Surgical management of a penetrating cardiac foreign body causing tamponade in a dog: case report

BACKGROUND: Penetrating cardiac foreign bodies are rare in dogs but can result in life-threatening complications, including pericardial effusion and cardiac tamponade. Prompt diagnosis, emergency stabilization, and definitive surgical management are essential to achieve a favorable outcome. CASE REPORT: An 8-year-old spayed female mixed-breed dog weighing 11.3 kg was presented for evaluation of lethargy. The owner suspected that a foreign body had become lodged in the left lateral thoracic wall approximately 24 h earlier. Thoracic radiographs identified a metallic foreign body within the fourth left intercostal space, directed toward the cardiac silhouette. Shortly after radiographic examination, the dog developed acute dyspnea, oral mucosal cyanosis, jugular venous distension, weak femoral pulses, and muffled heart sounds. Echocardiography revealed pericardial effusion causing cardiac tamponade and a hyperechoic structure consistent with a foreign body perforating the pericardium and left ventricular free wall. Emergency pericardiocentesis resulted in rapid clinical improvement. Computed tomography performed for surgical planning confirmed a metallic foreign body embedded approximately 3.1 cm within the left ventricular free wall, with its tip directed toward the left atrium. A left lateral thoracotomy followed by subphrenic pericardiectomy was performed, and the foreign body, identified as a 4.8-cm sewing needle, was successfully removed. At 9-day follow-up, the dog was clinically normal with an uncomplicated surgical wound and no radiographic evidence of pleural effusion or pulmonary abnormalities. Electrocardiography demonstrated persistent right bundle branch block and axis deviation. CONCLUSIONS: This case demonstrates that penetrating cardiac foreign bodies should be considered in dogs presenting with thoracic penetrating injuries and acute cardiovascular compromise. Echocardiography is invaluable for rapid diagnosis of cardiac tamponade, while computed tomography facilitates surgical planning. Emergency pericardiocentesis can be life-saving, and prompt surgical removal of the foreign body may result in an excellent short-term clinical outcome despite persistent postoperative conduction abnormalities.