Popliteal artery embolism of bullet after abdominal gunshot wound

Abstract

Bullet embolism to the peripheral arterial system is a rare phenomenon which frequently results in misdiagnosis due to lack of early symptoms. Embolisms can go to either arterial or venous systems with common sites of injury including the left ventricle, pulmonary vein, thoracic and abdominal aorta and peripheral arteries. Herein we present a case of a 19 year old patient with multiple gunshot wounds to the torso with a bullet embolism to the left popliteal artery necessitating embolectomy. This subsequently led to diagnosis and repair of an abdominal aortic psuedoaneurysm not clearly evident on initial imaging.

Femoral Embolization after Cardiac Gunshot

“…First, at the precise moment that the bullet passes into the heart, it must have a low kinetic energy in order to penetrate but not trespass the vessel or the heart. Second, the bullet must have a diameter less than the blood vessel to travel through the bloodstream [ 1 ]. In the crossing through the soft tissue and the bone tissue, there is a loss of kinetic energy that allows that penetration.…”

“…Without symptoms of limb ischemia, conservative management of impacted bullet has been reported [ 1 ]; however, embolectomy is the gold standard in the management of peripheral bullet arterial emboli [ 1 ]. The presence of an impacted bullet produces ischemia and infarction in most cases, although other complications such as the formation of a proximal clot, infection, and eventually death can also occur [ 14 ].…”

“…Bullet embolism is a rare, but potentially life-threatening, complication [ 1 , 2 ]. However, the rise in civilian trauma from low-velocity gunshot wounds increases the likelihood of encountering those kinds of lesions.…”

Femoral artery embolism of bullet after thoracic gunshot wound

“…3 Bullet embolism to the peripheral arterial system is an extremely rare phenomenon that frequently results in misdiagnosis because of lack of early symptoms. 4 The signs of acute arterial occlusion should always be evaluated; paresthesia, pain, pallor, pulselessness, poikilothermia, and paralysis are important to determine the duration of the ischemia and prognosis through the Rutherford classification. It is important to consider the possibility of a bullet embolism when entry and exit wounds are discordant.…”

Bullet and Shrapnel Embolism: When “Uncommon” Meets “Dangerous”

“…This, in turn, means that such projectiles are unlikely to embolize beyond the iliac arteries distally or the common carotid and subclavian arteries proximally. At the same time, shotgun projectiles can be found virtually anywhere in peripheral arterial or venous circulation, with each pellet measuring approximately 2 mm in diameter [26,27].…”