Fluoroscopic-Guided Removal of a Retained Bullet From the Chest Under Local Anesthesia

Area of Science:

• Trauma Surgery
• Public Health
• Medical Imaging

Background:

• Firearm injuries (FAIs) are a major public health issue.
• Retained bullets (RBs) present significant management challenges.
• Subcutaneous RBs can cause psychological distress and functional impairment.

Purpose of the Study:

• To describe a case of retained subcutaneous chest wall bullet.
• To evaluate fluoroscopy-guided extraction as a minimally invasive treatment.
• To highlight the importance of psychological factors in RB management.

Main Methods:

• A 24-year-old male with a retained chest wall bullet causing distress.
• Initial failed attempt at bullet removal under local anesthesia.
• Successful fluoroscopy-guided extraction under local anesthesia.

Main Results:

• Fluoroscopy enabled precise localization and targeted dissection of the retained bullet.
• The procedure avoided blind exploration and minimized tissue trauma.
• Successful bullet removal resolved patient's psychological distress and functional impairment.

Conclusions:

• Fluoroscopy-guided extraction is a safe and effective minimally invasive technique for RB removal.
• Psychological considerations are crucial in managing patients with retained bullets.
• This technique is particularly beneficial for anatomically challenging cases or after failed blind exploration.