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Sewing needle: a rare cause of intra-cardiac foreign body in a 3-year-old child

Published online by Cambridge University Press:  20 June 2016

Sandeep Choudhary ,
Suresh Pujar Venkateshacharya  and
Chinnaswamy Reddy
Sandeep Choudhary*
Affiliation:
Department of Pediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
Suresh Pujar Venkateshacharya
Affiliation:
Department of Pediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
Chinnaswamy Reddy
Affiliation:
Department of Pediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
*
Correspondence to: Dr S. Choudhary, Department of Pediatric Cardiology, Narayana Institute of Cardiac Sciences, 258/A, Bommasandra Industrial Area, Anekal Taluk, Bengaluru 560099, Karnataka, India. Tel: 941 441 6405; Fax: 080-27835222; E-mail: sandeepbugasara@gmail.com
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Abstract

Sewing needles are rare causes of penetrating cardiac injury. Suicidal attempt, accidental penetration, domestic violence, and child abuse are likely causes for such injury.1 Owing to their sharp nature, needles can rapidly migrate through the tissues. Fatalities are due to cardiac tamponade, infection, peripheral embolism, and valve dysfunction.

Keywords

Sewing needleintra-cardiac foreign bodychild abuse

Information

Type
Images in Congenital Cardiac Disease
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1425 - 1427
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Copyright
© Cambridge University Press 2016 

Case report

A 3-year-old boy presented to our institution after a foreign body was detected on his chest X-ray while being evaluated for cough. He was asymptomatic at admission with no visible scar marks on his chest or back. He had normal heart sounds and a grade 2–3/6 parasternal pan systolic murmur, suggestive of tricuspid regurgitation. The rest of his examination was unremarkable except for hepatomegaly.

His chest radiographs revealed three sewing needles in the chest cavity (Fig 1a and b); two-dimensional echocardiography and chest CT scan showed a hyper-refractile linear structure in the right heart across the tricuspid valve (Figs 2a and b) and two needles in the left lung. The patient underwent open-heart surgery, and all three needles were removed (Figs 3a and b). The anterior tricuspid leaflet, which was torn into two halves, was repaired, and a posterior tricuspid Doty’s annuloplasty was performed. Postoperatively, the patient developed subglottic stenosis causing stridor, which was relieved by anterior costal cartilage graft laryngotracheal reconstruction surgery. The patient was discharged in stable condition.

Figure 1

( a and b ) Chest radiograph – lateral and postero-anterior view – showing multiple sewing needles in the lung and cardiac silhouette.

Figure 2

( a ) Two-dimensional echocardiography, apical four-chamber view, showing a hyper-refractile structure traversing from the right atrium (RA) to the right ventricle (RV). ( b ) CT scan of the chest showing the needle lying across the RA and the RV.

Figure 3

( a ) Intra-operative picture showing a sewing needle in heart traversing from the right atrium to the right ventricle cavity. ( b ) Showing all three sewing needles removed from the patient’s chest.

In children, injuries caused by sewing needles usually occur accidentally except for some self-inflicted injuries caused by depressive behaviours or suicide attempts. Child abuse issues should be investigated in all such injury cases. In this case, the cause and timing of insertion of the needles into the chest cavity remain unknown. The possibility of child abuse or witchcraft rituals cannot be ruled out.

Acknowledgement

The authors acknowledge Dr Rahul Prakash Saraf for his help in evaluating the patient.

Financial Support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflicts of Interest

None.

References

1. Dong, X, Zhi, B, Li, W, Cui, Y, Chen, Z, Wang, P. Surgical removal of an intracrdiac sewing needle in 13 month old Chinese girl: report of a case. Int Surg 2015; 100: 510–513.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1 (a and b) Chest radiograph – lateral and postero-anterior view – showing multiple sewing needles in the lung and cardiac silhouette.

Figure 1

Figure 2 (a) Two-dimensional echocardiography, apical four-chamber view, showing a hyper-refractile structure traversing from the right atrium (RA) to the right ventricle (RV). (b) CT scan of the chest showing the needle lying across the RA and the RV.

Figure 2

Figure 3 (a) Intra-operative picture showing a sewing needle in heart traversing from the right atrium to the right ventricle cavity. (b) Showing all three sewing needles removed from the patient’s chest.