Migratory Bullet: Bullet Embolism into the Common Iliac Artery

Abstract

Intravascular bullet embolism is a rare phenomenon encountered during autopsies of firearm fatalities. In cases where the victim has died due to firearm wounds, single entrance wounds without exits necessitate locating the bullet/projectile inside the body. This task gets tricky if the projectile enters a blood vessel and further embolises onwards with the flow of blood. We present a case of a firearm wound over the upper back with the projectile piercing the arch of aorta. Radiological investigations including CT–chest proved blank for locating any bullet inside the body. Emergency sternotomy was done but surgical exploration couldn’t find the missing bullet and the patient later succumbed to internal blood loss. Pre-autopsy x-ray showed a hypo-dense metallic shadow in the lower middle abdomen slightly to the left. The missing bullet was located inside the lumen of the common iliac artery during autopsy after tracing the track from the wound in the arch of aorta downwards. A brief summation of diagnostic & treatment protocol and autopsy findings is presented.