Bullet embolism to the heart secondary to gunshot wound of the left subclavian vein: A case report

Ferreira, Gustavo de Sousa Arantes; Pfeffer, Jennifer; Aranha, Paulo Roberto de Souza; Benedicto, Lucas Soares Simizo; Pazeli, Luisa Jabour; Godinho, Camila Cordeiro; Moreira, Thaís Garcias; Belezia, Bruno de Freitas

doi:10.1016/j.tcr.2022.100639

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…In a case that de Sousa Arantes Ferreira et al reported, the patient underwent open surgery because the bullet's size was greater than 5 mm and its location was inside the right ventricle. In our case and the case reported by de Sousa Arantes Ferreira et al [7], the location of the missile was crucial in the decision to undergo surgical management to prevent the bullet from embolizing further with indeterminate consequences. Lastly, in a case reported by Busada et al, a bullet was located within the intrahepatic IVC, and the patient was treated with a hybrid approach with open and endovascular surgery.…”

Section: Discussionsupporting

confidence: 53%

“…Our cases describe embolization through the venous system, most commonly the inferior vena cava. However, the femoral and subclavian veins are potential access points for the bullet to embolize the heart and pulmonary system [ 7 ]. The first case demonstrates lodgment of the bullet within the pulmonary arterial branches of the right lower lobe with subsequent lung infarction due to poor perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Bullet retrieval is selected when the bullet is lodged within the myocardium, where an endovascular approach or open cardiothoracic surgery with or without cardiopulmonary bypass have been viable retrieval options. Open cardiothoracic surgery has been the most common approach when the bullet is embedded in the myocardium or its size is greater than 5 mm [ 2 , 7 ]. Other indications for open cardiothoracic surgery include symptomatic patients or bullets in the left side of the heart [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Open cardiothoracic surgery has been the most common approach when the bullet is embedded in the myocardium or its size is greater than 5 mm [ 2 , 7 ]. Other indications for open cardiothoracic surgery include symptomatic patients or bullets in the left side of the heart [ 7 ]. Endovascular retrieval has increased in frequency due to minimally invasive techniques, although open cardiothoracic surgery for bullet retrieval typically occurs when endovascular retrieval is unsuccessful [ 1 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Bullet Embolization After a Penetrating Gunshot Wound: A Case Report

Mussie,

Singh,

Kumaran

et al. 2023

Cureus

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Bullet embolization is an uncommon event after a penetrating gunshot wound. This phenomenon can occur in the venous or arterial vasculature, and patients can present with various symptoms. Physicians need to be familiar with the indications to suspect bullet embolization in patients with gunshot wounds to avoid crucial complications. We present two cases of venous bullet embolization following traumatic gunshot injuries. We will review the different types of bullet emboli, complications, and management.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Bullet Embolization After a Penetrating Gunshot Wound: A Case Report

Mussie,

Singh,

Kumaran

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Surgical intervention is recommended for large intracardiac projectiles (> 5 mm), those located in the left heart chamber, involvement of hollow viscera, symptomatic patients (defined as hemodynamic instability, pain, signs of ischemia), and arterial emboli. The surgical management of venous emboli is controversial as up to 70% are asymptomatic [7,15,16].…”

Section: Discussionmentioning

confidence: 99%

Projectile Embolism From a Firearm Injury: A Case Report

Zuluaga-Gomez,

Giraldo-Campillo,

González-Arroyave

et al. 2024

Cureus

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Projectile embolism resulting from firearm injuries is a rare but highly lethal complication when not diagnosed early. This report presents a case of projectile embolism from a firearm injury with an unusual entry site, the cerebral venous circulation, which subsequently migrates to the pulmonary circulation with a fatal outcome. A 24-year-old male patient was admitted to a high-complexity hospital due to a gunshot wound. A plain skull computed tomography (CT) revealed a left laminar subdural hematoma and traumatic subarachnoid hemorrhage with multiple metallic fragments embedded in the skull, some penetrating the galeal sinus, with perilesional bleeding. Contrast-enhanced chest tomography showed non-thrombotic embolism of metallic fragments in the pulmonary artery for the apical segment of the left upper lobe and right intraventricular regions. Transthoracic echocardiography revealed a hyperechoic image of 3 mm in the subvalvular apparatus toward the interventricular septum. Subsequently, the patient experienced neurological deterioration with signs of cerebral edema and parieto-occipital epidural hematomas with metallic fragments and projectiles. Measures to counteract cerebral edema were initiated. Later, the patient developed mydriasis, the absence of brainstem reflexes, and experienced cardiac arrest. This report delineates a case of projectile embolism, highlighting a distinctive aspect characterized by an unusual entry point.

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Diagnostic and therapeutic considerations in cases of civilian intravascular ballistic embolism: a review of case reports

Russell,

Vieira,

Freeman

et al. 2024

Trauma Surg Acute Care Open

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BackgroundBallistic embolism (BE) is a rare complication of firearm injuries notoriously associated with a vexing clinical picture in the trauma bay. Unless considered early, the associated confusion can lead to needless delay in the management of the patient with a gunshot wound. Despite this known entity, there is a relative paucity of high-grade evidence regarding complications, management, and follow-up in these patients.MethodsAn electronic database literature search was conducted to identify cases of acute intravascular BE in pediatric and adult civilians occurring during index hospitalization, filtered to publications during the past 10 years. Exclusion criteria included non-vascular embolization, injuries occurring in the military setting, and delayed migration defined as occurring after discharge from the index hospitalization.ResultsA total of 136 cases were analyzed. Nearly all cases of BE occurred within 48 hours of presentation. Compared with venous emboli, arterial emboli were significantly more likely to be symptomatic (71% vs. 7%, p<0.001), and 43% of patients developed symptoms attributable to BE in the trauma bay. In addition, arterial emboli were significantly less likely to be managed non-invasively (19% vs. 49%, p<0.001). Open retrieval was significantly more likely to be successful compared with endovascular attempts (91% vs. 29%, p<0.001). Patients with arterial emboli were more likely to receive follow-up (52% vs. 39%) and any attempt at retrieval during the hospitalization was significantly associated with outpatient follow-up (p=0.034). All but one patient remained stable or had clinically improved symptoms after discharge.ConclusionConsideration for BE is reasonable in any patient with new or persistent unexplained signs or symptoms, especially during the first 48 hours after a penetrating firearm injury. Although venous BE can often be safely observed, arterial BE generally necessitates urgent retrieval. Patients who are managed non-invasively may benefit from follow-up in the first year after injury.

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Bullet embolism to the heart secondary to gunshot wound of the left subclavian vein: A case report

Cited by 3 publications

References 10 publications

Bullet Embolization After a Penetrating Gunshot Wound: A Case Report

Bullet Embolization After a Penetrating Gunshot Wound: A Case Report

Projectile Embolism From a Firearm Injury: A Case Report

Diagnostic and therapeutic considerations in cases of civilian intravascular ballistic embolism: a review of case reports

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