Nail Gunshot Induced Hemopericardium, Detected by Point-of-care Ultrasound (POCUS) in the Emergency Department

Penetrating injuries to the heart often lead to pericardial effusion (PCE) that may result in cardiac tamponade which can be rapidly fatal. Thus, early detection of PCE is extremely important in initial resuscitation. A 37-year-old man without any past medical illness was sent to our emergency department by ambulance due to left chest wall penetrating injury by nail gun 30 minutes ago. Upon presentation, the patient was agitated and diaphoretic. The penetration site was in the region of cardiac box, which raised awareness that possible heart injury has been inflicted. Point-of-care ultrasound (POCUS) was used immediately to screen for PCE which was present. In addition, POCUS revealed a hyper-echoic point in the left ventricle (LV) which we speculate is the foreign body (FB). Non-contrast computed tomography confirmed the presence of PCE and FB in the LV. The patient received emergent blood transfusion and was immediately transferred to a level-1 trauma center where removal of FB and cardiorrhaphy of LV apex was performed. He was discharged one week later under stable condition. Take home Message: The presence of hemopericardium in penetrating thoracic trauma may cause life threatening injuries such as cardiac tamponade which warrants immediate intervention. POCUS is a reliable, repeatable, and readily available tool at bedside for detecting PCE in penetrating thoracic trauma patients. Given its high sensitivity and specificity, POCUS should be used as the initial screening tool for the presence of PCE in all thoracic penetrating trauma patients.