Pulmonary arterial embolus by an unusual wandering bullet

We report on a wandering bullet embolus to the left pulmonary artery after it had first passed from the right ventricular to the right renal vein via the inferior vena cava. Its presence in the left pulmonary artery was confirmed by pulmonary angiography. Hemorrhage due to the right ventricular wound was controlled by a median sternotomy and the bullet was extracted by left lateral thoracotomy. Intravascular migratory bullets continue to be a surgical curiosity. Clinical diagnosis may present a difficult aspect in emergency practice and angiography is mandatory. The removal of foreign bodies is recommended by the majority of authors.