Images in Clinical Medicine
Bullet Embolism
N Engl J Med 1998; 339:812September 17, 1998
- Article
Figure 1 A 19-year-old man presented to the emergency room after sustaining a gunshot wound to the right side of his chest. He had a hemopneumothorax, but his condition was otherwise stable, and a chest drainage tube was inserted. Sixteen hours after admission, profound left-sided weakness developed, and the patient became progressively obtunded. A computed tomographic scan obtained soon thereafter revealed mild effacement of the right lateral ventricle. Hyperdensity of the right middle cerebral artery, indicating acute thrombus, was also present (arrowhead in Panel A). A carotid arteriogram revealed complete occlusion of the right internal carotid artery by the bullet (Panel B; the arrowhead indicates the bullet, the straight arrow indicates the common carotid artery, and the curved arrow indicates the external carotid artery). The bullet was surgically removed, but the patient's condition progressively worsened, and he died as a result of herniation. Autopsy indicated that the bullet had entered the pulmonary vein and traveled to the carotid artery, where it became lodged and caused the acute stroke.
Kumar Rajamani, M.D.
Mark Fisher, M.D.
University of Southern California School of Medicine, Los Angeles, CA 90033- Citing Articles (2)
Citing Articles
1
Gideon Sandler, Neil Merrett, Craig Buchan, Andrew Biankin. (2009) Abdominal Shotgun Wound With Pellet Embolization Leading to Bilateral Lower Limb Amputation: Case Report and Review of the Literature of Missile Emboli Over the Past 10 Years. The Journal of Trauma: Injury, Infection, and Critical Care 67:6, E202-E208
CrossRef2
R NGUYEN, A OUEDRAOGO, M DENEUVILLE. (2006) Gunshot Wounds to the Chest with Arterial Bullet Embolization. Annals of Vascular Surgery 20:6, 780-783
CrossRef
