Retained pericardial pellets for 25 years: a case report.

Retained cardiac pellets are clinically silent foreign bodies that do not cause any cardiovascular disturbance. A 71-year-old woman presented with exertional chest pain. Her physical examination and surface electrocardiogram were normal. After a positive treadmill test, coronary angiography was performed which showed nonsignificant coronary lesions. During fluoroscopy, several pellets were observed throughout the neck and two of them were simultaneously moving within the heart shadow. Transthoracic and transesophageal echocardiography showed no evidence for pericardial effusion. Computed tomography scans of the chest showed the pellets above the left diaphragm in the pericardial area. Her past medical history revealed an accidental shot from a pellet rifle by her son 25 years before, at which time no surgical intervention was planned as she had been asymptomatic.