We report an amazing case of a 69-year-old man who accidently shot himself with a power-driven nail gun and ended up having 16 finishing nails (2.5-inch) in his left chest. Panel A is a computed tomography (CT) scan of his chest showing the multiple nails embedded in the heart. The patient managed to drive to the hospital and was admitted in moderate distress. An emergent median sternotomy with cardiopulmonary bypass was performed, and 15 nails were removed from the chest wall and the heart. Due to the patient's critical condition, 1 nail from the left ventricle (LV) could not be removed. Panel B is a CT scan of the chest with the single retained nail in the heart. The patient later underwent coronary angiography for anginal symptoms, which revealed the retained intracardiac nail along with diffuse nonobstructive coronary artery disease. Panel C displays the right coronary angiogram, right anterior oblique view, showing the intracardiac nail crossing the plane of the atrioventricular groove.

A repeat CT scan was conducted that demonstrated the retained nail in the LV cavity and crossing the coronary sinus posteriorly (D). Seven years later, the patient remains asymptomatic with the nail still in his heart. LA = left atrium.