Gunshot Wound to the Chest With Retained Epicardial Bullet.

Area of Science:

• Trauma Surgery
• Cardiovascular Surgery
• Emergency Medicine

Background:

• Gunshot wounds (GSWs) are a significant cause of penetrating trauma and mortality in children and adolescents in the U.S.
• Penetrating cardiac injuries have a high mortality rate, necessitating prompt diagnosis and intervention.
• Bullet trajectory, firearm type, and velocity influence the extent of damage in GSWs.

Observation:

• A 19-year-old male presented with a GSW to the right chest.
• Initial resuscitation included thoracotomy for hematoma evacuation.
• Surgical repair of cardiac and pulmonary injuries was performed; the bullet was initially not found.
• Postoperative imaging revealed a bullet lodged in the right ventricular outflow tract.

Findings:

• The patient survived a penetrating cardiac injury from a GSW.
• A bullet was successfully managed non-operatively after surgical repair of thoracic injuries.
• Close observation and appropriate imaging were crucial for managing the retained bullet.

Implications:

• The decision to retrieve or retain a bullet in penetrating cardiac injuries should be individualized.
• Non-operative management of retained bullets in specific cardiac injury cases can be feasible.
• This case highlights a successful outcome in a complex GSW with cardiac involvement, informing clinical practice.