Last Friday I posted an xray that showed a long, thin metallic foreign body projecting from the right chest area toward the right side of the heart. What is it?

The patient declined to tell us what he had been doing. And looking at the xray, which is a 2D representation of a 3D object, it’s impossible to tell where the object is in the z axis. It could be in his back, in his clothes, or in his heart.

A complete physical exam showed a pinhole just to the right of the xiphoid process. By gently running a (gloved) finger across the hole, something thin and sharp was palpable. 

What should we do next? More images and the final answer tomorrow!