INTRODUCTION: Traditionally promoted as "toy guns," air guns have long been used by children and lack many regulatory guidelines compared to conventional firearms. However these weapons possess serious lethal potential and have led to numerous injuries and deaths.
PRESENTATION OF CASE: We describe a 21 year old man who sustained a penetrating cardiac wound from a pellet gun that led to cardiac tamponade and death. Post-mortem examination showed the pellet had penetrated the left ventricle and anterior esophagus with subsequent intraluminal migration into the stomach.
DISCUSSION: Review of the literature identified 39 other cases of penetrating cardiac injuries from air guns. Sternotomy was the most frequently used surgical approach and the right and left ventricles were the most commonly affected chambers. Bullet embolization was the most frequently reported complication. Including our case, five deaths related to penetrating cardiac injury from air guns were identified.
CONCLUSIONS: This report highlights the seriousness of air guns and demonstrates a unique intra-thoracic injury.