Intravascular migratory bullet from left subclavian vein to right ventricle: interest of multi-modal imaging.

Abstract

A 68-year-old male victim of a firearm attack was hit by a bullet in the left shoulder. There was an entry point in the left supra-clavicular fossa with no exit wound (Panel A). The patient had a chest X-ray, which showed a fracture of the left clavicle (Panel B) and a bullet in the left lower thoracic cavity opposite the cardiac area (Panel C). A cardiac CT scan with volumetric reconstruction confirmed the entrance wound, the left subclavian vein injury, the bullet path, and the apical right ventricle location of the bullet on the vessel curved-planar reconstruction from the left subclavian vein injury to the right ventricle (Panel D). It showed magnification of the bullet entrance site showing the bone fracture of the left clavicle with subcutaneous emphysema and left subclavian vein injury (Panel E). The right ventricle axis showed a high attenuating bullet in the apex (Panel F) and 3D volume rendering showed the footprint of the bullet within the right ventricle cavity (Panel G).