Embolia balística venosa retrógrada transtorácica: relato de caso e revisão da literatura

Abstract

ResumoÊmbolo balístico é um fenômeno de ocorrência rara no atendimento ao traumatizado. Geralmente, são pouco sintomáticos ou assintomáticos, e o tratamento desses pacientes, apesar de estar em constante evolução, é ainda controverso. A abordagem endovascular tem se destacado como modalidade de tratamento para esse tipo de embolia com baixa morbimortalidade. Este artigo relata o caso de um paciente de 30 anos, do sexo masculino, vítima de ferimento por arma de fogo com múltiplos orifícios de entrada em tórax, submetido com sucesso à retirada do projétil por acesso endovascular após tentativa frustrada de retirada por toracotomia. Palavras-chave:Tratamento, embolia, projétil. AbstractBullet embolism is a rare event when providing care to traumatized patients. These cases usually present with few symptoms or are asymptomatic, and treatment is controversial, in spite of the evolution observed. The endovascular approach has stood out as a treatment modality for this type of embolism with low morbidity and mortality rates. This article reports the case of a 30-year-old male patient victim of gunshot thorax injury with multiple entrance signs who was successfully submitted to bullet removal by endovascular technique after failed attempt by thoracotomy.

Arterial bullet embolism after thoracic gunshot wound

“…The site of impaction depends on the projectile caliber and vessel diameter and mainly occurs at vascular bifurcations, because they have sudden reductions in caliber. 1 , 2 , 4 Other contributory factors may include the patient's position following wounding, respiratory and hemodynamic activity, and gravity. 11 , 12 The vessel most commonly occluded in arterial bullet embolism is the femoral artery (30 to 50% of cases).…”

“…11 , 12 The vessel most commonly occluded in arterial bullet embolism is the femoral artery (30 to 50% of cases). 2 , 4 Additionally, the left leg is more commonly involved than the right, because of the smaller angle between the left common iliac artery and the aorta. 11 , 13 , 14…”

“…A bullet embolus should be suspected in the absence of an exit wound, 2 , 12 when there is radiological evidence of the presence of a bullet in unusual anatomic sites, without any relationship to the entrance wound, and/or where radiographic evidence does not correspond to the expected bullet trajectory. 2 , 4 , 6 Migration usually occurs soon after the missile enters the circulation, but it can also occur days, weeks, or even years later. 3 , 4 , 6…”

“…2 , 4 , 6 Migration usually occurs soon after the missile enters the circulation, but it can also occur days, weeks, or even years later. 3 , 4 , 6…”

“…Treatment for these conditions is decided on a case-by-case basis and may or may not involve removal of the projectile. 4 , 5 We present a case report of an arterial embolism treated with both endovascular and open surgical approaches.…”