ABSTRACT
There have been numerous reports concerning gunshot wounds to the heart over the years. Many reports discuss bullets that have embolized and have migrated antegrade. However, there has never been a case reported on the retrograde embolization of a bullet from the right ventricle into the inferior vena cava. This case report involves a 15-year-old boy who was accidentally shot in the chest. The bullet entered at the mid-manubrial area, and penetrated the anterior wall of the right ventricle causing a tamponade. A chest x-ray film confirmed a bullet in the right ventricle. The patient was stabilized in the emergency department, and taken to the operating room for an emergent mediastinal exploration with evacuation of pericardial tamponade and repair of the right ventricle. After the tamponade was relieved, a Trans-Esophageal Echocardiogram was performed to locate the bullet, which could not be found in the ventricle. Chest and abdominal radiography were performed to locate the bullet. X-ray films confirmed that the bullet had migrated retrograde down into the inferior vena cava. Interventional radiology and vascular surgery departments were consulted. The consensus was to snag the bullet under fluoroscopic guidance, and pull it down into the right femoral vein for easy retrieval. The chest was closed and the patient was transferred from the surgery department to the interventional radiology department. Under fluoroscopy, the bullet was pulled down into the right common femoral vein. The bullet was extracted per venorrhaphy. The patient was extubated within hours after surgery and discharged home within 72 hours of surgery.