A 5-year-old girl with accidental needle penetration into the right side of the chest while playing was referred to our medical center from a rural hospital. The interval between referral and arrival at our center was 12 hours. Upon arrival, the patient was transferred to the pediatric intensive care unit due to the possibility of cardiovascular events. She was asymptomatic at admission with a visible scar mark on the right side of the chest at the entrance site of the needle. She had normal vital signs and heart and lung sounds. The rest of her physical examination revealed nothing remarkable except for intermittent restlessness in the absence of associated dyspnea.
 Eleven hours after hospitalization, via chest radiography and transthoracic echocardiography (TTE), our pediatric cardiologist detected a hyper-refractile linear structure behind the sternum. The object was tangent to the RV wall and superior to the tricuspid valve. One end of the needle was tangent to the lateral wall of the RV, and the other end was embedded into the lung tissue and moving with each heartbeat (Figures 1 & 2).
The patient's restlessness was aggravated with time. Two hours after TTE, a chest computed tomography (CT) scan showed the needle in the RV inside the pericardium. The difference in the location of the needle in the scan relative to that in echocardiography suggested the migration of the needle into the heart wall (Figure 3). 
The patient was treated with prophylaxis antibiotics for any infection possibilities. After consultation with a cardiac surgeon, she was sent to the operating room just 72 hours after needle penetration. A right thoracotomy revealed 0.5 cm of the needle, but the remainder of the needle (3 cm) was lodged in the RV. The surgeon grasped the needle with anatomical forceps and extracted it from the heart gently, without incising the muscle (Figure 4). 
Afterward, the laceration was repaired, and 100 mL of blood was evacuated from the pericardium cavity. The control TTE and chest X-ray showed no remaining pericardial effusion.