TY - JOUR T1 - Self-induced pneumatically powered nail removed from the mediastinum without opening the chest JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000797 VL - 6 IS - 1 SP - e000797 AU - Raisa Bushra AU - Mohamed Osman AU - Muhammad Rafiq AU - Luigia D'Errico AU - Kiran Salaunkey AU - Choo Ng Y1 - 2021/09/01 UR - http://tsaco.bmj.com/content/6/1/e000797.abstract N2 - A patient in his 50s shot himself with a nail gun presented to our center for further management after initial resuscitation in district general hospital. An echocardiogram report demonstrated mild pericardial effusion; he was hemodynamically stable at the time of admission. An urgent chest CT scan was performed which showed a nail in the left hemithorax between the fourth and fifth intercostal space anteriorly medial to the nipple, and the tip of the nail appeared to be in the pericardial space, next to the right ventricular outflow tract and left basal anterior wall without sign of perforation (figure 1 A,B). The pericardium was mildly thickened at the site of the nail entry and a small pericardial effusion of approximately 8 mm. There was no sign of vascular or cardiac structure perforation neither contrast leak. In addition, there was a small left pleural effusion which suggested a possible hemorrhagic component; a small amount of air was noted in the left pectoral muscle with no fractured bone.Figure 1 A and B, The CT scan showed a nail in the left hemithorax between the fourth and fifth intercostal space medial to the nipple, and the tip of the nail appeared to be in the pericardial space.1. Explore the chest with median … ER -