A 61-year-old seamstress with hypertension, dyslipidemia and diabetes was referred to our hospital for chest pain and a positive exercise test. The ECG and transthoracic echocardiogram were normal. Coronary angiography revealed 60% stenosis in the proximal right coronary artery and 70% stenosis in the posterolateral branch (Figure 1A). A sewing needle was detected in the left hemithorax (Figure 1B and C). Further investigation by thoracic computed tomography (CT) confirmed the location of the needle in the apical segment of the left inferior lobe (Figure 1D and E). When questioned, she mentioned an episode of acute pricking pain six months previously, which resolved spontaneously. A conservative approach, with imaging surveillance, was adopted by the thoracic surgery team given the absence of symptoms related to the foreign body. Repeat CT performed four weeks later showed the sewing needle in the same location. A lateral perfusion defect was identified by scintigraphy (Figure 1F) related to the posterolateral branch lesion. Medical treatment was the approach adopted in view of the caliber of the vessel, and the patient has remained asymptomatic.

Figure 1.

(A) Right coronary artery in left anterior oblique projection at 45°, caudal 10°, showing 60% proximal stenosis and 70% stenosis in the posterolateral branch; (B) left coronary artery in right anterior oblique projection at 30°, caudal 10°, showing no significant lesions but revealing a sewing needle in the left hemithorax; (C) anteroposterior view, 0° 0°, showing magnified image of the needle; (D) thoracic computed tomography (CT), sagittal plane, showing the needle in subpleural position, posterior to the apical segment of the left inferior lobe; (E) thoracic CT, pulmonary window, coronal plane, showing the needle, 40 mm in length, in cranial-caudal orientation; (F) myocardial scintigraphy: after exercise (above) and at rest (below), documenting a lateral perfusion defect with significant reversibility.

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