Unsuccessful suicidal attempts by sewing needle introducing to chest: Removing 17 ones from the right ventricle and breast tissue in two stages; case report and literature review.

INTRODUCTION AND IMPORTANCE: Penetrating cardiac injuries among the whole injuries confronting the trauma surgeon is more alarming. The introduction of needles as an attempt to inflict self-injury has rarely been described, so we only found 34 reported cases reviewing the available English literature since 1967.

CASE PRESENTATION: We have reported a case of a 35-year-old depressed female who had introduced 17 sewing needles through her chest wall, causing myocardial puncture and mastitis; underwent exploratory sternotomy and mammoplasty in two stages and survived.

CLINICAL DISCUSSION: Penetrating cardiac trauma is rare enough for surgeons to deal with direct injuries by sewing needles. Penetrating wounds in the "cardiac box" anatomic area" should elicit the highest concern for potential cardiac injury. The mentioned region is demarcated superiorly by the clavicles, inferiorly by the xiphoid, and the nipples laterally in an area of the anterior thorax.

CONCLUSION: Anterior aspect penetrating traumas to the cardiac box myocardial injuries should be in mind, and immediate and proper intervention should be needed. Ventricles, for their anatomical condition, are exposed to be injured.