Bullet embolism of pulmonary artery: a case report

Yamanari, M.; Mansur, Maria Clara Dias; Kay, Fernando Uliana; Silverio, P.R.B.; Jayanthi, S.; Funari, Marcelo Buarque de Gusmão

doi:10.1590/s0100-39842014000200018

Cited by 15 publications

(18 citation statements)

References 8 publications

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“…Moreover, bullet embolism should be suspected when a bullet lies outside the established trajectory, or a wandering bullet is demonstrated on radiographs [5]. A whole body radiography ± CT scan are often needed to make the diagnosis while angiography is usually reserved for supplementary diagnosis or may be used as therapeutic endovascular extraction procedure [1].…”

Section: Discussionmentioning

confidence: 99%

“…Venous BE may be complicated by pulmonary embolism, cardiac valve dysfunction, endocarditis, abscess formation, venous thrombosis, dysrhythmias, intraventricular communications, tissue erosion, hemorrhage, and cardiac ischemia. It is of interest to note that such complications may not occur immediately after the initial injury but may develop months, years, and even decades later [1,4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Besides the diameter of the bullet and its velocity, entrance profile and path of the bullet inside the body are important as well as the biological characteristics of the injured organ. Most high velocity bullets enter and leave the body in a straight trajectory while low velocity bullets may divert through bones or soft tissues and remain lodged, or may yet penetrate vessels, cardiac walls [1], or bowel [2] and behave as bullet emboli (BE) [3].…”

Section: Introductionmentioning

confidence: 99%

“…Unlike arterial BE, symptoms of venous BE are usually late and confined to just one-third of cases. Consequently, treatment of venous BE has remained controversial [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

Bakir¹,

Othman²,

Taha

2020

Cardiothorac Surg

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Unlike arterial BE, symptoms of venous BE are usually late and confined to just one-third of cases. Consequently, treatment of venous BE has remained controversial [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

Bakir¹,

Othman²,

Taha

2020

Cardiothorac Surg

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show abstract

“…In such cases, the radiological examination is critical to raising the diagnostic suspicion. Unlike foreign bodies composed of metal, bone, glass, or other radiopaque materials (2,3) , wooden objects are difficult to identify on radiological examinations. Only approximately 15% of wooden foreign bodies are identified on conventional X-rays (1) .…”

mentioning

confidence: 99%