Case report - Embolic shotgun pellet to the right internal carotid artery causing hemiplegia

Intravascular ballistic embolism is a rare and complex medical condition, posing diagnostic and management challenges. It involves the migration of ballistic materials within the arterial system, often stemming from neck and chest injuries.

A 13-year-old boy sustained a chest injury from an air rifle, leading to a pellet embolism in the right internal carotid artery, resulting in severe cerebral infarction. Despite intervention attempts, the lodged pellet left the patient with permanent hemiplegia.

Intravascular ballistic embolism, although infrequent, presents diagnostic and therapeutic complexities. Embolization can manifest after a delay, with neck and chest injuries serving as common entry points. This case raised potential embolization routes through the left ventricle or a chest wound to the aortic arch or right common carotid artery. Management strategies for intravascular ballistic embolism remain debated. Some cases are conservatively treated, while others undergo surgical or radiological procedures to remove the foreign body. These interventions carry risks, such as foreign body migration and reperfusion injury.

Effectively managing intravascular ballistic embolism necessitates a deep understanding of possible embolization routes and a careful evaluation of intervention risks. Collaborative research efforts are pivotal in establishing optimal management strategies for these intricate cases.