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Int J Angiol 2023; 32(04): 258-261
DOI: 10.1055/s-0042-1745846
Case Report

A Lost Bullet in the Coronary Sinus: A Cautionary Tale

Martin Halicek 
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Hossam Alslaim 
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Mrinal Shukla
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Arthur M. Freedman
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
,
William B. Bates
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Vijay S. Patel
1   Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Neal L. Weintraub
3   Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
,
Michael Winkler 
2   Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
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Funding None.
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Abstract

We present a case of venous bullet embolism to the right atrium following a gunshot wound (GSW) to the abdomen. A 53-year-old male presented after a GSW to the abdomen. His workup included a computed tomography (CT) scan demonstrating an aortic injury with aortocaval fistula. A radio-opaque object consistent with a bullet was visualized in the right atrium. First, this case details an important decision, choice of surgery versus an interventional approach. After repair of the aortocaval fistula, the patient underwent a planned attempt to extract the bullet through a right lateral thoracotomy approach utilizing cardiopulmonary bypass to facilitate a right atriotomy. Intraoperatively, the team was not able to localize the bullet in the right atrium despite fluoroscopic evaluation. A postoperative CT scan demonstrated that the bullet had migrated into the coronary sinus. Lastly, this case demonstrates successful positioning maneuvers to dislodge the bullet out of the heart and into the inferior vena cava, allowing for the endovascular extraction of the bullet.

Keywords

bullet embolism - coronary sinus - foreign object - endovascular extraction

Patient Consent

Informed consent was not required to be obtained from the patient due to our institutions' institutional review board policies because no patient-identifying information is included for publication in this case report and accompanying images.




Publication History

Article published online:
25 April 2022

© 2022. International College of Angiology. This article is published by Thieme.

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