136 Fig. 1 a CT scan. b Coronarog- raphy showed the nail in the lateral wall Int J Emerg Med (2010) 3:135–137 found the nail in the deep layers of the left ventricular wall with the tip protruding from the posterolateral wall (Fig. 2a, b). Moreover, a lesion of the left lung was found. The nail was gently removed and the lesions of the heart, at the entry and exit points, were repaired with a Prolene 4/0 stitch on a Teflon felt. A TachoSil sponge was applied in order to optimize hemostasis. Thepulmonary lesion was also treated with a TachoSil sponge to control the air leak. Questioning the patient about the accident, he remem- bered only to have been working with a nail gun. The hypothesis of an accidental injury appeared to be the most likely, but during the postoperative period, many psycho- logical evaluations supported the hypothesis of an attemp- ted suicide due to latent depression. The postoperative course was uneventful: the patient was discharged on the 10th postoperative day without complications. Discussion Nail gun injuries are common as a trauma of the arms or legs, but very few reports of heart injury are described. Given the remote settings in which these devices are often used, attention to the prevention of nail gun injuries should increase. Most of the nail guns are provided with security systems; nevertheless, accidental injury may occur [3]. Fig. 2 a Location of the nail penetrating into the wall of the left ventricle. b The nail after removal