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Updated: Jun 30, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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
Insights
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.
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.
Abstract:
There have been numerous reports concerning gunshot wounds to the heart over the years. Many reports discuss bullets that have embolized and have migrated antegrade. However, there has never been a case reported on the retrograde embolization of a bullet from the right ventricle into the inferior vena cava. This case report involves a 15-year-old boy who was accidentally shot in the chest. The bullet entered at the mid-manubrial area, and penetrated the anterior wall of the right ventricle causing a tamponade. A chest x-ray film confirmed a bullet in the right ventricle. The patient was stabilized in the emergency department, and taken to the operating room for an emergent mediastinal exploration with evacuation of pericardial tamponade and repair of the right ventricle. After the tamponade was relieved, a Trans-Esophageal Echocardiogram was performed to locate the bullet, which could not be found in the ventricle. Chest and abdominal radiography were performed to locate the bullet. X-ray films confirmed that the bullet had migrated retrograde down into the inferior vena cava. Interventional radiology and vascular surgery departments were consulted. The consensus was to snag the bullet under fluoroscopic guidance, and pull it down into the right femoral vein for easy retrieval. The chest was closed and the patient was transferred from the surgery department to the interventional radiology department. Under fluoroscopy, the bullet was pulled down into the right common femoral vein. The bullet was extracted per venorrhaphy. The patient was extubated within hours after surgery and discharged home within 72 hours of surgery.
