Sembiring Yan Efrata, Aldian Fan Maitri, Sukamto Amy Rosalie
Department of Thoracic Cardiac and Vascular Surgery, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia.
Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
Am J Case Rep. 2025 Aug 29;26:e948109. doi: 10.12659/AJCR.948109.
BACKGROUND Air rifles, frequently used in sports, can cause complex, violent, and traumatic cardiac injury associated with significant morbidity and mortality. Unlike firearm projectiles, air rifle pellets lack rotational movement but can achieve velocities of 100 to 230 m/s. CASE REPORT A 21-year-old man was referred to our hospital after sustaining an air rifle injury to the right chest. He presented 10 h after injury with chest pain but was hemodynamically stable. Physical examination revealed decreased breath sounds and tenderness in the right hemithorax. Chest X-ray showed right-sided hemothorax and pulmonary contusion, prompting chest tube placement, with initial drainage of 500 cc hemorrhagic fluid. Transthoracic echocardiography identified a hyperechoic mass in the right ventricle, with mild pericardial effusion. Computed tomography confirmed the projectile was lodged in the posterior right ventricle, 0.8 cm from the tricuspid annulus. Emergency surgery was performed and successfully extracted an intact 3×3×5 mm air gun pellet. Postoperatively, the patient experienced a brief tonic-clonic seizure, which was managed with midazolam and propofol. He received prophylactic ceftriaxone, intravenous phenytoin, vitamin B6, and folic acid and oral aspirin, ibuprofen, and omeprazole. The patient showed improvement by postoperative day 3 and was discharged on day 4. Weekly follow-ups and an EEG 1 month after discharge showed normal results. At the 2-month follow-up, the patient remained asymptomatic. CONCLUSIONS Awareness of cardiac penetrating wounds, bullet trajectory, and clinical signs, along with a multidisciplinary approach and patient-family involvement, is crucial for favorable outcomes and long-term follow-up.
背景 气步枪常用于体育运动，可导致复杂、剧烈且具有创伤性的心脏损伤，并伴有较高的发病率和死亡率。与火器发射物不同，气步枪子弹缺乏旋转运动，但速度可达100至230米/秒。病例报告 一名21岁男性因右胸部气步枪伤被转诊至我院。他受伤10小时后出现胸痛，但血流动力学稳定。体格检查发现右半侧胸廓呼吸音减弱及压痛。胸部X线显示右侧血胸和肺挫伤，遂行胸腔闭式引流，初始引流出500毫升血性液体。经胸超声心动图检查发现右心室内有一高回声团块，伴有少量心包积液。计算机断层扫描证实子弹嵌顿于右心室后壁，距三尖瓣环0.8厘米处。急诊手术成功取出一枚完整的3×3×5毫米气枪子弹。术后，患者出现短暂的强直阵挛性发作，使用咪达唑仑和丙泊酚进行处理。他接受了预防性头孢曲松、静脉注射苯妥英钠、维生素B6和叶酸以及口服阿司匹林、布洛芬和奥美拉唑治疗。患者术后第3天病情好转，第4天出院。出院后每周随访及出院1个月后进行脑电图检查均显示结果正常。在2个月的随访中，患者无症状。结论 了解心脏穿透伤、子弹轨迹和临床体征，采用多学科方法并让患者家属参与，对于取得良好预后和长期随访至关重要。
