Cardiogenic Shock Following Sewing Needle Aspiration.

BACKGROUND

Intracardiac foreign bodies are rare but may cause life-threatening complications, including cardiac tamponade and cardiogenic shock.

CASE SUMMARY: A 54-year-old man presented with acute chest pain, hypotension, and sinus tachycardia concerning for cardiogenic shock. Coronary angiography was normal. Computed tomography angiography performed for suspected pulmonary embolism revealed a moderate pericardial effusion and a linear metallic foreign body extending from the left hepatic lobe through the diaphragm into the pericardium with right ventricular penetration. The patient underwent urgent subxiphoid pericardial window with relief of tamponade followed by exploratory laparotomy and removal of a sewing needle. He later recalled accidental ingestion. He recovered fully and was discharged on postoperative day 6.

DISCUSSION: This unusual case highlights the need to consider foreign body injury in unexplained tamponade and to use multimodality imaging for diagnosis.

TAKE-HOME MESSAGE: Atypical presentation without prior medical conditions should prompt a thorough social history.