Penetrating wound of the heart manifested with periphery embolism: Case report (original) (raw)

2012, Vojnosanitetski pregled

Heart injuries can be classified as penetrating and non-penetrating (blunt). Penetrating wounds are usually caused by stabbing with a piercing object, weapon or projectiles -missiles. The right atrium is damaged in most cases, because of its anatomical position -making the most of the anterior side of the heart. Morbidity caused by stabbing injuries to the heart is 20%-30%, while piercing wounds cause 30%-60% of deaths. Case report. A 28year-old patient was admitted to our clinic with acute ischemia of the extremities. Angiography revealed a bullet in the right common femoral artery, occluding it. The patient denied having any piercing or shooting wound to his leg, but he said that four years before he had been shot to his chest. Echocardiography revealed an atrial septal defect of secondary type. An event reconstruction revealed that, four years after shooting, the bullet was displaced from the heart to the right common femoral artery. Conclusion. This case report is unique because of the rare type of injury, time that passed from the injury, the way bullet entered the artery (via atrial septal defect) and especially the success of both surgical procedures (embolectomy and repair of atrial septal defect).

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Bullet embolization to the heart: A rare and confounding penetrating cardiac injury case report

International Journal of Surgery Case Reports, 2020

Gunshot wounds to the cardiac region usually result in devastating injuries. However, if bullets embolize into the myocardium without significant damage to the organ, optimal evaluation and management remains unclear. We present the case of a hemodynamically stable gunshot wound patient who presented with a bullet to the heart. Sternotomy revealed that the bullet had embolized through the superior vena cava and embedded into the apex of the right ventricle. The patient was managed without retrieval of the bullet and continues to be well despite a retained intracardiac bullet. We discuss cases of bullet embolization to the heart and the emergence of minimally-invasive approaches for management.

Left Ventricular Bullet Embolus: A Case Report and Review of the Literature

The Journal of Emergency Medicine, 2010

Missile embolization to the heart occurs infrequently in penetrating trauma. The lack of a concentrated experience at any single institution contributes to the controversies pertaining to diagnostic and therapeutic approaches to management. The objective of this study was to describe a case of a left ventricular bullet embolus and provide a detailed diagnostic and therapeutic framework for management of intracardiac projectiles. Initial management of a patient with suspected intracardiac projectiles is dictated by his or her hemodynamic status. Unstable patients generally require operative intervention. In the stable patient, associated injuries must be sought. Localization of the projectile can be aided by echocardiogram, fluoroscopy, or angiography. Definitive management is individualized, and can range from observation to percutaneous or operative extraction. The decision depends on the cardiac chamber involved, the patients' symptoms, and the projectile's size, shape, and location within the chamber. Missile embolus to the heart is an infrequent occurrence, but when found presents a diagnostic and therapeutic challenge. Management strategies should be individualized. A detailed management algorithm is provided.

Intravascular Bullet Embolism to the Right Atrium

Journal of Forensic Sciences, 2011

Bullet embolism is a relatively unusual complication of gunshot wounds. Embolism to the right atrium comprises <5% of all reported intravascular bullet emboli. We report an additional case of bullet embolus to the right atrium of a 0.38-caliber bullet following a gunshot wound to the chest. The intracardiac bullet was recognized radiologically on presentation, but the patient was hemodynamically stable and managed conservatively, with the bullet left in place. The missile remained within the heart without clinical significance for several years and was recovered from the right atrium only at the time of autopsy. To the best of our knowledge, this is the first documented case of a 0.38-caliber bullet which embolized to the right atrium and remained inconsequential for an extended period of time.

Heart Injury with Projectile Lodged Inside the Heart

Brazilian journal of cardiovascular surgery

Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

The Cardiothoracic Surgeon

Background Cardiac gunshot wounds with bullet embolism (BE) into the pulmonary artery are rare. Most pulmonary BE follow injuries of peripheral veins without concomitant cardiac injury. Herein, we describe a case of cardiac gunshot injury in which the bullet migrated from right atrium through the inferior vena cava down to right internal iliac vein and back to the left pulmonary artery. Such bullet migration is too rare and unusual and to our knowledge not reported before. Case presentation On March 4, 2019, a man of 39 had a bullet injury during celebratory gunfire. He was clinically stable with entrance on right posterior chest but no exit. Chest CT scan showed a bullet in the right atrium. The next day, the bullet migrated to the right pelvis as shown by plain chest and pelvic radiographs. CT angiography 3 weeks afterwards displayed the bullet in the right internal iliac vein. Meanwhile, the patient was asymptomatic, thus discharged home. However, 3 months later, he was readmitte...

Case Report Femoral Embolization after Cardiac Gunshot

Case Rep Emerg Med, 2018

Bullet embolism is an uncommon complication from heart gunshot injuries because most of the patients die immediately after trauma. The low frequency of this complication combined with the possible absence of symptoms makes the condition a challenge for the surgeon, delaying diagnostics and leading to severe complications or death. In this case, a small calibre bullet entered the left ventricle and then impacted the femoris artery.

Penetrating Cardiac Injury

Medical Principles and Practice, 2005

Objectives: To report a case of penetrating cardiac injury with patient's survival. Clinical Presentation and Intervention: A 23-year-old man stabbed with a knife to the epigastric area just below the right costal margin was brought to the Emergency Room, Al-Adan Hospital, Kuwait, in a state of shock. Aggressive resuscitation was performed, chest X-ray showed no evidence of hemo-or pneumothorax. Exploratory laparotomy was performed revealing a severely congested liver, with no intraperitoneal hemorrhage to explain his being in a state of shock. Left thoracotomy revealed pericardial tamponade with perforation in the right ventricle and hemorrhage. A mattress suture was used to control bleeding from the right ventricle. Postoperative echography revealed a tear in the interventricular septum and papillary muscle. Openheart surgery was performed to repair the injured tissues. The patient made an uneventful recovery. Conclusion: This report shows that patients with penetrating cardiac injuries and detectable vital signs on arrival at the hospital can be salvaged by prompt surgical intervention.

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