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A 22-year-old male presented following a precordial stab. He was haemodynamically and metabolically normal. Initial investigations did not reveal pericardial fluid or haemothorax. At diagnostic laparoscopy, we encountered haemoperi-toneum and a diaphragmatic injury through which the heart was visible. After pericardial washout, laparoscopic repair was effected. This case highlights a potential problem with extended focused assessment with sonography in trauma (eFAST) in that it will only be positive if there is an accumulation of pericardial fluid. It also confirms the utility of diagnostic laparoscopy for penetrating left thoracoabdominal injuries and shows that principles of open surgery can be safely applied laparoscopically in select patients.

Penetrating cardiac injuries carry a grave prognosis. We present a rare case of thoracic gunshot injury where the bullet ricocheted and lodged in the pericardium without causing damage to the adjacent cardiac structures. Multimodality imaging helped in localizing the bullet, assessing damage, and planning safe surgical removal without cardiopulmonary bypass. (Level of Difficulty: Beginner.), Graphical abstract

Highlights • Air guns use compress air to cause bullet acceleration and can cause serious injury. • Cardiac injuries from air guns are rare, but can lead to cardiac tamponade/death. • Published cases of cardiac injuries from air guns most commonly occur in children., Introduction Traditionally promoted as “toy guns,” air guns have long been used by children and lack many regulatory guidelines compared to conventional firearms. However these weapons possess serious lethal potential and have led to numerous injuries and deaths. Presentation of case We describe a 21 year old man who sustained a penetrating cardiac wound from a pellet gun that led to cardiac tamponade and death. Post-mortem examination showed the pellet had penetrated the left ventricle and anterior esophagus with subsequent intraluminal migration into the stomach. Discussion Review of the literature identified 39 other cases of penetrating cardiac injuries from air guns. Sternotomy was the most frequently used surgical approach and the right and left ventricles were the most commonly affected chambers. Bullet embolization was the most frequently reported complication. Including our case, five deaths related to penetrating cardiac injury from air guns were identified. Conclusions This report highlights the seriousness of air guns and demonstrates a unique intra-thoracic injury.

Aim: Penetrating cardiac injuries (PCI) are mostly caused by sharp objects and comprise pericardial and myocardial deformation, which lead to myocardial dysfunction. Fifty percent of overall mortality in penetrating chest injuries are caused by PCIs. The aim of this study is to evaluate the results of patients who underwent cardiac surgery due to PCIs. Methods: In this retrospective cohort study, twenty-seven cases undergoing cardiac surgery due to PCI in Van Yuzuncu Yil University Hospital, Yozgat City Hospital and Bozok University Hospital between 2012 and 2019 were evaluated in terms of clinical findings, treatment methods and surgical techniques. Results: There were 3 females and 24 males. The mean age was 34.2 (13.2) years (range: 14-65 years) years. Firearms caused two and penetrating stab wounds caused twenty-five injuries, respectively. The patients were transported to the hospital within a mean time of 29.7 (14.6) minutes (range: 15-98 minutes). 29 injuries were observed in 27 patients, 18 (62.06%) of which were isolated cardiac injuries, and 11 (37.94%) were mixed type. Fourteen patients (51.8%) were operated following a transthoracic echocardiography, 12 patients (44.5%) due to clinical findings and one patient (3.7%) due to the contrast-enhanced thoracic computed tomography (TCT) result. The mean pericardial blood volume was 290 mL (range 140-460 mL) in patients with a cardiac tamponade. The most frequently injured cardiac section was the right ventricle, followed by the left ventricle. Coronary artery injuries were observed in two patients. Overall mortality rate was 44%. Conclusion: Early diagnosis, fast and safe transport, providing qualified surgical equipment, and a multidisciplinary approach are mandatory to decrease mortality and morbidity rates. It is also crucially important to prevent individual armament in preventing penetrating cardiac surgery cases.

Cardiac impalement is a rare and usually fatal injury. Immediate recognition and surgical intervention are decisive factors for patient survival. This is a reported case of cardiac impalement with left ventricular transfixation, whose prehospital management, surgical treatment and postoperative care were successful.

Identifying penetrating cardiac injury in hemodynamically stable patients can be challenging especially when the patient has no signs of cardiac tamponade and no pericardial effusion identified on transthoracic echocardiography. In this case report, we discuss both penetrating cardiac injuries diagnosis algorithm and treatment strategies. At present, it is difficult to refer to general guidelines transposable from one center to another. We report the paramount importance of multidisciplinary management with experienced teams to face any possible pitfalls in traumatology especially in the context of penetrating cardiac injury.