Flechette Wounds of the Heart: Clinical Manifestations, Diagnostics, and Surgical Treatment

Abstract

Each case of fragment injury to the heart is unique and requires careful diagnosis and surgical intervention. In some cases, the diagnosis of fragment injury to the heart and mediastinum is delayed. This is due to the fact that some penetrating and non-penetrating injuries to the heart may go unnoticed, due to the poor clinical presentation and the absence of significant damage to the chest, which may not be noticed on examination.

The aim. To present a case of a flechette wound of the heart and to explore the peculiarities of clinical manifestations, diagnostic findings of instrumental tests, and surgical treatment methods.

Material and methods. The article provides an analysis of methods of diagnosis and surgical treatment of a patient diagnosed with mine-explosive fragment penetrating wound of the chest with the presence of a foreign body (flechette) in the heart. In addition to the medical history, such research methods as computed tomography, X-ray examination, echo-cardiography, as well as laboratory tests were used for the diagnosis. Median sternotomy was used to perform the opera-tion to remove the fragment. The operation was performed on the fibrillation heart with the cardiopulmonary bypass.

Results. Due to the absence of a pronounced pain syndrome, significant damage of the skin, and signs of intense bleeding as a result of an explosive injury, doctors did not suspect a heart injury. Discomfort and tingling sensation in the area of the apex of the heart required computed tomography of the chest. As a result, an oblong metallic fragment was found in the wall of the right ventricle of the heart. Surgical treatment with the cardiopulmonary bypass enabled to remove the fragment, which turned out to be a flechette.

Conclusions. The external signs of a mine-explosive injury may not always correspond to the danger to the human body that may be caused by modern damaging agents. Only a carefully collected medical history, alertness of medical staff and proper use of radiological investigative methods can promptly identify the consequences of a mine-explosive damage, including the detection of potentially dangerous fragment locations, and provide the necessary medical assistance to the injured soldier.