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Look away: arterial and venous intravascular embolisation following shotgun injury.

Vedelago J, Dick E, Thomas R, Jones B, Kirmi O, Becker J, Alavi A, Gedroyc W - J Trauma Manag Outcomes (2014)

Bottom Line: We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury.The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis.This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

View Article: PubMed Central - PubMed

Affiliation: Radiology Department, St. Mary's Hospital, Praed Street, London, W2 1NY United Kingdom.

ABSTRACT
We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

No MeSH data available.


Related in: MedlinePlus

Axial image from non-contrast CT brain at presentation.
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Fig2: Axial image from non-contrast CT brain at presentation.

Mentions: A 55 year old male with low GCS was intubated and transferred to our level 1 trauma centre following a single shotgun bullet wound to the right anterior neck and supraclavicular region. He had been documented to be hypotensive post injury by ambulance first responders. CT was performed approximately three hours after the injury and demonstrated scores of spherical metallic shot pellets scattered over a 15 cm × 15 cm area of the neck and supraclavicular region. The CT head lateral scout revealed a single intracranial pellet, projected over the pterion (Figure 1 arrow). Non-contrast CT demonstrated early signs of an acute MCA infarct with loss of the insula ribbon grey-white matter differentiation and subtle hypoattenuation within the putamen and globus pallidus (Figure 2 white oval). Subsequent CT angiography of intracranial vessels confirmed an intra-arterial 3 mm pellet within the M1 segment of the right middle cerebral artery resulting in moderate flow reduction. Follow-up CT angiography performed 24 hours after arrival showed complete reperfusion of the right middle cerebral artery (Figure 3) with the shot fragment seemingly unchanged in position (arrow).Figure 1


Look away: arterial and venous intravascular embolisation following shotgun injury.

Vedelago J, Dick E, Thomas R, Jones B, Kirmi O, Becker J, Alavi A, Gedroyc W - J Trauma Manag Outcomes (2014)

Axial image from non-contrast CT brain at presentation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4414003&req=5

Fig2: Axial image from non-contrast CT brain at presentation.
Mentions: A 55 year old male with low GCS was intubated and transferred to our level 1 trauma centre following a single shotgun bullet wound to the right anterior neck and supraclavicular region. He had been documented to be hypotensive post injury by ambulance first responders. CT was performed approximately three hours after the injury and demonstrated scores of spherical metallic shot pellets scattered over a 15 cm × 15 cm area of the neck and supraclavicular region. The CT head lateral scout revealed a single intracranial pellet, projected over the pterion (Figure 1 arrow). Non-contrast CT demonstrated early signs of an acute MCA infarct with loss of the insula ribbon grey-white matter differentiation and subtle hypoattenuation within the putamen and globus pallidus (Figure 2 white oval). Subsequent CT angiography of intracranial vessels confirmed an intra-arterial 3 mm pellet within the M1 segment of the right middle cerebral artery resulting in moderate flow reduction. Follow-up CT angiography performed 24 hours after arrival showed complete reperfusion of the right middle cerebral artery (Figure 3) with the shot fragment seemingly unchanged in position (arrow).Figure 1

Bottom Line: We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury.The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis.This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

View Article: PubMed Central - PubMed

Affiliation: Radiology Department, St. Mary's Hospital, Praed Street, London, W2 1NY United Kingdom.

ABSTRACT
We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

No MeSH data available.


Related in: MedlinePlus