Download PDF
Int J Angiol 2023; 32(04): 258-261
DOI: 10.1055/s-0042-1745846
Case Report

A Lost Bullet in the Coronary Sinus: A Cautionary Tale

Martin Halicek 
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Hossam Alslaim 
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Mrinal Shukla
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Arthur M. Freedman
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
,
William B. Bates
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Vijay S. Patel
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Neal L. Weintraub
3   Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Michael Winkler 
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

We present a case of venous bullet embolism to the right atrium following a gunshot wound (GSW) to the abdomen. A 53-year-old male presented after a GSW to the abdomen. His workup included a computed tomography (CT) scan demonstrating an aortic injury with aortocaval fistula. A radio-opaque object consistent with a bullet was visualized in the right atrium. First, this case details an important decision, choice of surgery versus an interventional approach. After repair of the aortocaval fistula, the patient underwent a planned attempt to extract the bullet through a right lateral thoracotomy approach utilizing cardiopulmonary bypass to facilitate a right atriotomy. Intraoperatively, the team was not able to localize the bullet in the right atrium despite fluoroscopic evaluation. A postoperative CT scan demonstrated that the bullet had migrated into the coronary sinus. Lastly, this case demonstrates successful positioning maneuvers to dislodge the bullet out of the heart and into the inferior vena cava, allowing for the endovascular extraction of the bullet.

Keywords

bullet embolism - coronary sinus - foreign object - endovascular extraction

Patient Consent

Informed consent was not required to be obtained from the patient due to our institutions' institutional review board policies because no patient-identifying information is included for publication in this case report and accompanying images.




Publication History

Article published online:
25 April 2022

© 2022. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Patel KR, Cortes LE, Semel L, Sharma PV, Clauss RH. Bullet embolism. J Cardiovasc Surg (Torino) 1989; 30 (04) 584-590
    PubMedGoogle Scholar
  • 2 Yoon B, Grasso S, Hofmann LJ. Management of bullet emboli to the heart and great vessels. Mil Med 2018; 183 (9-10): e307-e313
    CrossrefPubMedGoogle Scholar
  • 3 Salahuddin S, Faizal A, Koshy S, Koya MM. An unusual shot-retrograde transthoraco-abdominal venous bullet embolization. Catheter Cardiovasc Interv 2020; 95 (05) 978-981
    CrossrefPubMedGoogle Scholar
  • 4 Kawai H, Kato Y, Motoyama S, Sarai M, Ozaki Y. Coil migration into coronary sinus: a rare complication of percutaneous transhepatic obliteration of portal systemic collaterals. J Cardiovasc Comput Tomogr 2013; 7 (05) 326-327
    CrossrefPubMedGoogle Scholar
  • 5 Bertoldo U, Enrichens F, Comba A, Ghiselli G, Vaccarisi S, Ferraris M. Retrograde venous bullet embolism: a rare occurrence-case report and literature review. J Trauma 2004; 57 (01) 187-192
    CrossrefPubMedGoogle Scholar
  • 6 Fernandez-Ranvier GG, Mehta P, Zaid U, Singh K, Barry M, Mahmoud A. Pulmonary artery bullet embolism—case report and review. Int J Surg Case Rep 2013; 4 (05) 521-523
    CrossrefPubMedGoogle Scholar
  • 7 Kortbeek JB, Clark JA, Carraway RC. Conservative management of a pulmonary artery bullet embolism: case report and review of the literature. J Trauma 1992; 33 (06) 906-908
    CrossrefPubMedGoogle Scholar
  • 8 John LC, Edmondson SJ. Bullet pulmonary embolus and the role of surgery. Thorac Cardiovasc Surg 1991; 39 (06) 386-388
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Miller KR, Benns MV, Sciarretta JD. et al. The evolving management of venous bullet emboli: a case series and literature review. Injury 2011; 42 (05) 441-446
    CrossrefPubMedGoogle Scholar
  • 10 Kuo AH, Gregorat AE, Restrepo CS, Vinu-Nair S. Systematic review of civilian intravascular ballistic embolism reports during the last 30 years. J Vasc Surg 2019; 70 (01) 298-306.e6
    CrossrefPubMedGoogle Scholar