Italy midfielder Daniele De Rossi has been banned for four games for elbowing USA striker Brian McBride in the face.
De Rossi shows his anguish as he gets his marching orders
It means De Rossi, who has served one match of the suspension, can only play again at the World Cup if Italy reach the final or third-place play-off.
Fifa's disciplinary committee also fined the Roma player 6,400 Euros.
The incident occurred in the first half of Italy's Group E match against USA and left McBride needing three stitches to a cut under his eye.