Delayed Pericardial Tamponade after Nail Gun Injury to the Right Ventricle

The use of nail guns has been expanded since 1950s, as it requires a minimum training. Nail guns can fire projectiles at a rapid speed for a distance up to 500 meters. Cardiac nail gun injuries are rare but life-threatening. Most of the cases presented within few minutes after injury and associated with hemodynamic compromise and some degree of pericardial tamponade. We describe a case of 19-years-old carpenter presented 15 hours after nail gun injury without hemohynamic compromise. Chest CT detected penetration of the nail tip in the pericardium with pericardial effusion. The hemodynamic status deteriorated during diagnostic workup. The bedside echocardiography revealed tamponading pericardial effusion. Through the left anterior thoracotomy, intrapericardial hematoma was removed, the nail was successfully extracted, and a laceration in the right ventricle was repaired. The postoperative course was uneventful. In conclusion, nail gun should be considered as one of the essential causes of penetrating cardiac injury. High index of suspicion and appropriate imaging studies result in successful management of hemodynamically stable patients. An aggressive approach without time consuming investigations is preferred for unstable patients after penetrating cardiac injury.