Air Rifle Pellet Injury to the Heart with Retrograde Caval Migration

Abstract

Great emphasis is placed on the lethality of modern high-powered street weapons, and their impact on mortality from firearm injuries. Presented is a case of an air rifle BB injury to the chest, resulting in a penetrating injury of the right heart, with apparent retrograde embolization to the inferior vena cava. Although no clinical evidence of pericardial tamponade was present 4 hours following injury, 150 mL of pericardial blood was encountered at median sternotomy, secondary to a right atrial appendage entry wound. This case exemplifies three important principles regarding penetrating chest trauma and air guns: (1) Modern air rifles, capable of muzzle velocities as high as 900 fps, are intrinsically lethal weapons; (2) missiles within the cardiovascular system have a propensity for embolization, and often follow an intuitively unexpected course; and (3) young healthy patients with potentially lethal penetrating cardiac injuries, particularly those caused by low velocity firearms, may appear stable and minimally injured in the emergency room. A strong suspicion of cardiac injury and prompt intervention should be extended to airgun injuries of the thorax.

Pellet gunfire injuries among agitated mobs in Kashmir

“…Antibiotics are typically reserved for patients with additional risk factors for wound infection (i.e., tissue devitalization, delay in treatment, or gross contamination). [5] All the patients in our series received prophylactic antibiotics, as most of them had contamination. Patients with potentially serious wounds should be admitted for observation, and if indicated, operative intervention.…”

“…[1] Many case reports of serious and even fatal non-powder firearm injuries have been published describing ocular, intracranial, abdominal, and thoracic wounds, [2][3][4][5][6][7][8][9] but there is no single data regarding the pattern, severity and outcome of pellet injuries inflicted while controlling agitated crowds in a defined population. A persisting problem is the lack of medical recognition of the severity of injuries that can result from these guns, including penetration of the eye, skin, internal organs, and bone.…”

Pediatric Nonpowder Firearm Injuries: Outcomes in an Urban Pediatric Setting

“…Antibiotics are typically reserved for patients with additional risk factors for wound infection (ie, tissue devitalization, delay in treatment, or gross contamination). 7 Patients with potentially serious wounds should be admitted for observation and, if indicated, operative intervention.…”

Retrograde migration and endovascular retrieval of a venous bullet embolus

“…3 There are a few reports of retrograde migration in this group with patient position, respiration, and missile caliber identified as contributing factors. [4][5][6] In our case, the path of retrograde migration led from the superior vena cava, through the right atrium and IVC to the iliac vessels. The bullet's momentum was reduced as it traveled through the sternum, allowing passage through the anterior wall of the brachiocephalic vein but not the posterior wall.…”