Saved by the Bar: A Report of Bullet Deflection by Nuss Bar

Abstract

This is the case of a 17-year-old male who was saved from a penetrating thoracic gunshot wound by the extra-thoracic segment of a Nuss bar, placed 7 months earlier for treatment of a pectus excavatum defect. We discuss the significance of non-penetrating thoracic trauma and the workup involved.tions in leads II, III, and aVF, with non-specific T wave inversion in V2. Two view chest radiographs demonstrated a single Nuss bar with bilateral stabilizing plates and no evidence of bullet fragments, rib fracture, pleural effusion, or pneumothorax ( Figure 1). Chest CT with contrast showed induration of subcutaneous fat inferior and lateral to the left nipple, just anterior to the Nuss bar, with no evidence of fracture, vessel injury, or other intrathoracic injury (Figure 2). Due to the wound location and depth, it was noted by radiology that the Nuss bar likely reflected the bullet, preventing penetrating thoracic injury.Due to concern for cardiac contusion, he was transferred to our trauma center. Echocardiogram demonstrated a structurally normal heart without wall motion abnormalities. Repeat EKG was unchanged and the patient was discharged after overnight observation. DiscussionIn our patient, there was clear evidence both by exam and on CT imaging (Figure 2) that the bullet struck the patient directly at the level of the extra-thoracic projection of the Nuss bar and was deflected. This is a fascinating case of bullet deflection by a metallic prosthesis but also a case that calls attention to the management and potential sequellae of non-penetrating gunshot wounds.The Nuss bar is used for the surgical correction of pectus excavatum defects for either cosmetic or functional purposes [1]. The U-shaped metal rod is often a 1-2 cm, flattened appliance that is threaded under the concavity of the sternum using an introducer to avoid both the pericardium and internal thoracic vessels [1,2].