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Management of intracardiac bullet embolisation and review of literature. BMJ Case Rep 2022 Mar 08;15(3)



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85126080200 (requires institutional sign-in at Scopus site)


Vascular injury is a common complication in firearm injuries; however, intravascular missile embolism is relatively rare. There are only 38 documented cases of intravascular missile embolisation to the heart. Bullet embolisms are difficult to diagnose even with multiple diagnostic modalities and even once identified, the most optimal choice of surgical management is debated. Our patient presented with a gunshot wound to the right posterior shoulder. Cardiac focused assessment with sonography for trauma, chest X-ray, CT and echocardiogram were performed, showing missile location adjacent to the right ventricle with inconclusive evidence of pericardial injury. Exploratory median sternotomy was performed, revealing intact pericardium and injury to the superior vena cava (SVC) with bullet embolisation to the right ventricle. The patient became temporarily asystolic secondary to haemorrhage from the SVC injury. Cardiac massage was performed, dislodging the missile into the inferior vena cava. A venotomy was performed to retrieve the bullet and vascular injuries were primarily repaired.

Author List

Nguyen P, Sirinit J, Milia D, Davis CS


Christopher Stephen Davis MD, MPH Associate Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Foreign-Body Migration
Vena Cava, Superior
Wounds, Gunshot