Case Report
 
Cardio-arterial Bullet embolization; a dilemma to cardiac surgeon
Ashur Y. Oraha1, Fitoon F. Yaldo2, Fahmi H. Kakamad3,4
1College of Medicine, Duhok University, Duhok, Kurdistan, Iraq
2Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
3University of Sulaimani, Old campus, Sulaimani, Kurdistan, Iraq
4Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq

Article ID: 100904Z01AO2018
doi: 5348/100904Z01AO2018CR

Corresponding Author:
Fahmi H. Kakamad,
Zerinok, Sulaiman, Kurdistan Regnion, Iraq

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How to cite this article
Oraha AY, Yaldo FF, Kakamad FH. Cardio-arterial Bullet embolization; a dilemma to cardiac surgeon. Int J Case Rep Images 2018;9:100904Z01AO2018.


ABSTRACT

Introduction: Cardio-arterial bullet embolization is an extremely rare presentation of penetrating chest trauma. The aim of this case report is to present and discuss a case of delayed cardio-arterial bullet embolization causing challenges in the management.

Case Report: A 13-year-old girl presented with bullet injury in the chest, the inlet was from the left back, medial to the lower end of scapula without outlet. On admission, the patient was dyspneic, and tachycardic. Chest-X-ray and computed tomography showed left side hemopneumothorax, multiple rib fractures with a metallic shadow in the apex of the heart. Tube thoracostomy was inserted followed by echocardiography which showed the bullet in the left ventricle. Under general anesthesia, the pericardial sac was opened, the bullet was palpated for a moment but disappeared. Intraoperative chest-X-ray was done and the bullet could not be visualized. The patient was closed. In the next day, peripheral angiography showed the bullet in the left common iliac artery, the patient was admitted back to the operative room the bullet was extracted.

Conclusion: Missile embolization is a rare and unique phenomenon yet it requires special attention and thorough knowledge because it might lead to catastrophic sequels.

Keywords: Bullet, Chest trauma, Embolization, Ischemia


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Author Contributions
Ashur Y. Oraha – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Fitoon F. Yaldo – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Fahmi H. Kakamad – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Ashur Y. Oraha et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.