rupture, aortoesophageal fistula, and death can result from the ingestion of pins, sewing needles, and safety pins, nails, screws, toothpicks, and bone [ 37 38 39 40 41 42 43 44 45 46 47 48 49 ]. The average transit time of an object in children is 3.6 days, while the average perforation time is 10.4 days [ 1 2 ].…”