[Intracardial migration of a bullet: diagnosis and management].
Venous pellet embolism to the cardia after shotgun wound is a very rare occurrence. Number and size of pellets, at the impact make this migration easier; embolism is asymptomatic and may occur 15 years after the injury. Many problems must be mentioned: mechanics of entry into the heart (own velocity, venous flow), topographic diagnosis (chest X-ray, transthoracic, transoesophageal ultrasound and CT-scan), local outcomes of this projectile (local erosion, clot, endocarditis), destination of a new migration (pulmonary embolism, left heart), indications of extraction, supervision. Extraction musn't be systematic, but only in the event of a patent foramen ovale with a risk of systemic embolism, which clinical outcomes are most serious or in the event of complications. The authors report on a 22 years old patient observation whose treatment was abstention and supervision.
Marchaland
J P
JP
Service de chirurgie orthopédique et traumatologique, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris, France. jp.marchaland@libertysurf.fr
Petit
A
A
Rillardon
L
L
Ségura
P
P
Chaara
M
M
Mebaaza
A
A
Sedel
L
L
D000328:Adult; D002299:Cardia / Q000473:pathology*; D003937:Diagnosis, Differential; D004617:Embolism / Q000209:etiology* / Q000473:pathology; D005548:Foreign-Body Migration; D006801:Humans; D008297:Male; D012307:Risk Factors; D014948:Wounds, Gunshot / Q000150:complications*