Bullet embolism after gunshot injury: a case report

We describe a case of gunshot injury presenting with cardiac tamponade in which a dummy bullet advanced through the aorta and caused embolization in the right renal interlobar artery after passing above the sternoclavicular joint and penetrating into the aorta. Emergency surgery with cardiopulmonary bypass was performed to repair the cardiac tamponade and aortic injury. Postoperatively, a direct abdominal x ray revealed a bullet image, confirmed by an ultrasonography examination that demonstrated the presence of a metal object in the right renal pelvis. The bullet was considered to have reached the kidney via an arterial route and to cause embolization in the distal bed. The procedure was successful, and the patient was discharged on postoperative day 8. In gunshot injuries, if all entrance points are not paired with exit points, the possibility of an organ or extremity embolism caused by the presence of a bullet or shrapnel fragments in circulation should be borne in mind, although such occurrences are rare.