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Right ventricular gunshot wound with retrograde embolization.

Richard L McLaughlin1, Spyro Analitis, Stacy VanVleet

  • 1Trauma Services, Rockford Memorial Hospital, Rockford, Illinois, USA. rhamcmc@uic.com

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This case report details a rare instance of retrograde bullet embolization from the right ventricle to the inferior vena cava following a gunshot wound. The bullet was successfully retrieved via interventional radiology.

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Radiology
  • Trauma Surgery

Background:

  • Gunshot wounds to the heart are frequently reported, with bullet embolization often occurring in an antegrade direction.
  • Retrograde embolization of a bullet from the right ventricle into the inferior vena cava is an exceptionally rare event.
  • This report addresses a unique case of cardiac trauma with unusual bullet migration.

Observation:

  • A 15-year-old male sustained a gunshot wound to the chest, resulting in right ventricular perforation and cardiac tamponade.
  • Initial imaging confirmed a bullet within the right ventricle.
  • Post-tamponade relief, the bullet was found to have migrated retrograde into the inferior vena cava.

Findings:

  • A novel case of retrograde bullet embolization from the right ventricle to the inferior vena cava is presented.
  • The bullet was successfully retrieved from the inferior vena cava using fluoroscopic guidance and interventional radiology techniques.
  • The patient experienced a rapid recovery, with extubation within hours and discharge within 72 hours.

Implications:

  • This case highlights the importance of considering unusual bullet migration patterns in penetrating cardiac trauma.
  • It demonstrates the efficacy of a multidisciplinary approach involving interventional radiology and vascular surgery for managing complex embolized foreign bodies.
  • The successful retrograde retrieval offers a minimally invasive alternative for similar rare clinical scenarios.