A Sewing Needle in the Right Ventricle

A 62-year-old woman with a history of hypertension and major depression was admitted complaining of mild, oppressive chest pain, which had begun 2 weeks earlier. The chest pain started after she attempted to commit suicide by stabbing herself in the precordium with a sewing needle. Risk factors for coronary artery disease included heavy tobacco use and hyperlipidemia.

The electrocardiogram showed sinus rhythm with nonspecific ST-T segment abnormalities. The chest radiograph revealed a foreign body in the right ventricle, and an echocardiogram showed a highly echogenic needle-like image between the septum and the free wall of the right ventricle.

Transvenous removal of the foreign object under fluoroscopic guidance was unsuccessful, and the patient was referred for left heart catheterization in anticipation of open heart surgery. Cardiac catheterization revealed normal coronary arteries and left ventricular hypertrophy. An unusual image of a needle inside the right ventricle was seen on biplane left ventricular angiography (Figs. 1 and 2).

Fig. 1 Right anterior oblique view of the left ventricular angiogram, showing a sewing needle in the right ventricle.

Fig. 2 Left anterior oblique view of the left ventricular angiogram, showing a sewing needle in the right ventricle.

Subsequently, a thoracotomy was performed, and a sewing needle was successfully retrieved from the right ventricle by expression. A small, hemorrhagic pericardial effusion was present at the time of surgery. The patient's course was uncomplicated, and she was transferred to a psychiatric hospital on the 5th postoperative day.