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Arterial bullet embolism after thoracic gunshot wound

2018; Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV); Volume: 17; Issue: 3 Linguagem: Inglês

10.1590/1677-5449.005315

1677-7301

Raquel Magalhães Pereira, José Emerson dos Santos Souza, Antônio Oliveira de Araújo, Priscilla Ribeiro dos Santos, Ricardo Dias da Rocha, Marcos Henrique Parisati, Marcos Velludo Bernardes, Leonardo Pessoa Cavalcante,

Vascular Procedures and Complications

Abstract Bullet embolization of the arterial or venous systems is a rare complication of penetrating gunshot injuries. A 29-year-old man presented at the emergency department with a gunshot wound to the left arm, which had transfixed the arm and entered the thorax, with no exit wound. Initial radiographies showed a projectile in the upper left thigh. Contrast-enhanced tomography showed a pseudo-aneurysm of the descending thoracic aorta and the bullet inside the proximal left superficial femoral artery. Physical examination found diminished left pedal pulses, and the patient complained of left toe numbness. Endovascular thoracic aortic pseudoaneurysm repair was performed, sealing the descending aortic orifice with an endograft, and thromboembolectomy/bullet retrieval was carried out via a left femoral incision, both successfully. Considering that diagnosis of missile emboli depends on a high degree of suspicion, physicians who manage gunshot wound patients must be acutely aware of the possibility of intravascular bullet embolism.