Bullet emboli in the pulmonary and systemic arteries

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Radiology

Background:

• Bullet embolization into systemic or pulmonary circulation is a rare but serious complication of penetrating trauma.
• Diagnosis can be challenging due to varied patient presentations, ranging from asymptomatic to acute arterial or pulmonary embolism symptoms.

Purpose of the Study:

• To review cases of bullet embolization treated at Grady Memorial Hospital between 1966 and 1975.
• To highlight diagnostic clues and treatment outcomes for bullet emboli.

Main Methods:

• Retrospective review of 10 patients with bullet emboli (5 systemic, 5 pulmonary).
• Diagnostic methods included plain radiography, screening X-rays, and arteriography.
• Treatment involved surgical embolectomy.

Main Results:

• Embolization occurred shortly after injury in most cases.
• Diagnosis was suspected based on absence of exit wound and missile location on initial X-rays.
• Screening X-rays and arteriography confirmed bullet location.
• All treated patients, except one with pulmonary embolus, underwent successful embolectomy with no residual disability.

Conclusions:

• Bullet embolization is an occasional complication of penetrating wounds.
• Suspect bullet embolus when no exit wound is present and the missile is not in the expected location.
• Prompt diagnosis with imaging and timely embolectomy yield favorable results.