title: Case report: lead toxicity associated with an extra-articular retained missile 14 years after injury.
abstract: Lead toxicity associated with extra-articular retained missiles (EARMs) is an uncommon yet potentially devastating complication of gunshot wounds. While the risk of lead toxicity with intra-articular retained missiles is well-known, EARMs are routinely permitted to remain in tissues indefinitely without surveillance for lead toxicity. We present a 34 year-old man who was found to have symptomatic lead toxicity 14 years after sustaining a gunshot-associated femoral fracture with retention of lead bullet fragments. A fluid-filled cyst containing two large lead bullet fragments was identified intraoperatively. Whole-blood lead concentration decreased after removal of the lead-filled cyst. Cyst formation and concomitant bone fracture are two of the risk factors for lead toxicity in patients with EARMs after gunshot wounds. Recognizing risk factors for EARM-associated elevation in lead levels is important as the adverse effects of increased lead burden may be asymptomatic and difficult to diagnose, yet debilitating and potentially lethal.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA. w.eward@alumni.duke.edu
authors.forename: William C
authors.initials: WC
authors.lastname: Eward
authors.forename: Dennis
authors.initials: D
authors.lastname: Darcey
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Dodd
authors.forename: Robert D
authors.initials: RD
authors.lastname: Zura
mesh_terms: D000328:Adult; D005264:Femoral Fractures / Q000209:etiology*; D006801:Humans; D007855:Lead Poisoning / Q000209:etiology*; D008297:Male; D014948:Wounds, Gunshot / Q000150:complications*