Gunshot Wound to the Thoracic Aorta with Peripheral Arterial Bullet Embolization

Embolia arterial periférica por projétil de arma de fogo em civis: diagnóstico confirmado pelo ultrassom vascular

“…Firearm bullets penetrating the pulmonary veins, left heart, aorta or large-caliber arteries of the thorax, abdomen and limbs may have enough energy to penetrate, but not to transfix the vessel, thus becoming an embolism. So, they travel through the blood flow until occluding a peripheral artery in a site that is distant from the initial perforation [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . As in all emergencies, an accurate diagnosis should made as soon as possible in order to minimize complications.…”

“…The migration of a firearm bullet through the circulatory tree can cause symptoms that mislead assistant doctors 10,12 , thus causing doubts as to diagnosis and treatment. Complications of such injuries also include: infection, pseudoaneurysm, and hemorrhage in the place where the projectile entered the circulation 14 .…”

“…Since it is rare, most reports consist of single cases, or with a small number of patients [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][23][24][25][26] . In civil trauma, 80% of the causes are caused by low-caliber bullets, with low speed [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] .…”

“…In civil trauma, 80% of the causes are caused by low-caliber bullets, with low speed [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . In case of acute arterial ischemia in a patient with trauma caused by firearm, the possibility of embolism caused by a projectile should be taken into account when it is not possible to visualize an exit hole, when the signs and symptoms are different from those expected due to lesions in organs that are in the supposed path of the projectile, and when the projectile is not visualized in imaging examinations 8,9,15 -considering that most arterial injuries caused by firearm are owed to lesions in the arterial wall, directly or indirectly.…”

“…To become an embolus, the bullet must penetrate the vessel lumen or the heart with only enough energy to cross one of the walls into the vessel, atrium or ventricle. For peripheral arterial embolism to occur, it should be transported in the blood stream from the entrance wound into the pulmonary circulation or from the left side of the heart or the aorta until the arterial point of occlusion [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Despite the existence of some cases in the literature of arterial and venous embolism due to trauma, cases in which the bullet becomes the arterial embolus itself are rare.…”