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The heart of the matter: Ventricular laceration
Case presentation
A 12-year-old male presents with an injury to the chest. Apparently, he was “playing” with a nail gun and it went off, causing a nail to enter his chest. The child’s vital signs show an afebrile patient, who looks apprehensive, pale, and diaphoretic. His heart rate is 112 beats per minute, respiratory rate is 22 breaths per minute, blood pressure is 112/62 mm Hg, and pulse oximetry reading is 95% on room air. He has what appears to be a wound to his right chest, just lateral to the sternum at the nipple line, without active bleeding. His breath sounds are equal. He does not have any other injuries.
Imaging considerations
Pediatric penetrating chest trauma accounts for up to 8% of pediatric trauma cases. The majority of cases are seen in adolescent populations. Associated injuries include pneumothorax, hemothorax, cardiac, and great vessel injuries. When penetrating injury to the heart occurs, the right ventricle is more commonly involved and associated cardiac tamponade is often present. , Nail gun injuries in the pediatric population are uncommon. For a complete discussion on pediatric thoracic trauma, see Chapter 47 (Chest Pains: Pediatric Chest Trauma).
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