Bullet embolism of pulmonary artery: a case report

The authors report the case of a patient victim of gunshots, with a very rare complication: venous bullet embolism from the left external iliac vein to the lingular segment of the left pulmonary artery. Diagnosis is made with whole-body radiography or computed tomography. Digital angiography is reserved for supplementary diagnosis or to be used as a therapeutic procedure.

Bullet embolism; Trauma; Computed tomography; Pulmonary arteriography

Authorship

Mauricio Gustavo Ieiri Yamanari

Physician Assistant at Instituto da Criança – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), Radiologist at Imaging Department – Hospital Israelita Albert Einstein, São Paulo, SP, BrazilUniversidade de São Paulo (ICr/HC-FMUSP)BrazilSão Paulo, SP, BrazilPhysician Assistant at Instituto da Criança – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), Radiologist at Imaging Department – Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

Maria Clara Dias Mansur

Fellow of Neuroradiology, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, BrazilUniversidade de São Paulo (InRad/HC-FMUSP)BrazilSão Paulo, SP, BrazilFellow of Neuroradiology, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil

Fernando Uliana Kay

Physicians Assistants, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), Radiologists at Imaging Department – Hospital Israelita Albert Einstein, São Paulo, SP, BrazilUniversidade de São Paulo (InRad/HC-FMUSP)BrazilSão Paulo, SP, BrazilPhysicians Assistants, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), Radiologists at Imaging Department – Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

Paulo Rogerio Barboza Silverio

Shri Krishna Jayanthi

Chief of Emergency Unit, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, BrazilUniversidade de São Paulo (InRad/HC-FMUSP)BrazilSão Paulo, SP, BrazilChief of Emergency Unit, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil

Marcelo Buarque de Gusmão Funari

Chief of Chest Division, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), Chief of Imaging Department – Hospital Israelita Albert Einstein, São Paulo, SP, BrazilUniversidade de São Paulo (InRad/HC-FMUSP)BrazilSão Paulo, SP, BrazilChief of Chest Division, Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), Chief of Imaging Department – Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

Mailing Address: Dr. Mauricio Gustavo Ieiri Yamanari. Rua Oscar Freire, 1735, ap. 131, Cerqueira César. São Paulo, SP, Brazil, 05409-011. E-mail: mauriciogustavo91@yahoo.com.br

*
Study developed at Instituto de Radiologia – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (4)

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Figure 1.
Plain chest radiography demonstrates the presence of a firearm projectile in the left pulmonary hilum. Neither pneumothorax, hemothorax nor fractures are identified.

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Figure 2.
Pelvic computed tomography (bone window) identifies presence of metal fragments adjacent to the left pelvic muscles.

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Figure 3.
Pelvic computed tomography (soft tissue window) demonstrates the presence of densification adjacent to left iliac vessels and a small amount of free fluid (arrow).

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Figure 4.
Pulmonary arteriography with selective characterization of left pulmonary artery demonstrates decreased blood flow toward the lingular segment of the left upper pulmonary lobe.

Figure 1. Plain chest radiography demonstrates the presence of a firearm projectile in the left pulmonary hilum. Neither pneumothorax, hemothorax nor fractures are identified.

Figure 2. Pelvic computed tomography (bone window) identifies presence of metal fragments adjacent to the left pelvic muscles.

Figure 3. Pelvic computed tomography (soft tissue window) demonstrates the presence of densification adjacent to left iliac vessels and a small amount of free fluid (arrow).

Figure 4. Pulmonary arteriography with selective characterization of left pulmonary artery demonstrates decreased blood flow toward the lingular segment of the left upper pulmonary lobe.

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