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

Firearm injuries (FAIs) are a significant public health concern, often resulting in retained bullets (RBs) that pose management challenges. We present a 24-year-old male with a retained subcutaneous chest wall bullet ~2 cm lateral to the midclavicular line, causing persistent psychological distress and functional impairment. Initial attempts at bullet removal under local anesthesia failed, leading to nonoperative management. However, the patient's ongoing anxiety, fear of death, and inability to work necessitated reconsideration of treatment. Fluoroscopy-guided extraction under local anesthesia enabled precise localization of the RB and facilitated targeted dissection, avoiding blind exploration, minimizing tissue trauma, and eliminating the need for general anesthesia. The procedure was completed successfully with resolution of symptoms. The case underscores the importance of integrating psychological considerations into RB management and highlights fluoroscopy-guided extraction as a safe, minimally invasive, and effective technique for bullet removal, particularly in anatomically challenging cases or after failed blind exploration.