Bullet Embolus to the Heart after Gunshot Wound to the Neck: A Case Report

Breeding, Jacob M.; Smith, R. Stephen; Dort, Jonathan

doi:10.1177/000313480707301210

Cited by 13 publications

(5 citation statements)

References 6 publications

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“…The period and path taken varies widely. Previous studies have shown embolization to the heart’s right atrium and ventricle [ 12 ], pulmonary artery [ 13 ], and through the left brachiocephalic vein to the right ventricle [ 14 ]. There may also be aspiration of the bullet into the larynx following initial impact on the mandible [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

2014

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IntroductionGunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet’s trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right carotid sheath, and 'wandering’; a first of its kind in East Africa.Case presentationA 27-year-old African-Ugandan woman of Nilotic ethnicity was referred to the Accident and Emergency Department of a tertiary hospital in Uganda, having sustained complex injuries due to an inadvertent AK-47 rifle gunshot injury. The gunshot injury was to the right side of her face with a large ragged entry wound and no exit wound. Prior basic wound care and radiological imaging showed a comminuted fracture of her mandible with lodgment of the bullet in her neck, anterior to her sixth and seventh cervical vertebrae. Standard debridement of her wound was done. A computed tomography scan showed an apparent cephalad shift ('wandering’) of the bullet, leaving it lying partially anterior to her fifth cervical vertebra as well as within her carotid sheath. Other injuries were to her facial and trigeminal nerves, and her middle ear. The 'wandering’ bullet was successfully removed surgically. It had caused no damage to any part of her neck structure.ConclusionAK-47 rifle bullet injuries may present with uncharacteristically large entry wounds and cause complex structural injuries at the area of impact. The consequent trajectory is difficult to predict making regional examination and radiological investigations essential in management. Bullets may be retained, leaving no exit wound. Securing the airway, controlling hemorrhage and identifying other injuries are the first vital steps. This case illustrates all these interventions and the important decision to extract the entrapped bullet from the patient’s neck because it had started to 'wander’ and could have caused grave injury over time with further migration. Maxillofacial, plastic, trauma, general and military surgeons, otorhinolaryngologists and emergency physicians can gain from this experience because it calls for a multidisciplinary team approach.

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Section: Introductionmentioning

confidence: 99%

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

2014

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“…Es habitual que se acompañen de manifestaciones como derrame pericárdico (1) o neumotórax como consecuencia de su trayectoria. Es mucho más infrecuente que estos cuerpos extraños lleguen a las cavidades cardíacas por impacto de proyectiles en otra localización anatómica como cuello (3)(4) o extremidades inferiores (5) , afectando estructuras vasculares y embolizando hasta el endocardio. En estos casos pueden no existir manifestaciones extracardíacas e incluso pueden encontrarse como hallazgo casual de un evento previo no estudiado en su momento.…”

Section: Discussionunclassified

Proyectiles en ventrículo derecho. ¿Sin puerta de entrada?

Francia¹,

Roy²,

Zamora³

et al. 2019

Rev Ecocar Pract (RETIC)

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La presencia de cuerpos extraños intracardiacos y su tratamiento suponen todavía un tema controvertido dada la variedad de localizaciones en las que se puede presentar y las diferentes manifestaciones clínicas e implicaciones pronósticas de cada una de ellas. El número de casos publicados en los que no existe puerta de entrada directa del cuerpo a las cavidades cardiacas, diagnosticando o asumiendo su embolización a distancia, es mucho más reducido. Presentamos el caso de un varón adulto con herida cervical por arma de fuego y dos cuerpos extraños alojados en ventrículo derecho sin puerta de entrada directa.

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“…Intravascular embolization of shotgun pellets or single bullets has been previously described to the brain, with or without catastrophic sequelae [ 3 – 8 ]. Whilst retrograde intravascular embolisation of intravascular missiles is a relatively infrequently described event [ 9 – 12 ], the radiologist and emergency department physician involved in assessment of firearm injury must be aware of the increased probability of both antegrade and retrograde intravascular embolisation in shotgun trauma. Missile embolization may not be suspected at the time of injury [ 13 ] or may be delayed [ 14 ].…”

Section: Discussion Of Findingsmentioning

confidence: 99%

Look away: arterial and venous intravascular embolisation following shotgun injury

Vedelago

Dick

Thomas

et al. 2014

J Trauma Manage Outcomes

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We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction – both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

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Bullet Embolus to the Heart after Gunshot Wound to the Neck: A Case Report

Cited by 13 publications

References 6 publications

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

Proyectiles en ventrículo derecho. ¿Sin puerta de entrada?

Look away: arterial and venous intravascular embolisation following shotgun injury

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