Innocuous cardiac gunshot that proved fatal: A bitter lesson learned

Mishra, Biplab; Joshi, Mohit; Kumar, Subodh; Kumar, Atin; Gupta, Amit; Rattan, Amulya; Sagar, Sushma; Singhal, Maneesh; Misra, Mahesh Chandra

doi:10.1016/j.cjtee.2016.05.006

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…The most common mechanisms of air entering the pericardial sac include: i) prolonged positive airway pressure, particularly in the presence of parenchymal pulmonary contusion; ii) direct communication with the external environment; iii) airflow from ruptured alveoli; iv) concomitant lesions of the esophagus or bronchial tree; and v) congenital communication of the pleural and pericardial spaces [12,13]. Yet if the visceral pleura remains intact, as in our case, the patient may develop isolated PPC, a clinical entity that appears to occur in less than 0.2% of chest trauma patients [3,14]. In cases of blunt chest trauma, PPC can occur as a result of alveolar rupture caused by a sudden rise in intrathoracic pressure, culminating in an air leak into the pericardium space in the presence of a pleuropericardial tear.…”

Section: Discussionmentioning

confidence: 66%

“…Other proposed mechanisms entail direct air entry into the pericardium via congenital or traumatic pleuro-pericardial contact, or from a force strong enough to rupture the trachea, bronchus, or pericardium [15]. As mentioned above, the air in the pericardium can infrequently compress the heart and cause tPPC, which presents radiographically as a globally small cardiac silhouette and clinical signs of cardiac tamponade [14]. tPPC following blunt trauma is an uncommon condition associated with increased fall height, as well as aortic, pericardial, and myocardial ruptures [2].…”

Section: Discussionmentioning

confidence: 99%

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Isolated Pneumopericardium: A Rare Manifestation of Penetrating Chest Trauma

Passos¹,

Fortounis²,

Papavasileiou³

2023

Cureus

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Pneumopericardium (PPC) is a clinical entity defined by the presence of air in the pericardial sac. It occurs mainly in patients who sustain blunt or penetrating chest trauma and may coexist with pneumothorax, hemothorax, rib fractures, and pulmonary contusions. Although it is a strong indicator of cardiac injury and therefore requires immediate attention for possible surgical treatment, it still remains a commonly misdiagnosed condition in the trauma bay. Only a few cases of isolated PPC associated with penetrating chest trauma have been reported to date. We present the case of a 40-year-old man who was stabbed in the anterior chest, specifically in the left subxiphoid area and left forearm. Imaging, which included chest x-ray, chest computed tomography, and cardiac ultrasound, demonstrated the presence of rib fractures in addition to isolated PPC, with no pneumothorax or active bleeding. The patient was managed conservatively and actively monitored for three days and remained hemodynamically stable upon discharge. PPC is an uncommon clinical entity, suggestive of severe thoracic trauma. Clinical features may include chest discomfort and dyspnea, while asymptomatic patients have also been reported. Since it can be monitored by electrocardiograms and cardiac ultrasound, its presence is not an absolute indicator for surgical intervention, while the treatment plan should be based on the patient's clinical indications and symptoms.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Isolated Pneumopericardium: A Rare Manifestation of Penetrating Chest Trauma

Passos¹,

Fortounis²,

Papavasileiou³

2023

Cureus

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“…The management of stable patients with asymptomatic intracardiac projectiles is debatable. It has been suggested that patients with retained bullets should be kept under observation without any intervention; surgery for removal of such foreign bodies may cause more damage to the surrounding structures than the projectile itself ( 5 ). However, careful assessment of the extent of damage by using multiple imaging modalities can help in individualizing treatment for every patient.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Gunshot Injury

et al. 2021

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Penetrating cardiac injuries carry a grave prognosis. We present a rare case of thoracic gunshot injury where the bullet ricocheted and lodged in the pericardium without causing damage to the adjacent cardiac structures. Multimodality imaging helped in localizing the bullet, assessing damage, and planning safe surgical removal without cardiopulmonary bypass. ( Level of Difficulty: Beginner. )

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“…Some recommend leaving in place as the short -term follow-up reported no adverse effects 1 . However, Mishra et al 2 . reported the death of a 26-year -->-old man after -->3 weeks of discharge with small pellet in the pericardium due to haemorrhagic effusion.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous retrieval of an embolized gunshot bullet from right ventricle: a case report and review of literature

Naeim¹,

Abuelatta²,

Sandogji³

et al. 2019

European Heart Journal - Case Reports

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Background Gunshots embolizing to the heart is a rare occurrence. We report a case of percutaneous retrieval of a gunshot bullet from the right ventricle (RV) cavity of a 40-year-old lady. To the best of our knowledge, this is the first case to be reported with a right supraclavicular inlet of the bullet and successful percutaneous retrieval using a snare from the RV cavity. Case summary A 40-year-old female patient was referred to our cardiac centre from a general hospital with a gunshot injury 8 days prior. On arrival, she was haemodynamically stable, there was an inlet wound at the right supraclavicular area. Transthoracic echocardiography revealed the bullet in the RV cavity. Under conscious sedation, right femoral vein access succeeded to retrieve the shot from the RV to the groin. The bullet slipped out and resnared from the right internal iliac vein and came out safely from the right femoral vein through the 24-Fr sheath. The vein was closed using a figure of 8 suture. The patient discharged home after 2 days. Discussion Bullet emboli to the heart are rare, endovascular retrieval of a bullet from the right ventricular cavity is feasible and relatively safe; however, more research is required. Echocardiography during the procedure is strongly recommended to early detect any complications. Accurate use of available tools such as X-ray, echocardiography, computed tomography, and fluoroscopy is a must for precise diagnosis.

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Innocuous cardiac gunshot that proved fatal: A bitter lesson learned

Cited by 4 publications

References 6 publications

Isolated Pneumopericardium: A Rare Manifestation of Penetrating Chest Trauma

Isolated Pneumopericardium: A Rare Manifestation of Penetrating Chest Trauma

Cardiac Gunshot Injury

Percutaneous retrieval of an embolized gunshot bullet from right ventricle: a case report and review of literature

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