Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 8 , ISSUE 2 ( May-August, 2019 ) > List of Articles

CASE REPORT

Pulmonary Artery Bullet Emboli: To Retrieve or Not? A Contemporary Reassessment

Stephanie Goldberg, Anthony Cassano, Rao R Ivatury

Keywords : Bullet, Chest, Embolus, Penetrating trauma, Pulmonary artery

Citation Information : Goldberg S, Cassano A, Ivatury RR. Pulmonary Artery Bullet Emboli: To Retrieve or Not? A Contemporary Reassessment. Panam J Trauma Crit Care Emerg Surg 2019; 8 (2):96-101.

DOI: 10.5005/jp-journals-10030-1243

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Aim: We present two patients with bullet emboli to the pulmonary artery and discuss their management based on a review of the literature. Background: Bullet emboli to the pulmonary arteries from abdominal gunshot wounds are rare. It is unclear whether these bullets should be removed in stable, asymptomatic patients. Case description: We discuss the management of two cases of bullet emboli to the pulmonary arteries and the associated morbidity and mortality, based on a thorough review of the relevant literature. Conclusion: We recommend elective removal of the asymptomatic bullet to the pulmonary artery once patients have been appropriately resuscitated or on a close follow-up of the compliant patient. Clinical significance: The complex management of these patients necessitates an individualized management with a collaborative approach between cardiothoracic and trauma surgeons.


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  1. Shannon FL, McCroskey BL, et al. Venous bullet embolism: rationale for mandatory extraction. J Trauma 1987 Oct;27(10):1118–1122. DOI: 10.1097/00005373-198710000-00004.
  2. Miller KR, Benns MV, et al. The Evolving Management of Venous Bullet Emboli: A Case Series and Literature Review. Injury Int J Care Injured 2011;42:441–446. DOI: 10.1016/j.injury.2010.08.006.
  3. Rehm C, Alspaugh JP, et al. Bullet embolus to the right hepatic vein after agunshot wound to the heart and its percutaneous retrieval. J Trauma 1988;28(5):719–720. DOI: 10.1097/00005373-198805000-00035.
  4. Patel KR, Cortes LE, et al. Bullet embolism. J Cardiovasc Surg (Torino) 1989;30(4):584–590.
  5. Schmelzer V, Mendez-Picon G, et al. Case report: transthoracic retrograde venous bullet embolization. J Trauma 1989;29(4):525–527. DOI: 10.1097/00005373-198904000-00021.
  6. Vázquez-Valdés E, Centeno-Olguín V, et al. Embolism caused by a bullet. Report of a case and review of the literature. Rev Invest Clin 1989;41(1):57–62.
  7. Michelassi F, Pietrabissa A, et al. Bullet emboli to the systemic and venous circulation. Surgery 1990;107(3):239–245.
  8. John LC, Edmondson SJ. Bullet pulmonary embolus and the role of surgery. Thorac Cardiovasc Surg 1991 Dec;39(6):386–388. DOI: 10.1055/s-2007-1020007.
  9. Van Arsdell GS, Razzouk AJ, et al. Bullet fragment venous embolus to the heart: case report. J Trauma 1991;31(1):137–139. DOI: 10.1097/00005373-199101000-00027.
  10. Colquhoun IW, Jamieson MP, et al. Venous bullet embolism: a complication of airgun pellet injuries. Scott Med J 1991;36(1):16–17. DOI: 10.1177/003693309103600107.
  11. Kortbeek JB, Clark JA, et al. Conservative management of a pulmonary artery bullet embolism: case report and review of the literature. J Trauma 1992;33(6):906–908. DOI: 10.1097/00005373-199212000-00020.
  12. Martí V, Augé JM, et al. Bullet embolism of the right ventricle following gunshot wound. Rev Esp Cardiol 1992;45(7):489–491.
  13. Nazir Z, Esufali ST, et al. Venous bullet embolism: a case report and review of the literature. Injury 1992;23(8):561–563. DOI: 10.1016/0020-1383(92)90163-M.
  14. Nagy KK, Massad M, et al. Missile embolization revisited: a rationale for selective management. Am Surg 1994;60(12):975–979.
  15. O'Neill PJ, Feldman DR, et al. Trans-jugular extraction of bullet embolus to the heart. Mil Med 1996;161(6):360–361. DOI: 10.1093/milmed/161.6.360.
  16. Panichabhongse V, Kasantikul V, et al. Bullet embolus to the right pulmonary artery after abdominal gunshot wound with “piggyback bullet”. J Med Asso Thai 1996 Oct;79(10):676–679.
  17. Schurr M, McCord S, et al. Paradoxical bullet embolism: case report and literature review. J Trauma 1996;40(6):1034–1036. DOI: 10.1097/00005373-199606000-00034.
  18. Headrick Jr JR, Mugosa M, et al. Venous bullet embolism: controversies in management. Tenn Med 1997;90(3):103–105.
  19. Lodder JV. Venous bullet embolism. a case report. S Afr J Surg 1997;35(2):94–97.
  20. Schöpf R, Lungenschmid D, et al. Bullet embolism in the right pulmonary artery. Aktuelle Radiol 1998;8(4):203–204.
  21. Kaushik VS, Mandal AK. Non-surgical retrieval of a bullet embolus from the right heart. Catheter Cardiovasc Interv 1999;47(1):55–57. DOI: 10.1002/(SICI)1522-726X(199905)47:1<55::AID-CCD12>3.0.CO;2-H.
  22. Pollak S, Ropohl D, et al. Pellet embolization to the right atrium following double shotgun injury. Forensic Sci Int 1999;99(1):61–69. DOI: 10.1016/S0379-0738(98)00177-7.
  23. Obermeyer RJ, Fecher A, et al. Embolization of bullet to the right ventricle. Am J Surg 2000;179(3):189. DOI: 10.1016/S0002-9610(00)00290-7.
  24. Luison F, Inculet RI. Soft-tissue images. Bullet embolism. Can J Surg 2001;44(4):258.
  25. Best IM. Transfemoral extraction of an intracardiac bullet embolus. Am Surg 2001;67(4):361–363.
  26. Wales L, Jenkins DP, et al. Delayed presentation of right ventricular bullet embolus. Ann Thorac Surg 2001;72(2):619–620. DOI: 10.1016/S0003-4975(00)02580-7.
  27. Kalimi R, Angus LD, et al. Bullet embolization from the left internal iliac vein to the right ventricle. J Trauma 2002;52(4):772–774. DOI: 10.1097/00005373-200204000-00030.
  28. Lucena JS, Romero C. Retrograde transthoracic venous bullet embolism. report of a case following a single gunshot with multiple wounds in the left arm and chest. Forensic Sci Int 2002;125(2–3):269–272. DOI: 10.1016/S0379-0738(02)00010-5.
  29. Berkan O, Günay I. An unusual case of birdshot embolism. Circ J 2002;66(7):707–708. DOI: 10.1253/circj.66.707.
  30. Corbett H, Paulsen EK, et al. Paradoxical bullet embolus from the vena cava: a case report. J Trauma 2003;55(5):979–981. DOI: 10.1097/01.TA.0000028835.94166.68.
  31. Bertoldo U, Enrichens F, et al. Retrograde venous bullet embolism: a rare occurrence-case report and literature review. J Trauma 2004;57(1):187–192. DOI: 10.1097/01.TA.0000135490.10227.5C.
  32. Bett N, Walters L. Delayed presentation of right ventricular bullet embolus. Heart 2004;90(11):1298. DOI: 10.1136/hrt.2004.037804.
  33. Demirkilic U, Yilmaz AT, et al. Bullet embolism to the pulmonary artery. Interact Cardiovasc Thorac Surg 2004;3(2):356–358. DOI: 10.1016/j.icvts.2004.02.002.
  34. Hughes BD, Vender JR. Delayed lead pulmonary emboli after a gunshot wound to the head. Case report. J Neurosurg 2006;105(3 Suppl):233–234.
  35. Agarwal SK, Singh A, et al. Wandering bullet embolizing to the pulmonary artery: a case report. Asian Cardiovasc Thorac Ann 2007;15(2):154–156. DOI: 10.1177/021849230701500215.
  36. Bining HJ, Artho GP, et al. Venous bullet embolism to the right ventricle. Br J Radiol 2007;80(960):e296–e298. DOI: 10.1259/bjr/64277826.
  37. Breeding JM, Smith RS, et al. Bullet embolus to the heart after gunshot wound to the neck: a case report. Am Surg 2007;73(12):1245–1246.
  38. Chen JJ, Mirvis SE, et al. MDCT diagnosis and endovascular management of bullet embolization to the heart. Emerg Radiol 2007;14(2):127–130. DOI: 10.1007/s10140-007-0592-2.
  39. Dulić G, Candrlić K, et al. Pulmonary embolism caused by a migrated gunshot projectile. Coll Antropol 2007;31(2):629–631.
  40. Ettinger J, Hohlenwerger C, et al. Cardiac bullet embolus after thoracic vena cava penetrating injury causing tricuspid valve insufficiency. Int J Surg 2007;5(1):66–68. DOI: 10.1016/j.ijsu.2006.04.008.
  41. Bors V, Aubert S, et al. Bullet embolization from the left brachiocephalic vein to the right ventricle. J Card Surg 2008;23(2):176–177. DOI: 10.1111/j.1540-8191.2007.00515.x.
  42. Engelgardt P, Wolska E, et al. Bullet embolism. Arch Med Sadowej Kryminol 2008;58(4):224–227.
  43. Raikar SS, Jureidini SB, et al. The fantastic journey of a bullet: out with a snare. Pediatr Cardiol 2009;31(1):108–110.
  44. Jo C, Steed MB, et al. Bullet embolus to the pulmonary artery after gunshot wound to the face: case report and review of literature. J Oral Maxillofac Surg 2010;68(3):504–507. DOI: 10.1016/j.joms.2009.04.052.
  45. Nolan T, Phan H, et al. Bullet embolization: multidisciplinary approach by interventional radiology and surgery. Semin Intervent Radiol 2012 Sep;29(3):192–196. DOI: 10.1055/s-0032-1326928.
  46. Mctyre E, McGill L, et al. Missile pulmonary embolus secondary to abdominal gunshot wound. RCR 2012;7:2–3. DOI: 10.2484/rcr.v7i3.709.
  47. Fernandez-Ranvier GG, Mehta P, et al. Pulmonary artery bullet embolism-Case report and review. Int J Surg Case Rep 2013;4(5):521–523. DOI: 10.1016/j.ijscr.2013.02.017.
  48. Yamanari MGI, Mansur MCD, et al. Bullet embolism of pulmonary artery: a case report. Radiol Bras 2014 Mar-Apr;47(2):128–130. DOI: 10.1590/S0100-39842014000200018.
  49. Doud AN, Hines MH, et al. Management of Venous Bullet Embolus in a Child. Am Surg 2014 Sep;80(9):832–833.
  50. Lu K, Gandhi S, et al. Approach to Management of Intravascular Missile Emboli: Review of the Literature and Case Report. West J Emerg Med 2015;16(4):489–496. DOI: 10.5811/westjem.2015.5.25553.
  51. Duke E, Peterson AA, et al. Migrating bullet: a case of a bullet embolism to the pulmonary artery with secondary pulmonary infarction after gunshot wound to the left globe. Emerg Trauma Shock 2014 Jan;7(1):38–40. DOI: 10.4103/0974-2700.125638.
  52. Echeverria A, Feliciano DV, et al. Pulmonary artery bullet embolism necessitating operative removal. Am Surg 2015 Feb;81(2):E80–E81.
  53. Pavlek S, Alempijevi D, et al. Unusual venous bullet embolism e Case report. J Forensic Leg Med 2016;42:33–36. DOI: 10.1016/j.jflm.2016.05.012.
  54. Imbert PY, Goin G, et al. Pulmonary Artery Bullet Embolism following Cardiac Gunshot Wound. Ann Vasc Surg 2016 Oct;36:290. DOI: 10.1016/j.avsg.2016.02.038.
  55. Wilkins T, Rosenkranz ER, et al. Venous bullet embolus to the left pulmonary artery. J Card Surg 2016;31:523–525. DOI: 10.1111/jocs. 12786.
  56. Stephenson LW, Workman RB, et al. Bullet emboli to the pulmonary artery: a report of 2 patients and review of the literature. Ann Thorac Surg 1976;21:333–336. DOI: 10.1016/S0003-4975(10)64322-6.
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