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Wed Jul 19 19:32:28 BST 2006

Once again, an imagined conjecture as to how it may happen in no way approaches reality--does this actually happen outside of your imagination?  Such a low level of "feeling" in no way justifies the adamant authoritative assertion that this is what happened, as was related--and we still have no information as to location of bullet, especially in relation to the dissection.  As physicians, we really must have a bit more integrity and reality based conclusions than this--really!
ERF 

-----Original Message-----
From: mmcbridemd at yahoo.com
To: trauma-list at trauma.org
Sent: Wed, 19 Jul 2006 1:10 PM
Subject: Re: Old bullet, new aortic dissection

Aortic dissection is certainly reported in association with blunt traumatic 
injury. All that is needed for dissection is some mechanism for development of 
subintimal hematoma. Penetrating ulceration and subintimal hemorrhage related to 
chronic irritation of a proximate foreign body or even to degenerating focal 
changes from remote injury seem like plausible associations, especially if in 
the absence of other reasonable etiologies.

  I don't know that I'd discredit causality here with no better reason than the 
fact that no one has written up and published a report in the past.

  KMATTOX at aol.com wrote:

In a message dated 7/19/2006 7:18:51 A.M. Central Standard Time, 
docrickfry at aol.com writes:

young man arrives with an acute aortic dissection (Debakey III). Several 
years earlier he sustained a gun shot wound to the chest and the bullet was left 

in place. Per the CT surgeon, tt was felt that his dissection was a result 
of erosion of the bullet as it slowly burrowed its way into the aorta. 

This postulation is not founded on ANY data. I am unaware of any cases in 
which such an association has been made. The mechanisms for media dissection 
and hematoma are well established. 

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Old bullet, new aortic dissection