Bullet Emboli in the Pulmonary and Systemic Arteries

Abstract

Bullet embolization into the systemic and the pulmonary circulation is a rare complication of penetrating wounds. From 1966 to 1975 10 patients with bullet embolus (5 in the systemic and 5 in the pulmonary arteries) were treated at Grady Memorial Hospital. The embolization occurred shortly after the initial injury in all cases except for two in which it occurred within two weeks. The patients with bullet embolus were either asymptomatic or some of those with systemic arterial embolization had symptoms and signs of acute arterial occlusion and some of the patients with pulmonary embolization had symptoms and signs of pulmonary embolus. The diagnosis was suspected in all cases because there was no wound of exit and because of the plain regional xray studies, the missile was not present in the expected area. The diagnosis was strengthened when, on screening xray studies of the rest of the body, the missile was found in a remote area and it was confirmed by arteriography. Embolectomy was performed in all cases of both groups except one with pulmonary embolus, and all patients did well and have no residual disability related to the embolus. This study suggests that bullet embolization to the systemic or pulmonary circulation occasionally occurs following bullet wound injury. The diagnosis should be strongly suspected when there is no exit wound and when roentgenographically the missile is not found in the suspected area. In such cases, screening xray pictures of the rest of the body should be obtained, and, if the bullet is found in a remote area, arteriography should be performed to confirm the diagnosis. Embolectomy should be done as soon as feasible and it usually affords very good results.

An unusual case of foreign body pulmonary embolus: case report and review of penetrating trauma at a pediatric trauma center

“…Most emboli to the systemic circulation typically require surgical intervention, as with one of our patients who required bullet embolectomy after arterial occlusion of the right femoral artery. Many authors have suggested that bullet emboli to the pulmonary vascular system should be removed due to the risks associated with leaving the emboli behind, including vessel erosion, embolization further distally, and infection [8,9]. Symbas and Harlaftis described 10 cases of bullet embolus, 5 to the pulmonary circulation (4 removed) and 5 to the systemic circulation (all removed) [9].…”

“…Survival is contingent upon rapid diagnosis and treatment of major injuries [2]. Embolization of traumatic foreign bodies is even more uncommon [3][4][5][6][7][8][9][10][11][12][13]. Recently, we successfully treated a patient with penetrating cardiac trauma with embolization of a foreign body to the pulmonary circulation without major operative intervention.…”

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

“…Pacientes são assintomáticos em cerca de 70% dos casos 1,6 .Os sintomas, quando presentes, dependem da localização do êmbolo e associação com complicações como dor, dispnéia, astenia, hemorragia, trombose, arritmias, disfunção valvar, endocardite, sepse, erosão ou oclusão vascular 3,4,7,8 . O deslocamento do projétil pode ser favorecido pela baixa velocidade e pequeno calibre do projétil, envolvendo a circulação pulmonar ou sistêmica, via sistema venoso ou arterial 9 .…”

“…Dentre as diversas modalidades de tratamento disponíveis, a cirurgia endovascular tem ganhado cada vez mais espaço por suas vantagens em relação à cirurgia aberta, como o uso de anestesia local e a menor morbimortalidade 3,4,[7][8][9] . A cirurgia endovascular tem sido também considerada como primeira opção de tratamento para êmbolos móveis, sendo a técnica mais freqüentemente utilizada a remoção percutânea por cateteres do tipo cesta (basket) ou laço (snare) 11 .…”

“…Desde então, foram relatados na literatura diversos outros tipos de materiais relacionados à embolia pós-traumática ou iatrogênica, como agulhas, ponta de cateter, fragmentos metálicos e projéteis de arma de fogo [1][2][3][4][5][6][7][8][9][10][11][12] .…”