Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 21, 2007; 13(31): 4278-4281
Published online Aug 21, 2007. doi: 10.3748/wjg.v13.i31.4278
Correct diagnosis and successful treatment for pericardial effusion due to toothpick injury: A case report and literature review
Yu-Yin Liu, Jeng-Hwei Tseng, Chun-Nan Yeh, Ji-Tseng Fang, Hsiang-Lin Lee, Yi-Yin Jan
Yu-Yin Liu, Chun-Nan Yeh, Hsiang-Lin Lee, Yi-Yin Jan, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, China
Jeng-Hwei Tseng, Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, China
Ji-Tseng Fang, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Chun-Nan Yeh, MD, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan, China. ycn@adm.cgmh.org.tw
Telephone: +886-3-3281200 Fax: +886-3-3285818
Received: April 11, 2007
Revised: May 7, 2007
Accepted: May 12, 2007
Published online: August 21, 2007
Abstract

We reported a 55-year-old man who suffered from chest pain and dyspnea on exertion for two weeks associated with night sweating, general malaise, poor appetite, and body weight loss. Physical examination revealed friction rub with distant heart sound, bilateral clear breathing sound, no abdomen tenderness, and normal bowel sound. Subsequent chest X-ray revealed cardiomegaly and cardiac echo showed massive pericardial and pleural effusion with normal left ventricular function. Constrictive pericarditis was diagnosed based on clinical information. Tuberculosis (TB), malignancy, autoimmune disease, infection, hypothyroidism, and idiopathic could be the causes but excluded by further study. High-resolution lung CT scan after reconstruction revealed a moderate amount pericardial effusion with possible superimposed infection. Thickness of pericardium and left lobe liver abscess were found. A straight tubular structure about 6 cm in length transverses the lateral segment of liver to pericardial space and unknown foreign body was suspected. Laparotomy was performed, 6.5 cm toothpick was found through the liver into pericardium. Post-operative course was uneventful and he discharged one week later. The patient could not remember swallowing the toothpick before. He had no chest pain and dyspnea on exertion during a 6-mo follow-up period.

Keywords: Toothpick injury; Pericardial effusion; Laparotomy