Soft Tissue Cyst Secondary to Bullet Retention

Abstract

56-year-old man presented with a painful soft tissue mass in the posterior aspect of the right upper extremity, proximal to the elbow joint. The mass first became noticeable shortly after a gunshot injury to his right elbow region 28 years prior to presentation. Recently, the mass had enlarged to approximately 14 cm. A radiograph of the right elbow revealed a retained bullet within the confines of a well-defined cystic soft tissue lesion, posterior to the distal end of the humerus (Figure 1, arrowheads). Magnetic resonance imaging demonstrated no evidence of communication between the cystic mass and the adjacent joint. Following excision, gross examination revealed a 640-g, 14 3 9 3 6-cm, thick-walled cyst containing 400 mL of turbid brown fluid. The inner surface of the cyst wall was tan-red, smooth, and contained loosely attached necrotic debris. A distorted, silver-gray bullet measuring