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Case Reports
. 2018 Jul-Sep;17(3):262-266.
doi: 10.1590/1677-5449.005315.

Arterial bullet embolism after thoracic gunshot wound

Raquel Magalhães Pereira  1 , José Emerson Dos Santos Souza  2 , Antônio Oliveira de Araújo  3 , Priscilla Ribeiro Dos Santos  2 , Ricardo Dias da Rocha  2 , Marcos Henrique Parisati  2 , Marcos Velludo Bernardes  2   3 , Leonardo Pessoa Cavalcante  1   2   3
Affiliations
Case Reports

Arterial bullet embolism after thoracic gunshot wound

Raquel Magalhães Pereira et al. J Vasc Bras. 2018 Jul-Sep.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] J Vasc Bras. 2018 Jul-Sep;17(3):273. doi: 10.1590/1677-5449.001703. J Vasc Bras. 2018. PMID: 30644456 Free PMC article.

Abstract
in English, Portuguese

Bullet embolization of the arterial or venous systems is a rare complication of penetrating gunshot injuries. A 29-year-old man presented at the emergency department with a gunshot wound to the left arm, which had transfixed the arm and entered the thorax, with no exit wound. Initial radiographies showed a projectile in the upper left thigh. Contrast-enhanced tomography showed a pseudo-aneurysm of the descending thoracic aorta and the bullet inside the proximal left superficial femoral artery. Physical examination found diminished left pedal pulses, and the patient complained of left toe numbness. Endovascular thoracic aortic pseudoaneurysm repair was performed, sealing the descending aortic orifice with an endograft, and thromboembolectomy/bullet retrieval was carried out via a left femoral incision, both successfully. Considering that diagnosis of missile emboli depends on a high degree of suspicion, physicians who manage gunshot wound patients must be acutely aware of the possibility of intravascular bullet embolism.

A embolia balística pelo sistema arterial ou venoso é uma complicação rara de ferimentos penetrantes por arma de fogo. Um homem de 29 anos se apresentou na emergência com um ferimento por arma de fogo no braço esquerdo, que transfixou o braço e atingiu o tórax, sem ferimento de saída. Radiografias iniciais mostraram o projétil na coxa superior esquerda. A tomografia contrastada mostrou um pseudoaneurisma da aorta torácica descendente e o projétil no interior da artéria femoral superficial proximal esquerda. Ao exame físico, o pulso pedioso esquerdo estava diminuído e o paciente referiu dormência no hálux esquerdo. Foi realizado o reparo endovascular da aorta torácica e a tromboembolectomia/retirada do projétil por incisão femoral esquerda, ambos bem-sucedidos. Considerando que o diagnóstico de embolia balística depende de um alto grau de suspeição, os médicos que manejam pacientes com ferimentos por arma de fogo devem estar atentos a essa possibilidade.

Keywords: aorta; embolism; endovascular procedures; femoral artery; wounds gunshot.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Gunshot wound to the left arm that transfixed the anterior area of the arm and entered the thorax.
Figure 2
Figure 2. Contrast-enhanced tomography showing a pseudoaneurysm in the descending thoracic aorta.
Figure 3
Figure 3. Contrast-enhanced tomography showing the bullet inside the proximal superficial femoral artery.
Figure 4
Figure 4. Pigtail angiographic control after the initial right femoral puncture, showing the pseudoaneurysm in the descending thoracic aorta.
Figure 5
Figure 5. Retrograde positioning of a 24 mm × 130mm endograft that adequately sealed the descending thoracic aortic defect.
Figure 6
Figure 6. Bullet retrieval/thromboembolectomy after a left femoral incision.
See this image and copyright information in PMC

References

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