Arterial bullet embolism after thoracic gunshot wound

Abstract

Bullet embolization of the arterial or venous systems is a rare complication of penetrating gunshot injuries. A 29-year-old man presented at the emergency department with a gunshot wound to the left arm, which had transfixed the arm and entered the thorax, with no exit wound. Initial radiographies showed a projectile in the upper left thigh. Contrast-enhanced tomography showed a pseudo-aneurysm of the descending thoracic aorta and the bullet inside the proximal left superficial femoral artery. Physical examination found diminished left pedal pulses, and the patient complained of left toe numbness. Endovascular thoracic aortic pseudoaneurysm repair was performed, sealing the descending aortic orifice with an endograft, and thromboembolectomy/bullet retrieval was carried out via a left femoral incision, both successfully. Considering that diagnosis of missile emboli depends on a high degree of suspicion, physicians who manage gunshot wound patients must be acutely aware of the possibility of intravascular bullet embolism.

Air GunPellet Embolization to common femoral vein: A case report and literature review

“…However, the change of the location of the foreign body in X-ray lead to the decision to go to more invasive investigation, which is CT angiography, which determined the exact location of the pellet. Authors recommended conservative management of bullet or pellet for asymptomatic and inaccessible missiles [13] . Conservative management includes anticoagulation, regular follow up to determine any features of lead poising or migration.…”