Recovery of a Missile Embolus From the Right Ventricle

doi:10.1016/j.athoracsur.2016.06.107

The Annals of Thoracic Surgery

Volume 103, Issue 1, January 2017, Pages e69-e71

https://doi.org/10.1016/j.athoracsur.2016.06.107 Get rights and content

Missile embolism is a clinical entity in which a projectile object enters a blood vessel and is carried to a distant part of the body. We present a case of the discovery of an iliac vein to right ventricle missile embolus in a young man, with successful extraction through a right atriotomy. We provide a historical overview of the literature concerning missile embolism, and we argue that whereas acute embolized projectiles should be removed in almost all cases, it may be reasonable to simply observe an asymptomatic chronic missile embolus.

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Comment

Missile embolism is an unusual and rare occurrence that has attracted the curiosity of surgeons since at least 1834, when Thomas Davis [1] reported the discovery of an embolized wooden fragment in the heart of a deceased 10-year-old boy (Fig 3) [2]. Although the majority of missile emboli involve entry into the arterial system [3], perhaps owing to the greater firmness of arteries compared with veins, our patient’s missile embolus was of venous origin. A 2011 review of cases of venous missile

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Systematic review of civilian intravascular ballistic embolism reports during the last 30 years
2019, Journal of Vascular Surgery
Intravascular ballistic embolization is a rare complication of missile injury. Because of its rarity, much remains to be known about its presentation, pathophysiology, complications, and management. In this study, we analyze case reports of ballistic embolization in the last 30 years and available cases from our institution to determine the likely patient, the nature of the embolization, the possible complications, and a general management strategy.
A PubMed search was performed in search of missile embolization cases from 1988 to 2018 in the English language, including only cases of intravascular emboli. Cases resulting from combat and explosive devices were excluded. In addition, five cases from our institution were included in the analysis.
A total of 261 cases were analyzed. The most common presentation was that of a young man (reflecting the demographics of those sustaining gunshot wound injuries) with injury to the anterior torso from a single gunshot wound. Venous entry was most common, most often through large-caliber vessels. There was roughly equal involvement of the right and left circulation. Left circulation emboli were frequently symptomatic, with ischemia being the most frequent sequela. In contrast, a right circulation embolus was rarely associated with significant complications.
Despite its rarity, ballistic embolization should be considered in gunshot injury with known large-vessel injury when an exit wound is not identified. In particular, signs of ischemia distant from the injury site warrant timely investigation to maximize tissue salvageability. We present a management strategy model for consideration.
Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review
2023, Frontiers in Cardiovascular Medicine
Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: A case report and review of the literature
2018, Journal of Medical Case Reports

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Case reportRecovery of a Missile Embolus From the Right Ventricle

Section snippets

Comment

Am J Surg

Injury

Foreign bodies in the cardiovascular system

Br J Surg

Case report
Recovery of a Missile Embolus From the Right Ventricle