Can a foreign body migrate against natural body barriers?

Abstract

Pericardial foreign bodies (FBs) are a rare cause of chest pain in children. They can reach the pericardium through several routes including direct or iatrogenic implantation, transbronchial or transesophageal migration of inhaled or swallowed FBs. We reported a case of a 4-year-old girl presenting with persistent chest pain for 1 month. The child described the pain as ‘stitching’ in nature localized on the left side of the sternum. The child presented with increased pain intensity and a new onset of fever and cough. No history of chocking or swallowing of FB and no signs of trauma or child abuse were noted. Chest radiography revealed a needle in the left side of the chest. Computed tomography scan and echocardiography were used to precisely localize the needle and exclude intracardiac extension. ECG showed elevated ST segment and cardiac enzymes were normal. Removal of the needle was carried out surgically under fluoroscopic guidance. A small portion of the needle was found intrapericardially complicated by localized purulent pericarditis. The child had uneventful recovery and was discharged from the hospital on postoperative day 3.

Keywords: foreign bodies, pain, pediatrics, pericardium, thoracic surgery