Management of Bullet Emboli to the Heart and Great Vessels

Yoon, Brian; Grasso, Samuel; Hofmann, Luke J.

doi:10.1093/milmed/usx191

Cited by 28 publications

(39 citation statements)

References 56 publications

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“…reported a similar course of a bullet at 1982; he removed the bullet surgically. -->Yoon et al 4 did a very lovely search about management of bullet emboli to the heart in the last 55 years; he demonstrated most of the bullets embolized to RV, 30 cases reported, 19 cases underwent surgical removal, 6 cases managed by observation, and 5 cases attempted a trial of endovascular removal. Three of the five cases failed, and the bullet removed surgically.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…concluded that there are no established guidelines about the management of migrating bullets. The mortality rate for a retained bullet is 6% associated with complication in 25% of cases; the mortality rate decreases to 1–2% if the bullet is removed 4 . Carter et al 8 .…”

Section: Discussionmentioning

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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“…18 Factors associated with embolization of ballistic projectiles include vascular access from wounds, direct propulsion, vascular erosion, projectile size and shape, body position, gravity, muscular and respiratory motion, and other causes. [18][19][20][21] Ballistic projectiles entering the venous system with cardiac embolization commonly migrate to the right heart, especially the right ventricle, 22 with the pulmonary artery, lung, and other final destinations reported less frequently.…”

Section: Video Highlightsmentioning

confidence: 99%

Air Gun Ballistic Projectile Lodged in the Interventricular Septum of an Asymptomatic Dog

Fox

Hohenhaus

Kharbush

2020

CASE

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“…The true incidence in the civilian population is largely unknown. However, the rate may be higher given the prevalence of lower velocity weapons and lower kinetic energy [7].…”

Section: Introductionmentioning

confidence: 99%

“…Bullet emboli are either arterial (75%) or venous (20%). Very occasionally, BE may pass from veins to arteries (or vice versa) through a traumatic arteriovenous fistula (AVF) or an intra-cardiac communication [2,4,7]. Such (paradoxical) BE constituted 2.4% of emboli in Springer et al's review (Springer et al cited in [4]) while they reached 5% in other reports [2,7].The phrase "venous bullet emboli" refers to emboli to the right heart or pulmonary arteries [7].…”

Section: Introductionmentioning

confidence: 99%

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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Management of Bullet Emboli to the Heart and Great Vessels

Cited by 28 publications

References 56 publications

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

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

Air Gun Ballistic Projectile Lodged in the Interventricular Septum of an Asymptomatic Dog

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

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