Successful treatment and survival after gunshot wound to the aortic arch with bullet embolism to superficial femoral artery

Gunshot Wound to the Right Superior Pulmonary Vein With Bullet Embolization to the Aortic Bifurcation: Emergent Surgical Repair

Bullet embolization is a rare complication of gunshot wound injuries with most of the literature consisting of case reports. We report a case regarding bullet embolization to the distal aorta following entry into the right superior pulmonary vein as a result of a gunshot wound to the posterior chest. The patient presented with signs of lower extremity ischemia. Imaging revealed an intrabdominal bullet at the level of L4 and laparatomy identified the bullet to be within the aorta at the bifurcation. Successful repair of the cardiac injury and removal of the intra-aortic bullet were achieved by sternotomy and laparatomy.

Bullet embolism: a rare cause of acute ischaemia

Embolization of a bullet or shrapnel from the heart (left ventricle) to the peripheral arterial circulation is practically unknown. We present a 38-year-old man with no comorbidities who was referred to our centre with a bullet injury to the left side of his chest. The patient complained of mild pain and numbness in his right lower limb. A trauma series was advised. A contrast angiogram of the peripheral lower limbs showed a bullet in the right popliteal artery with no flow in the tibial arteries. A bullet was removed from the distal popliteal artery at its bifurcation with a long thrombus proximal to it. Removal of the foreign body is the widely accepted management, especially when it leads to symptoms like ischaemia or signs of infection, as was the situation in our case.

Missile embolisation to the right common femoral artery following thoracic injury, without any conspicuous source of entry

Embolisation of a projectile metallic body in the arterial system is not an unusual entity and has been reported off and on, in literature. We report the successful treatment and survival of a patient with thoracic injury, with a metallic projectile embolisation to the right common femoral artery and acute limb ischemia. Curiously, there was no identifiable entry point, on multiple imaging. The patient remained functionally independent, and without any complication on discharge.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12055-021-01291-1.

Gunshot Wounds Causing Distal Arterial Bullet Embolisms

We report two cases involving small-caliber gunshot wounds to the chest with embolization of the bullet which complete occluding arterial circulation into the left lower extremity. A 30-years-old and 19-years-old men suffered gunshots wound to the thorax and abdomen with subsequent arterial embolisms into their left legs. Image studies revealed the left popliteal and femoral arteries occlusion by the missiles. Arteriotomies were auspiciously performed to retrieve the projectiles along with Fogarty catheters thrombectomies which conclude successful outcomes. At a 6 and 36 months' follow-up, the patients were doing well without any vascular associated complications. Bullet embolization of the arterial or venous systems is a rare complication of penetrating gunshot injuries with diagnostic and therapeutic challenges. This complication's suspicion should rise when there is a gunshot injury without an exit wound and with sudden pain or ischemia in an extremity. Individualized treatment should be urgently performed to avoid irreversible damage to the affected area.

A Magic Bullet: Bullet Embolism From the Heart to the Femoral Artery

A case study a patient who was emergently evaluated with an intraoperative transesophageal echocardiography after suffering a gunshot wound to the back is provided. This diagnostic examination revealed a left atrium to aorta fistula, due to the path of the bullet through the body. Immediate postoperative imaging with computed tomography revealed that the bullet had embolized to the left femoral artery from which it was later surgically removed. This rare clinical phenomenon of bullet embolization, involving the heart and associated vasculature, is reviewed.

The wandering bullet: An unusual case of paradoxical embolization involving the neck, aortic arch, and iliac artery

Paradoxical intravascular bullet embolism involving the aortic arch (AA) is a rare and highly lethal condition. We describe an unusual case of a civilian gunshot injury to the neck. A bullet entered in the neck, injured the internal jugular vein (IJV), and then continued into the lumen of the common carotid artery (CCA). The bullet traveled under its own momentum and against the flow of blood, along the carotid and brachiocephalic vessels, finally lodging in the wall of the lesser curvature of the AA. The injury tract resulted in an arterial-venous fistula between IJV and CCA and a pseudoaneurysm of the AA. Open surgical repair of the neck and AA was complicated by secondary distal embolization of the bullet, requiring an embolectomy.