Migrating bullet: A case of a bullet embolism to the pulmonary artery with secondary pulmonary infarction after gunshot wound to the left globe

Duke, Eugene; Peterson, Andrew A.; Erly, William K.

doi:10.4103/0974-2700.125638

Cited by 27 publications

(37 citation statements)

References 8 publications

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“…Many authors reported cases of venous BE mostly managed by endovascular techniques [10][11][12][13] while others were managed by open surgery [14][15][16][17][18][19][20] or nonoperatively [5,21]. Open surgery was either used as a primary procedure or after failure of endovascular intervention.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

Bakir¹,

Othman²,

Taha

2020

Cardiothorac Surg

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Background: Cardiac gunshot wounds with bullet embolism (BE) into the pulmonary artery are rare. Most pulmonary BE follow injuries of peripheral veins without concomitant cardiac injury. Herein, we describe a case of cardiac gunshot injury in which the bullet migrated from right atrium through the inferior vena cava down to right internal iliac vein and back to the left pulmonary artery. Such bullet migration is too rare and unusual and to our knowledge not reported before. Case presentation: On March 4, 2019, a man of 39 had a bullet injury during celebratory gunfire. He was clinically stable with entrance on right posterior chest but no exit. Chest CT scan showed a bullet in the right atrium. The next day, the bullet migrated to the right pelvis as shown by plain chest and pelvic radiographs. CT angiography 3 weeks afterwards displayed the bullet in the right internal iliac vein. Meanwhile, the patient was asymptomatic, thus discharged home. However, 3 months later, he was readmitted because of chest pain, dyspnea, and sweating. A repeat chest CT scan showed the bullet in the left lower lobe pulmonary artery. Hence, pulmonary BE was suspected and eventually a 0.36 bullet was removed via left thoracotomy. Conclusions: This is a case of symptomatic venous BE with typical diagnostic criteria (a small low-velocity bullet with inlet but no exit located away from anticipated trajectory with migration proven by serial radiographs). Endovascular removal was preferred but was not available. BE of the heart is exceedingly rare. Hence, diagnosis requires a high degree of clinical awareness.

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Section: Discussionmentioning

confidence: 99%

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

Bakir¹,

Othman²,

Taha

2020

Cardiothorac Surg

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“…Computed tomography showing a 5 mm bullet that embolized to the left lower lobe pulmonary artery, causing a pulmonary infarction (a = lung window images; b = bone window images). Source: Duke et al [1]. Images used under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike License (CC BY-NC-SA), which permits noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.…”

Section: Bullet or Projectile Embolismmentioning

confidence: 99%

“…Both traumatic and iatrogenic foreign intravascular object emboli (FIOE) have been described in the literature [1][2][3]. Traumatic bullet or "projectile" emboli (BPE) are mostly secondary to bullets or bullet fragments [1,4,5], with various types of shrapnel contributing to a smaller number of total cases [6]. In general, smaller caliber projectiles such as shot gun pellets are among the most common BPEs [8].…”

Section: Introductionmentioning

confidence: 99%

Foreign Intravascular Object Embolization and Migration: Bullets, Catheters, Wires, Stents, Filters, and More

Wojda¹,

Dingley²,

Wolfe³

et al. 2017

Embolic Diseases - Unusual Therapies and Challenges

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Foreign intravascular object embolization (FIOE) is an important, yet underreported occurrence that has been described in a variety of settings, from penetrating trauma to intravascular procedures. In this chapter, the authors will review the most common types of FIOEs, including bullet or "projectile" embolism (BPE), followed by intravascular catheter or wire embolization (ICWE), and conclude with intravascular noncatheter object (e.g., coil, gelatin, stent, and venous filter) migration (INCOM). In addition to detailed topic-based summaries, tables highlighting selected references and case scenarios are also presented to provide the reader with a resource for future research in this clinical area.

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“…Bullet embolism (BE) is a term used to describe the intravascular movement of a projectile distant to the entry site 1. Cranial BE is rare and mostly observed in the anterior circulation, which is thought to be due to the diameter and flow of the internal carotid artery (ICA) 2 3.…”

Section: Introductionmentioning

confidence: 99%

Gunshot bullet embolisation in the middle cerebral artery

Sahin

Yakar²,

Özgüral

et al. 2017

J R Army Med Corps

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Migrating bullet: A case of a bullet embolism to the pulmonary artery with secondary pulmonary infarction after gunshot wound to the left globe

Cited by 27 publications

References 8 publications

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

Foreign Intravascular Object Embolization and Migration: Bullets, Catheters, Wires, Stents, Filters, and More

Gunshot bullet embolisation in the middle cerebral artery

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