Division of Surgery, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, NV.
Division of Pulmonary and Critical Care, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, NV.
Chest. 2023 Sep;164(3):e61-e63. doi: 10.1016/j.chest.2022.12.051.
Venous bullet embolism is an exceedingly rare trauma diagnosis that presents diagnostic and therapeutic challenges. We present the case of a 32-year-old man who sustained multiple gunshot wounds with a venous bullet embolism to the right pulmonary artery. Imaging at first demonstrated a bullet lodged within the right lower lobe. The patient underwent multiple bronchoscopies and ultimately was found to have a bullet embolus in the right pulmonary artery. Repeat endovascular attempts failed at removal, and during a right thoracotomy, the bullet migrated to the left pulmonary artery. Coil embolization of the left lower lobe pulmonary artery was performed, and the patient was found to be asymptomatic at the 1-year follow-up. To our knowledge, this is the first case to demonstrate coil embolization of the pulmonary artery as a method of endovascular treatment for a venous bullet embolus. We present this case report to emphasize the difficulty in diagnosis, localization, and management of a migratory bullet within the pulmonary circulation.
静脉子弹栓塞是一种极为罕见的创伤诊断，具有诊断和治疗方面的挑战。我们报告了 1 例 32 岁男性，其因多处枪伤导致静脉子弹栓塞至右肺动脉。最初的影像学检查显示，1 枚子弹位于右下肺叶内。患者接受了多次支气管镜检查，最终发现右肺动脉中有 1 枚子弹栓子。反复进行血管内取出尝试均未成功，在进行右侧开胸手术时，子弹迁移至左肺动脉。对左肺下叶肺动脉进行了线圈栓塞，患者在 1 年的随访中无症状。据我们所知，这是首例报道显示线圈栓塞肺动脉作为治疗静脉子弹栓塞的血管内治疗方法。我们提出这个病例报告，强调了在肺循环内的迁移性子弹的诊断、定位和处理的困难。
