A needle in the heart dr crockett is visited by two new orleans detectives who have questions about his past dr choi puts his life in danger to save a child dr charles gives fatherly advice to his young daughter. A note a strong echo reflecting structure sewing needle visible inside the left ventricle arrow b systole note oval shaped soft tissue echo structure thrombus located on the tip of the anterior mitral valve leaflet c diastole anterior mitral valve leaflet is resting on the tip of the needle resulting in fresh thrombus formation. Case 1 an intracardiac needle was first discovered in a 49 year old woman undergoing a radiologic examination of her stomach we saw her 8 years later and found no organic heart disease the needle was located in the apex of the left ventricle as evidenced by a chest x ray film fig 1 an echocardiogram and a computed tomographic scan. Needles embedded in the pericardium and myocardium have been previously described using other imaging modalities 6 8 needle embolization has been reported in intravenous drug users 9 and acupuncture patients 10 the presence of a needle shaped fb in the heart may result from either a direct injury or embolization from distal penetration 11
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