Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review

Missile embolism (ME) is a rare condition and was seen in 0.3% of gunshot wounds during the Vietnam War. It was first reported by Thomas Davis in 1834. ME occurs when a small caliber, slow velocity projectile penetrates a wall in the vasculature; loses its kinetic energy; and gets carried away along...

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Main Authors: Radhikaraj C Govindaraju, Jagannath P Kolwalkar
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2019-01-01
Series:Journal of Emergencies, Trauma and Shock
Subjects:
Online Access:http://www.onlinejets.org/article.asp?issn=0974-2700;year=2019;volume=12;issue=3;spage=218;epage=221;aulast=Govindaraju
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spelling doaj-f87f26c85a9a446ba3bd355c6c8449ad2020-11-24T22:20:30ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27002019-01-0112321822110.4103/JETS.JETS_59_19Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature reviewRadhikaraj C GovindarajuJagannath P KolwalkarMissile embolism (ME) is a rare condition and was seen in 0.3% of gunshot wounds during the Vietnam War. It was first reported by Thomas Davis in 1834. ME occurs when a small caliber, slow velocity projectile penetrates a wall in the vasculature; loses its kinetic energy; and gets carried away along the bloodstream to occlude another vessel at a distant site. Civilian victims of low-velocity bullets account for 60% of such cases. ME can be arterial, venous, or paradoxical. Systemic arterial embolization accounts for 80% of published reports and occurs after the projectile penetrates the left chambers of heart, aorta, or very rarely pulmonary veins (PVs). There are only nine published reports of ME through PV till date. We report here, embolism of an air-gun pellet entering through the right thorax, into right PV, embolizing into right femoral artery, causing acute limb ischemia, in a young male. Emergency arteriotomy and removal of the embolic pellet saved the limb with good recovery. He did not require a thoracotomy. The clinical picture, radiological findings, operative details, and the management are presented and discussed with relevant literature. The purpose of this report is to highlight the unique presentation of ME through PV, as its management is different from other cases of arterial ME. Early diagnosis of the condition is imperative to prevent permanent ischemic damage of end organ and its sequelae. We present an analysis of all published reports of systemic ME through PV and also give our recommendations for its management.http://www.onlinejets.org/article.asp?issn=0974-2700;year=2019;volume=12;issue=3;spage=218;epage=221;aulast=GovindarajuAir gun pelletbullet embolismfemoral artery embolismpulmonary vein embolismthoracic gunshot injury
collection DOAJ
language English
format Article
sources DOAJ
author Radhikaraj C Govindaraju
Jagannath P Kolwalkar
spellingShingle Radhikaraj C Govindaraju
Jagannath P Kolwalkar
Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review
Journal of Emergencies, Trauma and Shock
Air gun pellet
bullet embolism
femoral artery embolism
pulmonary vein embolism
thoracic gunshot injury
author_facet Radhikaraj C Govindaraju
Jagannath P Kolwalkar
author_sort Radhikaraj C Govindaraju
title Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review
title_short Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review
title_full Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review
title_fullStr Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review
title_full_unstemmed Missile embolism from pulmonary vein to systemic circulation: Case report with systematic literature review
title_sort missile embolism from pulmonary vein to systemic circulation: case report with systematic literature review
publisher Wolters Kluwer Medknow Publications
series Journal of Emergencies, Trauma and Shock
issn 0974-2700
publishDate 2019-01-01
description Missile embolism (ME) is a rare condition and was seen in 0.3% of gunshot wounds during the Vietnam War. It was first reported by Thomas Davis in 1834. ME occurs when a small caliber, slow velocity projectile penetrates a wall in the vasculature; loses its kinetic energy; and gets carried away along the bloodstream to occlude another vessel at a distant site. Civilian victims of low-velocity bullets account for 60% of such cases. ME can be arterial, venous, or paradoxical. Systemic arterial embolization accounts for 80% of published reports and occurs after the projectile penetrates the left chambers of heart, aorta, or very rarely pulmonary veins (PVs). There are only nine published reports of ME through PV till date. We report here, embolism of an air-gun pellet entering through the right thorax, into right PV, embolizing into right femoral artery, causing acute limb ischemia, in a young male. Emergency arteriotomy and removal of the embolic pellet saved the limb with good recovery. He did not require a thoracotomy. The clinical picture, radiological findings, operative details, and the management are presented and discussed with relevant literature. The purpose of this report is to highlight the unique presentation of ME through PV, as its management is different from other cases of arterial ME. Early diagnosis of the condition is imperative to prevent permanent ischemic damage of end organ and its sequelae. We present an analysis of all published reports of systemic ME through PV and also give our recommendations for its management.
topic Air gun pellet
bullet embolism
femoral artery embolism
pulmonary vein embolism
thoracic gunshot injury
url http://www.onlinejets.org/article.asp?issn=0974-2700;year=2019;volume=12;issue=3;spage=218;epage=221;aulast=Govindaraju
work_keys_str_mv AT radhikarajcgovindaraju missileembolismfrompulmonaryveintosystemiccirculationcasereportwithsystematicliteraturereview
AT jagannathpkolwalkar missileembolismfrompulmonaryveintosystemiccirculationcasereportwithsystematicliteraturereview
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