Approach to Management of Intravascular Missile Emboli: Review of the Literature and Case Report

Lu, Kevin; Gandhi, Sanjay; Qureshi, Moqueet A.; Wright, Andrew S.; Kantathut, Narongrit; Noeller, Thomas P.

doi:10.5811/westjem.2015.5.25553

Cited by 18 publications

(25 citation statements)

References 34 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…It is not surprising, therefore, that shotgun pellets and DOI: http://dx.doi.org/10.5772/intechopen. 90736 22-caliber bullets are the two most common projectiles associated with BSE [3,17,18]. In fact, the vast majority of the cases in literature feature bullets that are 0.38 caliber and smaller, with only one recorded case of a 0.40 caliber bullet embolism [18].…”

Section: Anatomic Pathophysiological and Diagnostic Considerationsmentioning

confidence: 99%

“…Given that significant proportion of BSE are sufficiently large to occlude a medium diameter vessel, the clinical relevance of bullet or shrapnel embolism becomes readily apparent. Not surprisingly, approximately 80% of arterial emboli are symptomatic and thus tend to present earlier and prompt more immediate treatment [3]. The foremost intervention utilized for arterial emboli is embolectomy, which is currently considered as the gold standard, with both open and endovascular techniques described [4,24].…”

Section: Anatomic Pathophysiological and Diagnostic Considerationsmentioning

confidence: 99%

“…With approximately only 300 published cases to date, bullet and shrapnel emboli (BSE) constitute a rare, but well-established, phenomenon in trauma [1][2][3]. The incidence of BSE has been reported to range between 0.3 and 1.1% of penetrating injuries, depending on the type of projectile, the setting of injury, and various patient characteristics [4].…”

Section: Introductionmentioning

confidence: 99%

“…The literature on the topic is heavily case-based, limiting both the generalizability and applicability of the findings [1][2][3]5]. Consequently, clinical progress appears to follow the publication of major case series and definitive reviews on the topic.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bullet and Shrapnel Embolism: When “Uncommon” Meets “Dangerous”

Dingley¹,

Darby²,

Irick³

et al. 2020

Embolic Diseases - Evolving Diagnostic and Management Approaches

View full text Add to dashboard Cite

Bullet and shrapnel embolism (BSE) is well described in the literature. Despite that, its rare occurrence creates a diagnostic challenge for providers tending to penetrating trauma victims. As with other forms of embolic phenomena, cases of BSE require a blend of superb clinical expertise and experience, as well as a high diagnostic index of suspicion. Management is highly individualized and spans a broad spectrum of options from "watchful waiting" to open heart surgery. Due to the risk of retained projectile migration through tissues, including erosion into surrounding anatomic structures, non-operative approaches warrant long-term clinical surveillance. When promptly recognized and treated appropriately, patients with BSE can be expected to have excellent clinical outcomes.

show abstract

Venous bullet embolism to the right ventricle: Case report and review of management

Henderson

Wachsman

Chikwe

et al. 2020

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

Approach to Management of Intravascular Missile Emboli: Review of the Literature and Case Report

Cited by 18 publications

References 34 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

Bullet and Shrapnel Embolism: When “Uncommon” Meets “Dangerous”

Venous bullet embolism to the right ventricle: Case report and review of management

Contact Info

Product

Resources

About