The Evolving Management of Venous Bullet Emboli: A case series and literature review

Embolism of a pellet after shotgun injury: from liver to right ventricle

“…[4] Migrating venous foreign bodies lodge in the right ventricle more often than in the pulmonary arterial tree, as they tend to be trapped beneath the tricuspid valve or chordae tendinae, eventually encapsulated with fibrous tissue. [4,7] Following encapsulation, the foreign body may remain silent, as in the present case, or result in valvular dysfunction or myocardial instability. Only one-third of venous embolizations become symptomatic, with symptoms most commonly including dyspnea, chest pain, and hemoptysis.…”

“…Bullet embolism should be suspected in any patient presenting with a gunshot entrance wound without exit wound, when signs and symptoms do not correlate with expected trajectory, and when radiographic location of a retained bullet changes during serial imaging. [7,11] X-ray, CT, and echocardiography can be utilized in the investigation of suspected foreign body embolism. X-rays can demonstrate the extent of bullet spread throughout the injury site.…”

“…[2,12] Advances in endovascular techniques and technology have increased use and success of bullet retrieval with a snare device since the method was first reported by Hartzler et al in 1980. [7,13] However, conservative management may be suitable in cases of asymptomatic venous embolism and when endovascular retrieval has failed. [14] Conservative management requires regular follow-up, with special attention to possible indications of embolus complications.…”

Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

“…6 To date, less than 200 cases have been described in the global medical literature. 4 Brazilian authors have described three cases of femoral artery embolization treated by conventional surgery over the last 12 years. Bullet embolization is difficult to diagnose and suspicion should be aroused by three observations, as follows: 1-inconsistency between the number of projectile entry and exit wounds, with no definitive confirmation by radiographic or intraoperative observation of projectiles within body cavities; 2-an X-ray showing the bullet in a body cavity distant from the presumed trajectory of the projectile; and; 3-finally, as in the case described here, serial…”

“…[2][3][4] We describe a case of bullet embolization of the abdominal aorta complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, which was treated using a hybrid approach.…”