Missile embolism: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Number of entry wounds do not match exit wounds | |||
*Location of bullet not consistent with predicted trajectory | |||
*Bullet within intravascular or cavity without evidence of adjacent direct tissue injury | |||
*Fluoroscopy showing foreign body move within vascular cavity | |||
*[[CXR]] showing blurred foreign body within cardiac silhouette | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Missile embolism types}} | |||
==Evaluation== | |||
== | |||
*Need to maintain high index of suspicion, obtain full body radiography when indicated<ref name="IJSCR" /> | *Need to maintain high index of suspicion, obtain full body radiography when indicated<ref name="IJSCR" /> | ||
*TEE/TTE if intrathoracic | |||
*Serial fluoroscopy, especially if intracardiac, but will not determine if buried in myocardium or free moving within cavity | |||
*FAST exam as reasonable supplement | |||
==Management== | ==Management== | ||
*Controversial - not all need to be removed | *Controversial - not all need to be removed | ||
*Refer to diagram / literature review references | |||
==Disposition== | ==Disposition== | ||
*Admit to trauma floor vs. ICU based on hemodynamic stability vs. risk of further embolism complication | |||
==See Also== | ==See Also== | ||
*[[Gun shot wounds]] | |||
*[[Blast injuries]] | |||
==References== | ==References== | ||
Latest revision as of 07:42, 9 September 2016
Background
- Also known as "bullet embolism"
- Occurs when a bullet or bullet fragment enters the bloodstream.
- Can be arterial (80%) or venous[1]
- Usually a small-caliber, low velocity projectile.[1]
- For this reason, incidence higher in non-military setting due to predominance of lower velocity projectiles
- Incidence = 1.1% in recent combat operations[2]
Clinical Features
- Number of entry wounds do not match exit wounds
- Location of bullet not consistent with predicted trajectory
- Bullet within intravascular or cavity without evidence of adjacent direct tissue injury
- Fluoroscopy showing foreign body move within vascular cavity
- CXR showing blurred foreign body within cardiac silhouette
Differential Diagnosis
Missile embolism types
- Intrapericardial foreign body
- Systemic venous embolism
- Right heart and pulmonary artery embolism
- Pulmonary vein embolism
- Left heart embolism
- Coronary artery embolism
- Paradoxical embolus (due to patent foramen ovale)
Evaluation
- Need to maintain high index of suspicion, obtain full body radiography when indicated[1]
- TEE/TTE if intrathoracic
- Serial fluoroscopy, especially if intracardiac, but will not determine if buried in myocardium or free moving within cavity
- FAST exam as reasonable supplement
Management
- Controversial - not all need to be removed
- Refer to diagram / literature review references
Disposition
- Admit to trauma floor vs. ICU based on hemodynamic stability vs. risk of further embolism complication
See Also
References
- ↑ 1.0 1.1 1.2 Fernandez-Ranvier, Gustavo G. et al. Pulmonary artery bullet embolism—Case report and review. International Journal of Surgery Case Reports , Volume 4 , Issue 5 , 521 - 523
- ↑ Lu K et al. Approach to Management of Intravascular Missile Emboli: Review of the Literature and Case Report. West J Emerg Med. 2015 Jul; 16(4): 489–496.