[Intracardial migration of a bullet: diagnosis and management]

Venous pellet embolism to the cardia after shotgun wound is a very rare occurrence. Number and size of pellets, at the impact make this migration easier; embolism is asymptomatic and may occur 15 years after the injury. Many problems must be mentioned: mechanics of entry into the heart (own velocity, venous flow), topographic diagnosis (chest X-ray, transthoracic, transoesophageal ultrasound and CT-scan), local outcomes of this projectile (local erosion, clot, endocarditis), destination of a new migration (pulmonary embolism, left heart), indications of extraction, supervision. Extraction musn't be systematic, but only in the event of a patent foramen ovale with a risk of systemic embolism, which clinical outcomes are most serious or in the event of complications. The authors report on a 22 years old patient observation whose treatment was abstention and supervision.