Thoracic Missile Emboli and Retained Bullets

Abstract

Firearm injuries are common with approximately 700 daily in the United States. Missile emboli by contrast are relatively rare occurring in approximately 0.3% of penetrating wounds in the Vietnam conflict. Experience and recommendations stem from case series and reports. Management can be challenging and may confront any practitioner who deals with shrapnel or gunshot wounds. Clinical suspicion should be maintained whenever a penetrating missile entry wound is detected without a clearly defined exit point. Bullets and missiles may embolize when they possess low kinetic energy at the time of passage through the venous or arterial wall and the diameter of the projectile does not exceed that of the vessel. Remote radiologic and complete neurovascular examination should be performed in all missile wounds in which the projectile is not accounted for. Radiologic whole body surveillance imaging may be required for wounds to the chest and abdomen.