Development of a Scoring Method Based on a Chest CT Scan to Determine the Outcomes of COVID-19 Patients.

Introduction As COVID-19 shifts from pandemic urgency to endemic management, healthcare systems are faced with the evolving challenge of providing optimized care and adept resource allocation in this evolving landscape of the disease. However, the timely management and accurate assessment of disease severity remains a cornerstone of effective treatment. This study presents a pioneering scoring system, based on the primary chest CT scan findings, to predict patient outcomes and to equip clinicians with a tool that can expedite decision-making. Method A retrospective cohort study was conducted involving 406 confirmed COVID-19 cases referred to two of our hospitals in Tehran, between February and April 2020. Radiographic and CT scan data were sourced from the imaging archive system and evaluated by a certified radiologist. We devised distinct severity scores for CT findings, demographic factors, and clinical indicators. These were synthesized into a comprehensive severity score to forecast critical patient outcomes, such as mortality, ICU admission, intubation, or extended hospitalization. Of the total cases, 161 (39.7%) were classified as severe, while 245 (60%) fell into the low or moderate severity category. Results The mean score of demographic, CT scan, and clinical characteristics was significantly higher for those in the severe COVID-19 than the non-severe group. The cutoff score for predicting the outcomes in COVID-19 patients for demographic, clinical, and chest CT scan factors was 2.5, 9.5, and 8.5, respectively. Multivariate analysis indicated that each unit increase in these scores elevated the odds of fatal outcomes by 24%, 2.8%, and 12%, respectively. Then, using the comprehensive severity score, which is the sum of the above scores, we further predicted the disease severity. Conclusion The findings suggest that our innovative scoring system, based on initial chest CT scan findings, serves as a robust predictor of COVID-19 outcomes.

Frailty syndrome in women with osteoporosis, should physicians consider screening? A cross-sectional study.

Despite its high prevalence and profound impact, frailty syndrome often goes undiagnosed. The study revealed a significant correlation between osteoporosis and frailty syndrome, with predictive accuracy exceeding 75 %. Given these findings and the existing recommendation for osteoporosis screening in older women, we underscore the importance of concurrently screening osteoporotic women for frailty. Introduction: Frailty syndrome, a prevalent and significant geriatric condition, impacts healthcare costs and quality of life. Previous reviews have associated frailty syndrome with osteoporosis, but original research on this link is limited and has produced conflicting results. This study aims to investigate the relationship between frailty syndrome, osteoporosis, bone mineral densitometry T-score, and other influencing factors. Methods: In this cross-sectional study, post-menopausal women underwent screening for osteoporosis and frailty syndrome using bone mineral densitometry and the Fried phenotype. Exclusion criteria included a history of diseases related to bone loss or medications affecting bone metabolism. Bivariate and multivariable tests were used to examine the correlation between frailty syndrome and various covariates, including the diagnosis of osteoporosis. Results: A total of 272 women aged 60 to 89 years (mean age 68.57 ± 6.22) were evaluated. Osteoporosis was prevalent in 44.9 % of participants, and frailty syndrome was identified in 36.4 %. The regression model identified age, menopausal age, and the diagnosis of osteoporosis as variables significantly and independently associated with frailty syndrome. A T-score lower than -2.5 in the femur neck or lumbar spine exhibited a sensitivity of 86.6 % and specificity of 76.5 % in predicting frailty syndrome. Conclusion: Older adults with osteoporosis face an increased risk of frailty syndrome. Therefore, we recommend that primary care providers screen osteoporotic women for frailty syndrome and, when appropriate, refer this group to geriatric specialists for further evaluation.

Ruptured splenic abscess as an extremely rare cause of pneumoperitoneum: A comprehensive review with a case report.

Splenic abscess leading to rupture and pneumoperitoneum is a very rare condition that is limited to a few case reports. In this study, we first introduced a case of an adolescent girl with a medical history of diabetes mellitus who presented with left upper quadrant abdominal pain and fever. Ultrasound revealed an abscess in the spleen and a computed tomography (CT) scan of the abdomen revealed evidence of pneumoperitoneum secondary to the rupture of this abscess. The patient underwent splenectomy without postoperative complications. Secondly, we reviewed and discussed the current literature on this topic which predominantly denotes that the pneumoperitoneum following splenic abscess rupture mostly occurs in the immunocompromised status, without a specific predominant infectious agent but the culprit is a gas-forming organism, acute abdomen ensues if the diagnosis is delayed, diagnosis is via abdominal CT when there is hemodynamic stability otherwise exploratory laparotomy uncovers the diagnosis, and splenectomy with broad-spectrum antibiotic therapy is the mainstay of treatment.

A life-threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report.

Key Clinical Message: Physicians must be alert for the exocrine pancreatic insufficiency diagnosis through the follow-up of postgastrectomy patients, regardless the severity and lag time. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed. Abstract: It is documented that exocrine pancreatic insufficiency (EPI) can develop after gastrectomy. Steatorrhea, malnutrition, and weight loss are common symptoms of the disease; however, it is usually mild to moderate postgastrectomy. This article reports a case of EPI manifested by hypoalbuminemia leading to dyspnea and anasarca, which are not typical symptoms of postgastrectomy EPI. A 61-year-old man with a history of gastric adenocarcinoma treated by total gastrectomy and chemoradiotherapy was admitted to the hospital with dyspnea and anasarca. Despite being diagnosed as a case of malignancy recurrence in another hospital, based on the symptoms described, no evidence of malignancy was found. His ascites and pleural effusion were determined to be caused by hypoalbuminemia. In addition, he claimed steatorrhea, and his stool elastase was lower than expected. EPI was diagnosed based on his medical history, paraclinical tests, and examinations. He remained asymptomatic for 1 year after being treated with albumin and pancreatic enzymes. Postgastrectomy EPI may be severe enough to cause steatorrhea or hypoalbuminemia. Hence, regardless of the severity of the presentation, physicians must be alert for this diagnosis throughout the follow-up of patients with a history of gastrectomy. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed.

Predictive value of hematological indices on incidence and severity of pulmonary embolism in COVID-19 patients.

BACKGROUND: Pulmonary thromboembolism (PTE) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which raises the COVID-19 disease's fatality rate from 3% to 45%. Nevertheless, due to fairly indistinguishable clinical symptoms and a lack of validated clinical prediction models, PTE diagnosis in COVID-19 patients is challenging. This study aims to investigate the applicability of hematological indices to predict PTE incidence and its severity in SARS-CoV-2 patients. METHODS: A retrospective cohort study was conducted on hospitalized patients with a confirmed diagnosis of SARS-CoV-2 infection who underwent CT angiography to assess probable PTE in them. The correlation between complete blood count parameters 1 day before CT angiography and CT angiography outcomes, and simplified pulmonary embolism severity index (s-PESI) was investigated. RESULTS: We discovered that among individuals with a probable PTE, males and those with higher platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios had a greater likelihood of PTE incidence (p < .001, .027, and .037, respectively). PLR was a significant and independent predictor of PTE with a p value of .045. Moreover, a higher neutrophil count was associated with a higher s-PESI score in COVID-19 patients developing PTE (p: .038). CONCLUSIONS: Among hematological indices, NLR and more precisely PLR are cost-effective and simply calculable markers that can assist physicians in determining whether or not COVID-19 patients with clinically probable PTE require CT angiography and the higher neutrophil count can be employed as an indicator of PTE severity in COVID-19 patients. Further large multicenter and prospective studies are warranted to corroborate these observations.

A systematic review and meta-analysis of efficacy, safety, and satisfaction rates of laser combination treatments vs laser monotherapy in skin rejuvenation resurfacing.

Laser therapies have been well-established in ameliorating skin-aging consequences. This systematic review aims to determine the efficacy, safety profile, and satisfaction rates of laser combination therapies on skin rejuvenation resurfacing. A systematic search was performed in four major databases up to September 2022. Skin rejuvenation studies were eligible comprising at least one laser combination arm, inclusive of all laser types (ablative or non-ablatives), and one monotherapy arm selected from one of the combined modalities. Studies combining one laser modality with radiofrequency (RF) or intense pulse light (IPL) were also assessed. Trials that did not encompass a monotherapy control arm were evaluated independently as single-arm studies. Eighteen clinical trials recruiting 448 cases were included after screening. A total of 532 nm KTP + 1064 nm Nd:YAG and 2940 nm Er:YAG + Nd:YAG were the two most utilized laser combinations and exerted higher improvements and milder adverse events, compared to their monotherapy in most studies. Combining CO2 with rhodamine-IPL or gallium arsenide laser increased efficacy and satisfaction and brings about faster skin recovery time. Augmenting CO2 + RF did not increase improvement vs CO2 laser alone but prolonged skin erythema. Our meta-analysis revealed the pooled prevalence of quartile improvement rates as 0%, 28%, 40%, 27% in laser combination group, and 0%, 9%, 31%, 17% in laser monotherapy group, respectively. The satisfaction within each quartile category was 39%, 25%, 15%, 7% in laser combination and 20%, 25%, 16%, 17% in laser monotherapy, respectively, suggestive of the higher efficacy and satisfaction of laser combination group. The pain scores were lower in laser combination group than monotherapy (4.8 ± 1.18 vs 7.18 ± 0.7, converted on a scale of 0 to 10). Post-laser skin erythema lasted less longer in the combination group (12.8 vs 15.24 days). Laser combination therapies were discovered to be superior to their monotherapies in terms of clinical improvement rates, diminished adverse events such as pain and erythema and patients satisfaction rates. Due to paucity of high-quality reportings, additional trials are warranted to corroborate these results.

Thrombotic thrombocytopenic purpura following ChAdOx1 nCov-19 vaccination: A case report.

Vaccine-associated thrombotic thrombocytopenic purpura (TTP) is a rare type of acquired TTP recently reported after COVID-19 vaccination. Merely four cases are ascribed to the ChAdOx1 nCoV-19 vaccine in the medical literature till the preparation of this study. In this case report, we describe a 43-year-old man who developed symptoms of TTP four days after receiving the second dose of the ChAdOx1 nCoV-19 vaccine. Peripheral blood smear demonstrated multiple schistocytes. Given a high plasmic score, he received plasma exchange, corticosteroids, and rituximab, and later, low ADAMTS 13 activity and high-titer ADAMTS inhibition antibody confirmed the diagnosis of COVID-19 vaccine-associated TTP. COVID-19 vaccine-associated TTP is an infrequent consequence of SARS-CoV-2 vaccination but with a substantial mortality rate which must be considered as one of the crucial differential diagnoses of post-COVID-19 vaccine thrombocytopenia besides vaccine-induced immune thrombotic thrombocytopenia and Immune thrombocytopenic purpura.

Immune thrombocytopenic purpura secondary to COVID-19 vaccination: A systematic review.

INTRODUCTION: This systematic review aimed to retrieve patients diagnosed with de novo immune thrombocytopenic purpura (ITP) after COVID-19 immunization to determine their epidemiological characteristics, clinical course, therapeutic strategies, and outcome. MATERIALS AND METHODS: We conducted the review using four major databases, comprising PubMed, Scopus, Web of Science, and the Cochrane library, until April 2022. A systematic search was performed in duplicate to access eligible articles in English. Furthermore, a manual search was applied to the chosen papers' references to enhance the search sensitivity. Data were extracted and analyzed with the SPSS 20.1 software. RESULTS: A total of 77 patients with de novo COVID-19 vaccine-associated ITP were identified from 41 studies, including 31 case reports and 10 case series. The median age of patients who developed COVID-19 vaccine-associated ITP was 54 years (IQR 36-72 years). The mRNA-based COVID-19 vaccines, including BNT16B2b2 and mRNA-1273, were most implicated (75.4%). Those were followed by the adenovirus vector-based vaccines, inclusive of ChAdOx1 nCoV-19 and vAd26.COV2.S. No report was found relating ITP to other COVID-19 vaccines. Most cases (79.2%) developed ITP after the first dose of COVID-19 vaccination. 75% of the patients developed ITP within 12 days of vaccination, indicating a shorter lag time compared to ITP after routine childhood vaccinations. Sixty-seven patients (87%) patients were hospitalized. The management pattern was similar to primary ITP, and systemic glucocorticoids, IVIg, or both were the basis of the treatment in most patients. Most patients achieved therapeutic goals; only two individuals required a secondary admission, and one patient who presented with intracranial hemorrhage died of the complication. CONCLUSIONS: De novo ITP is a rare complication of COVID-19 vaccination, and corresponding reports belong to mRNA-based and adenovirus vector-based vaccines, in order of frequency. This frequency pattern may be related to the scale of administration of individual vaccines and their potency in inducing autoimmunity. The more the COVID-19 vaccine is potent to induce antigenic challenge, the shorter the lag time would be. Most patients had a benign course and responded to typical treatments of primary ITP.

A concealed history behind the disaster: Extremely rare presentations of metformin toxicity in a patient with body dysmorphic disorder.

Metformin is a widely used anti-hyperglycemic agent with weight loss effect properties but besides its various utilities, despite being very rare, it has its characteristic toxicity and adverse effects when used in large doses and for the long-term or in patients with renal impairment. We presented here a case of a 36-year-old woman who developed several presentations with diverse features during three years comprising neuropathic symptoms, severe lactic acidosis, three episodes of cardiogenic shock, acute kidney injury, megaloblastic anemia, pancytopenia, and hyponatremia and did not receive a definite diagnosis after each presentation until when she inadvertently disclosed her abuse of extremely unusual doses of metformin during these three years with aim of weight reduction obsessively without knowing that her symptoms could pertain to metformin overdose. She was eventually diagnosed with a body dysmorphic disorder which led to unreasonable abuse of metformin pills that consequently caused its toxicity. Thereafter, with cease of metformin use and psychiatric treatment, her symptoms did not recur and she was doing well after one year of her last admission. Based on the review of the literature, this is the first case of metformin toxicity in a patient with body dysmorphic disorder who was affected with extremely rare features of this intoxication, nevertheless, every manifestation of the patient was discussed exhaustively according to the current and available medical literature.

Constrictive pericarditis following inactivated virus COVID-19 vaccine: a case report with review of the literature.

Cardiac adverse effects of the COVID-19 vaccine are very rare, myocarditis and pericarditis are the most common amid them, and constrictive pericarditis (CP) is reported to be restricted to a few cases following mRNA COVID-19 vaccines. We report a case of a 72-year-old male patient who developed symptoms of right-sided heart failure, which started after 8 days of receiving the third dose of inactivated virus COVID-19 vaccine and his diagnostic tests comprising transthoracic echocardiography, chest CT scan, cardiac magnetic resonance were in favor of CP. Ultimately, invasive cardiac catheterization confirmed the diagnosis of CP. Due to the lack of satisfactory response to corticosteroid therapy, pericardiectomy was performed, which gave rise to symptom relief progressively and substantially. Considering the temporal course of the patient's symptoms and exclusion of other possible etiologies based on the patient's medical history and diagnostic evaluation, immunization with the COVID-19 vaccine was recognized as a culprit for developing CP. Despite being a scarce phenomenon, the COVID-19 vaccine could have a tendency to provoke pericardial inflammation in so far as causing CP. Hence, physicians should have a high index of suspicion in these circumstances and accelerate the diagnostic investigation.

Successful liver and kidneys transplant following aortic dissection and subclavian artery rupture: A case report.

INTRODUCTION AND IMPORTANCE: Despite the increasing number of liver and kidney transplants, the number of patients awaiting for a proper donor is still exceeding. Therefore, the preservation of donor organs is critically advocated. CASE PRESENTATION: Herein, we presented a successful liver and kidney transplant from a brain-dead donor who was found preoperatively to have simultaneous aortic dissection and intramural hematoma and additionally developed left subclavian artery dissection and perforation, which was noticed following sternotomy. CLINICAL DISCUSSION: This case experience highlights the key role of cardiac surgeons in preserving visceral organs by rapid repair of the dissection and perforation sites of the aorta and its branches which culminate in lifesaving organ donation. CONCLUSION: This case report introduces the first case of a successful; liver and kidneys transplant in a patient with concurrent aortic dissection and subclavian artery rupture which served as a lifesaving donor.

Concurrent COVID-19 and pneumocystis carinii pneumonia in a patient subsequently found to have underlying hairy cell leukemia.

SARS-CoV-2 infection manifestation has great diversity and it becomes even greater while co-infection occurs or there is a serious underlying disease in an affected patient. In this case report, we present a case of a 71-year-old man who underwent a chest CT scan following the development of fever, weakness, and pulmonary symptoms. Chest CT scan showed segmental consolidation with centrilobular nodular infiltration, ground glass opacifications in the inferior segment of the left upper and lower lobes, and left lung pleural thickening which was atypical for either COVID-19 infection or pneumocystis carinii pneumonia but his SARS-CoV-2 PCR result was positive and he received COVID-19 treatment. His symptoms recurred after a few months with the same chest CT findings and subsequent bronchoalveolar lavage revealed the presence of pneumocystis carinii infection. Consequently, he received cotrimoxazole which caused improvement in symptoms, nonetheless splenomegaly and anemia remained in his clinical and laboratory investigation. Accordingly, bone marrow study and flow cytometry was done and confirmed the previously undiagnosed hairy cell leukemia. This case accentuates the fact that when we face atypical clinical or paraclinical features in a COVID-19 patient, we should explore for coinfection or unknown underlying diseases.

COVID-19 and COVID-19 vaccine-related dermatological reactions: An interesting case series with a narrative review of the potential critical and non-critical mucocutaneous adverse effects related to virus, therapy, and the vaccination.

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS-CoV-2 pandemic: virus itself, treatment-related, vaccine-induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine-related were mainly self-limited and non-severe. Treatment-related reactions could be life-threatening.

A systematic review on mucocutaneous presentations after COVID-19 vaccination and expert recommendations about vaccination of important immune-mediated dermatologic disorders.

With dermatologic side effects being fairly prevalent following vaccination against COVID-19, and the multitude of studies aiming to report and analyze these adverse events, the need for an extensive investigation on previous studies seemed urgent, in order to provide a thorough body of information about these post-COVID-19 immunization mucocutaneous reactions. To achieve this goal, a comprehensive electronic search was performed through the international databases including Medline (PubMed), Scopus, Cochrane, Web of science, and Google scholar on July 12, 2021, and all articles regarding mucocutaneous manifestations and considerations after COVID-19 vaccine administration were retrieved using the following keywords: COVID-19 vaccine, dermatology considerations and mucocutaneous manifestations. A total of 917 records were retrieved and a final number of 180 articles were included in data extraction. Mild, moderate, severe and potentially life-threatening adverse events have been reported following immunization with COVID vaccines, through case reports, case series, observational studies, randomized clinical trials, and further recommendations and consensus position papers regarding vaccination. In this systematic review, we categorized these results in detail into five elaborate tables, making what we believe to be an extensively informative, unprecedented set of data on this topic. Based on our findings, in the viewpoint of the pros and cons of vaccination, mucocutaneous adverse events were mostly non-significant, self-limiting reactions, and for the more uncommon moderate to severe reactions, guidelines and consensus position papers could be of great importance to provide those at higher risks and those with specific worries of flare-ups or inefficient immunization, with sufficient recommendations to safely schedule their vaccine doses, or avoid vaccination if they have the discussed contra-indications.

Acute gastric volvulus following rapid and incomplete chewing of vegetables: A case report.

One of the rare but serious causes of acute abdomen is gastric volvulus. It is considered an emergent surgical condition when it takes place acutely due to the risk of gastric strangulation, gangrene, and perforation. In this study, we introduce a case of a previously healthy young adult patient who presented with sudden severe epigastric and left upper quadrant abdominal pain along with nausea and retching following insufficient mastication and rapid swallowing of large amounts of vegetables. Radiological studies with chest and abdominal X-rays were in favor of acute gastric outlet obstruction and finally, laparotomy confirmed the diagnosis of acute, primary mesenteroaxial gastric volvulus. We postulated a probable justifying mechanism of the presence of a flaccid gastrocolic ligament (found through the laparotomy) besides rapid entrance of great pieces of vegetables into the stomach precipitated instant gastric rotation.

A case report of an extremely rare type of cardiac tumor: Primary cardiac angiofibroma.

Cardiac angiofibroma is a very rare diagnosis when a patient develops an intracardiac mass. It is a primary benign cardiac tumor with a scarcity of information in the literature. This case report illustrates a 26-year-old man with a complaint of chronic chest tightness who was first diagnosed with right ventricle tumor by echocardiography then underwent cardiac magnetic resonance imaging (CMR) which confirmed the presence of a highly-vascular tumor with radiologically benign behavior. Then his tumor was excised, his postoperative course was uncomplicated and he was well within almost 2 months after discharge. Ultimately the histopathologic findings demonstrated vascular and stromal tissue in favor of angiofibroma and excluded the other diagnoses with immunohistochemical and trichrome staining. Angiofibroma is a benign, highly vascular tumor, mostly discovered in the nasopharynx. When it is found in the heart, CMR and pathology are pivotal to rule in its diagnosis. It is isointense in T1 weighted and hyperintense in T2 weighted sequences with intense enhancement following contrast injection. Its pathology contains an admixture of vasculatures with CD31 positive immunoreactivity for endothelial cells and fibrotic tissue with bluish coloration in trichrome staining. Eventually, its treatment includes merely surgical excision given its benign nature.

Simultaneous Occurrence of Cerebral Venous Sinus Thrombosis and Immune Thrombocytopenic Purpura in a Patient with a History of COVID-19 Infection.

Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, multiple but rare complications of this infection have been described, comprising cerebral venous sinus thrombosis (CVST) and immune thrombocytopenic purpura (ITP). Although these two complications have been reported as separate entities, to the best of our knowledge, their concurrent presentation has not been reported. In this case report, we present a middle-aged man with a history of COVID-19 infection who developed a sudden-onset severe occipital headache followed by right-sided blindness (right homonymous hemianopia). Upon his diagnostic workup, brain computed tomography scan with and without contrast was indicative of thrombosis of the left transverse venous sinus and hemorrhagic venous infarction. In addition, laboratory data revealed thrombocytopenia, which upon investigation confirmed a diagnosis of ITP. We postulate three pathophysiological mechanisms for this circumstance: either COVID-19 infection caused ITP and then ITP gave rise to CVST, or COVID-19 complications themselves resulted in ITP and CVST independently and simultaneously, or another plausible mechanism is immune-mediated thrombocytopenia caused by the anti-platelet 4-factor antibody, which is the proposed mechanism for CVST after the COVID-19 vaccine.

Predictors of critical COVID-19 in an Iranian population: Age and disabilities play a special role.

Background: Ever since coronavirus disease 2019 (COVID-19) has emerged as a global public health problem, risk factors for severe disease have been reported in studies from Western countries. However, apart from studies of Chinese origin, few reports are available on COVID-19 severity among the Asian population. This study investigates potential risk factors for development of critical COVID-19 in an Iranian population. Methods: In this retrospective cohort study, we included all adults with COVID-19 from 2 tertiary centers in Iran who had been diagnosed between February 20 and April 1, 2020, in either inpatient or outpatient settings. "Critical COVID-19" was proposed when a hospitalized patient was scheduled for admission to intensive care unit, assisted by mechanical ventilation, or pronounced dead. We used univariable and multivariable logistic and linear regression models to explore the potential risk factors associated with critical COVID-19, admission to hospital, and length of hospital stay. Results: Of the 590 recruited patients, 427 (72.4%) were hospitalized, 186 (31.5%) had critical COVID-19, and 107 (18.2%) died. In the multivariable regression analysis, age >60 years and physical/mental disabilities were associated with critical COVID-19 (odds ratio (OR), 2.33 and 7.03; 95% CI, 1.51-3.60 and 2.88-17.13, respectively); and history of renal, heart, or liver failure was associated with both COVID-19 hospitalization (OR, 4.13; 95% CI 1.91-8.95; p<0.001) and length of hospital stay (Beta 1.90; 95% CI, 0.76-3.04; p=0.001). Conclusion: Age >60 years and physical/mental disabilities can predict development of critical COVID-19 in the Iranian population. Also, the presence of renal, heart, or liver failure might predict both COVID-19 hospitalization and length of hospital stay.

Role of chest CT scan in atypical cardiac trauma management: Left ventricle injury by a nail gun.

We report a case of an accidental penetrating cardiac trauma with a nail gun. A 28-year-old man was repairing a sofa with a nail gun when a nail was misfired to his chest. At the time of his presentation, he underwent chest CT scan, showing the nail as a sharp hyperdense foreign body penetrating the chest wall passing through the lower lobe of the left lung and finally the anterior aspect of left ventricle cavity. This report highlights the utility of the chest CT scan to detect trajectory of the misfired nail accurately and instantaneously in a hemodynamically stable patient to assist in the surgery plan.