While there are reports of nonprojectile cardiac and intracardiac foreign bodies in the veterinary literature, there is no standard for managing projectile metallic cardiac foreign bodies. The most consistent recommendation in human literature is to remove them; accurate localization of the foreign body is essential, yet no single imaging technique has been consistently accurate in doing so.
A 5-month-old Brittany spaniel originally presented for a puncture wound at the point of the shoulder. Radiographs showed a metallic projectile foreign body overlaying the cardiac silhouette. Heart and lung sounds were normal and the dog was treated with a 7-day course of amoxicillin. At 3.5 years of age, the dog presented with a 10-day history of decreased activity and appetite. Muffled heart sounds and irregular heart rhythm with weak and intermittently dropped pulses were noted. Pericardial effusion was detected by echocardiography and ascites identified by abdominal ultrasound. Radiographs indicated that the foreign body appeared to have moved. A pericardiectomy was performed, but the foreign body was not recovered; 6 months later, the dog remained asymptomatic. In a similar case, a dog developed secondary pericarditis 3 years after being shot with a shotgun. These cases suggest that, as in humans, nonsurgical management of pericardial projectile metallic foreign bodies may lead to complications that can be acute, severe, and at prolonged intervals from the original injury.
This report highlights several issues, including the lack of information on managing foreign bodies available in veterinary literature. Given that paucity of information, the authors provided a comprehensive review of the human guidelines for managing intracardiac foreign bodies and the reasonable strategy of using human medicine for guidance on a case-by-case basis. Because no single imaging modality has consistently or accurately located these foreign bodies, however, diagnostic workup will likely involve multimodal imaging techniques.—Sarah Gray, DVM, DACVECC
Diagnostic challenges and treatment options of a suspected pericardial metallic projectile foreign body in a dog. Elliott JM, Mayhew PD. JVECC 21:684-691, 2011.
This capsule is part of the One Health Initiative