Swallowed needle leads to serious heart damage—persistent care saves the day
Accidentally swallowing a sewing needle could have cost one 54-year-old patient his life. His care team was persistent, however, exploring his unexplained symptoms until they identified the problem.
Researchers detailed the unusual case in JACC: Case Reports, an American College of Cardiology journal.
The patient in question was experiencing severe chest pain with several additional symptoms, including hypotension and an elevated heartbeat. He was a heavy smoker, but had no history of heart disease. When he first arrived, he gave no indication that he may have swallowed something out of the ordinary.
The patient underwent a cardiac catheterization at first, but clinicians were unable to explain his symptoms. A CT scan was much more helpful, showing signs of pericardial effusion and helping clinicians see the needle.
“The foreign body was seen extending from the left hepatic parenchyma through the diaphragm toward the right ventricular region and was considered a likely cause of the pericardial effusion,” wrote first author M. Abdullah Shafiq, a researcher with the University of Saskatchewan, and colleagues. “Additional findings included patchy consolidation in the right lower lobe with a small right basal effusion, trace ascites, and imaging features concerning for acalculous cholecystitis, including gallbladder wall thickening and pericholecystic fluid on ultrasound.”
Cardiothoracic and general surgeons worked together to form a treatment strategy. They agreed to perform a subxiphoid pericardial window to drain excess fluid and then surgically remove the needle with a hemostat. The patient was discharged within a week and has now recovered.
Multimodality imaging to the rescue
Shafiq et al. noted that multimodality imaging played a critical role in this case. Looking back at the images captured during that early cardiac catheterization, the group retrospectively realized the needle was visible. Initially, however, it was missed completely. It was not until a CT scan that the cause of the patient’s symptoms were confirmed.
Also, how did a 54-year-old man swallow a sewing needle? The care team later learned that he was a tailor who had a habit of keeping needles in his mouth as he worked. He did not mention any of this when he first presented for care.
“The patient initially denied trauma or penetrating injury; however, after stabilization, he recalled a habit of holding sewing needles in his mouth while working,” the authors explained. “This information provided a plausible explanation for accidental ingestion and subsequent migration of the needle. Such occupational exposures may be overlooked during the initial assessment but can provide critical diagnostic insight in unusual clinical presentations.”
Click here to read more in JACC: Case Reports.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.