An asymptomatic patient with a pellet within the myocardium.

Penetrating injuries to the myocardium are rare but potentially lethal. We present a 22-year-old asymptomatic male patient with a pellet lodged in the myocardium as a result of a gunshot that took place three years before. His medical history was otherwise unremarkable. The chest X-ray showed multiple pellets within the thorax. Computed tomography of the chest demonstrated many pellets in the anterior chest wall, while a few lodging within the lung tissue and one within the myocardium. Transthoracic echocardiography showed a pellet within the left ventricular myocardium presenting as an acoustic shadowing. Thickening of the adjacent pericardium was also noted. There were no signs of constrictive pericarditis or regional wall motion abnormality. Holter monitoring and treadmill exercise test did not show any abnormal finding. The patient was included in a periodic follow-up program.