Int J Emerg Med (2010) 3:135–137 As in our case, the patient was initially referred to a peripheral hospital without a cardiac surgery division and at the moment of the diagnosis, many problems concerning patient management emerged. However, the patient was clinically stable and the transfer to our cardiac surgery division was uneventful. In our case, the left ventricular involvement was the most unusual finding, very rarely reported in the literature, maybe because the patient pushed the nail shot from the gun into the left chest wall laterally. Moreover, the left ventricular lesion did not bleed and the patient did not suffer from cardiac tamponade, as usually happens in cases like this. Conclusion In conclusion, nail gun injuries to the heart, even though rare, can occur and are survivable. Despite being injuries caused by a projectile, mortality and treatment appear similar to those of low-velocity mechanisms of injury, such as stab wounds. This case demonstrates that physical 137 examination plays a fundamental role and also the examination of chest wall may give in some cases useful elements for diagnosis. Even though a chest X-ray should offer some information about nail presence, CT scanning is mandatory for the evaluation of heart damage and nail location. Our experience with the present case demonstrates that left ventricular involvement may be possible and the key to survival is expedient care that recognizes the physical nature of the injury. References 1. Eren E, Keles C, Sareyyupoglu B, Bozbuga N, Balkanay M, Yakut C (2004) Penetrating injury of the heart by a nail gun. J Thorac Cardiovasc Surg 127:598 2. Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A et al (1998) One hundred five penetrating cardiac injuries: a 2- year prospective evaluation. J Trauma 44:1073–1082 3. Karger B, Teige K (1995) Suicide with a nail gun device: wound ballistics and wound entry morphology (in German). Arch Kriminol 195:153