Hepatic vein bullet embolus as a complication of left thoracic gunshot injury.
The case of a patient with a hepatic vein bullet embolus complicating a left ventricular gunshot injury is described. The patient presented hypotensive with a left midaxillary entrance wound. Initial radiographs showed a bullet fragment below the right hemidiaphragm. Emergency open thoracotomy was performed with release of a tense pericardial effusion and repair of a left ventricular penetrating wound. Surgical exploration failed to reveal direct penetrating injury to the diaphragm or abdominal viscera. After a hepatic venogram localized the bullet fragment in a branch of the right lobe hepatic vein, a periscopically directed catheter extraction of the fragment was successfully performed. A discussion of missile embolization, its pathology, clinical presentation, diagnosis, and management is presented.
D000328:Adult; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging; D006503:Hepatic Veins; D006801:Humans; D010690:Phlebography; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D014948:Wounds, Gunshot / Q000150:complications* / Q000000981:diagnostic imaging