Makramalla Abouelmagd, Buchino James, Johannigman Jay, Ristagno Ross
University of Cincinnati, 234 Goodman St, Cincinnati, OH 45267-0761, USA.
Radiol Case Rep. 2018 Jul 29;13(5):940-944. doi: 10.1016/j.radcr.2018.06.014. eCollection 2018 Oct.
Venous bullet embolism is a rare complication of trauma. We describe a patient who sustained a gunshot wound. Computed tomography revealed antegrade embolization of the bullet to the right hepatic vein (RHV). The risk of not retrieving the bullet embolus and subsequent embolization to the pulmonary circulation includes pulmonary artery thrombosis, bleeding, or abscess formation. The bullet was retrieved through right internal jugular vein access; assisted by percutaneous transhepatic repositioning and endovascular balloon-immobilization of the bullet. The balloon served to "isolate" the bullet within the RHV to avoid the risk of endovascular migration to the pulmonary circulation. Transhepatic access allowed repositioning of the bullet within the RHV leading to successful snare retrieval. This technique demonstrates advantages of percutaneous and endovascular accesses, that repositioned and immobilized the bullet in the RHV to accomplish controlled endovascular retrieval.
静脉子弹栓塞是创伤的一种罕见并发症。我们描述了一名遭受枪伤的患者。计算机断层扫描显示子弹顺行栓塞至右肝静脉（RHV）。不取出子弹栓子以及随后栓塞至肺循环的风险包括肺动脉血栓形成、出血或脓肿形成。通过右颈内静脉通路取出子弹；在经皮经肝重新定位和血管内球囊固定子弹的辅助下进行。球囊用于将子弹“隔离”在右肝静脉内，以避免血管内迁移至肺循环的风险。经肝通路允许在右肝静脉内重新定位子弹，从而成功用圈套器取出。这项技术展示了经皮和血管内通路的优势，即将子弹在右肝静脉内重新定位并固定，以完成可控的血管内取出。
