Traumatic aortocaval fistula from gunshot wound, complicated by bullet embolization to the right ventricle

Aortocaval fistulas are most commonly the result of spontaneous rupture or erosion of an abdominal aortic aneurysm into the inferior vena cava (80-90%). The remaining 10-20% of aortocaval fistulas are usually the result of penetrating or iatrogenic trauma from gunshot or stab wounds. We report the case of a 19-year-old male, status post multiple gunshot wounds. To our knowledge, this is the first case report of bullet embolization to the right ventricle from a traumatic aortocaval fistula. We discuss pertinent imaging findings and management of both aortocaval fistulas and bullet emboli.