Gunshot wound of the main pulmonary artery: A case report

Abstract

CLINICAL SUMMARY An 18-year-old man was brought to the emergency department immediately after being injured with a penetrating gunshot wound to his chest caused by a bullet from a pistol. The vital signs of the patient were unstable, he was unconscious, and urgent surgical intervention was required. Physical examination revealed only 1 entrance wound in the middle of the sternum, but there was no exit wound. Urgent computed tomographic (CT) analysis of the chest showed a fixed bullet on the cardiac mass, minimal pericardial hematoma, and left pneumothorax (Figure 1). After a chest tube was inserted into the left thorax in the emergency department, he was immediately taken to the operating room. Median sternotomy was performed, and the pericardium was opened. As the hematoma was promptly cleaned, a bullet hole (blood jetting) was observed on the anterior wall of the main pulmonary artery. Finger pressure was applied on the main pulmonary artery to control the bleeding, and the patient’s hemodynamics became stable. The wound was repaired with propylene sutures. The bullet, which was fixed (immobile) on CT, could not be found. The aorta and the posterior side of the pulmonary artery were seen to be intact. The left and right sides of the chest were examined by means of digital control in an attempt to find the fixed bullet. However, no mass that could be imagined to be a bullet was found by means of palpation either in the pulmonary trunk or in the left lung hilus. Fluoroscopic investigation was then used in the operating room. Interestingly, the bullet had migrated out of the mediastinum. The embolization of the bul-