Pericardial Effusion: Chest Pain Caused by a Porcupine Quill

Journal of the American Academy of Physician Assistants

A 49-year-old woman reported to the emergency department with complains of shortness of breath and chest pain that worsened on lying down.

The doctors examined the woman and fortunately, they were able to find the underlying cause of the chest pain. She had an abnormal collection of fluid present in the sac surrounding the heart. This sac is known as the pericardium, and it protects the heart from friction during contraction. Additionally, the aorta was also damaged.

Chest pain: What happened next?

The doctors had to quickly intervene in order to prevent any complications. Therefore, they drained the excess fluid from the heart. However, this procedure had to be performed two more times in the span of 9 days, bringing the total tally to 3!

When the fluid was evacuated the third time; the doctors discovered blood in the fluid. To find the reason for this unprecedented bleeding, the doctors performed more tests. Sure enough, they discovered that the previous defect in the aorta had increased in size. Thus, bleeding from this vessel was made the provisional diagnosis.


The doctors had to make the decision of performing a crucial surgery on the patient. On exploration of the aorta, the doctors found a “black quill”. They removed it from the large vessel and also repaired the defect in the wall.

The doctors sent the quill for pathology, which confirmed the doctor’s suspicion: the quill belonged to a porcupine!

Swallowing a porcupine quill: the woman’s story

After the surgery, the patient told the doctors that she had to remove porcupine quills from her dog after it had encountered a porcupine outside. However, she was unaware that she swallowed one of the quills!

According to the doctors, the quill had pierced her esophagus and had entered her aorta, causing the vessel wall defect and hence the effusion.


The doctors discharged the lady 3 weeks after the surgery. Fortunately, there were no complications.


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