A rare window for conservative extraction: learning from an asymptomatic thoracic nail gun injury

TL;DR

A 60-year-old man with a nail lodged near a lung artery was safely treated with a conservative extraction method instead of surgery.

Contribution

Demonstrates a safe, non-invasive approach for removing retained foreign bodies in stable thoracic injury patients.

Findings

A 10 cm nail near a pulmonary artery was successfully removed using a conservative method.

The patient recovered well and was discharged the next day without complications.

Conservative extraction can be a viable alternative to invasive surgery in select cases.

Abstract

Penetrating thoracic injuries involving retained foreign bodies (RFBs) present a significant clinical challenge. While removal is generally indicated to prevent complications, invasive surgical approaches carry inherent risks. We present the case of a 60-year-old male who sustained an accidental nail gun injury to his left chest. Imaging revealed a 10 cm nail lodged in the lung, 3 mm from a branch of the pulmonary artery. Despite the proximity to a major vessel, the patient’s haemodynamic stability permitted a conservative approach. Under local anaesthesia and mild sedation, a prophylactic chest drain was inserted, and the nail was successfully extracted along its entry path. The patient recovered without incident and was discharged the following day. This case highlights that in select, stable patients, a carefully planned conservative extraction can be a safe and effective alternative to more invasive procedures like thoracotomy or video-assisted thoracic surgery, minimizing patient morbidity.

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