Surgical Management of a Bullet Embolism to the Pulmonary Artery

Bullet embolism is a rare but potentially serious complication of a gunshot wound. This case report describes a 26-year-old male who presented with a gunshot to the lower back. Diagnostics revealed a migrating bullet that became lodged in the left pulmonary artery. After two unsuccessful attempts at endoscopic removal, the decision was made by the multidisciplinary team to retrieve the bullet surgically. The patient recovered well postoperatively. Four- and eight-month follow-up in the emergency department revealed no significant postoperative complications. Bullet embolism should be suspected when radiographs reveal a migrating projectile. Treatment options include conservative management, endoscopic bullet retrieval, and surgical removal. No guidelines for the management of a bullet embolism exist. Management should be based on the patient's clinical status and comorbidities, facility resources, and perceived risk of undergoing surgical retrieval of the bullet.