An unusual shot‐retrograde transthoraco‐abdominal venous bullet embolization

Salahuddin, Salman; Faizal, Ali; Koshy, Sudeep Kurien; Koya, Muneer Moideen

doi:10.1002/ccd.28434

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…2 While the typical venous bullet embolism is anterograde, it is possible that a bullet can travel retrograde in the venous system, as in this patient from the right coronary sinus to the IVC. 3 As we report in our case, once the bullet is stabilized within the right atrium, it may reposition into the coronary sinus. The normal coronary sinus anatomy is shown in ►Fig.…”

Section: Discussionmentioning

confidence: 53%

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A Lost Bullet in the Coronary Sinus: A Cautionary Tale

et al. 2022

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We present a case of venous bullet embolism to the right atrium following a gunshot wound (GSW) to the abdomen. A 53-year-old male presented after a GSW to the abdomen. His workup included a computed tomography (CT) scan demonstrating an aortic injury with aortocaval fistula. A radio-opaque object consistent with a bullet was visualized in the right atrium. First, this case details an important decision, choice of surgery versus an interventional approach. After repair of the aortocaval fistula, the patient underwent a planned attempt to extract the bullet through a right lateral thoracotomy approach utilizing cardiopulmonary bypass to facilitate a right atriotomy. Intraoperatively, the team was not able to localize the bullet in the right atrium despite fluoroscopic evaluation. A postoperative CT scan demonstrated that the bullet had migrated into the coronary sinus. Lastly, this case demonstrates successful positioning maneuvers to dislodge the bullet out of the heart and into the inferior vena cava, allowing for the endovascular extraction of the bullet.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

A Lost Bullet in the Coronary Sinus: A Cautionary Tale

et al. 2022

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“…These cases will have no exit wound and can present with embolization. 15 The treatment depends on the final destination site of the bullet fragment and compromise of adjacent structures and should be individualized. Some studies suggest that all intracardiac emboli should be surgically removed.…”

Section: Discussionmentioning

confidence: 99%

Case Illustrations of the Utility of Echocardiography in Gunshot Wound Trauma

Nandkeolyar

Bansal

Floridia

et al. 2022

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Management of intracardiac bullet embolisation and review of literature

et al. 2022

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Vascular injury is a common complication in firearm injuries; however, intravascular missile embolism is relatively rare. There are only 38 documented cases of intravascular missile embolisation to the heart. Bullet embolisms are difficult to diagnose even with multiple diagnostic modalities and even once identified, the most optimal choice of surgical management is debated. Our patient presented with a gunshot wound to the right posterior shoulder. Cardiac focused assessment with sonography for trauma, chest X-ray, CT and echocardiogram were performed, showing missile location adjacent to the right ventricle with inconclusive evidence of pericardial injury. Exploratory median sternotomy was performed, revealing intact pericardium and injury to the superior vena cava (SVC) with bullet embolisation to the right ventricle. The patient became temporarily asystolic secondary to haemorrhage from the SVC injury. Cardiac massage was performed, dislodging the missile into the inferior vena cava. A venotomy was performed to retrieve the bullet and vascular injuries were primarily repaired.

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An unusual shot‐retrograde transthoraco‐abdominal venous bullet embolization

Cited by 4 publications

References 8 publications

A Lost Bullet in the Coronary Sinus: A Cautionary Tale

A Lost Bullet in the Coronary Sinus: A Cautionary Tale

Case Illustrations of the Utility of Echocardiography in Gunshot Wound Trauma

Management of intracardiac bullet embolisation and review of literature

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