Videothoracoscopic approach to the extraction of a cardiac retainer missile.

The presence of foreign bodies (FB) retained in the heart or pericardium secondary to penetrating trauma in stable patients is a very rare event and its management is controversial. We present the case of a 19-year-old patient who was admitted to our trauma center hemodynamically stable because of two gunshot wounds in the lumbar region. A chest x-ray (CXR) revealed a blurred foreign body over the right heart chamber, thoracoabdominal computed tomography (CT) scan showed a free projectile over the left atrial wall, and transesophageal echocardiogram (TEE) showed a hyperrefringent pericardial sac image near the right ventricle. Finally, the patient went to surgery where a missile was removed from the pericardial sac by video-assisted thoracoscopic surgery (VATS).