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The patient sustained a gunshot wound to the lower right thorax. He was admitted to the emergency department and remained haemodynamically normal throughout his assessment. There was a right pneumothorax on Chest X-ray and a chest tube was placed. The patient was taken to CT for assessment of the bullet track and injuries.

The bullet had passed through the right thorax, causing injury to the right lung and a pneumothorax:

It then hit the spine, fracturing the anterior vertebral body:

Before coming to rest posterior to the aorta.

There was no clinical evidence of oesophageal injury, and barium swallow was normal.

The pneumothorax resolved with chest tube management alone, and this was removed at day 4. The bullet was left alone and the patient discharged on day 5.

Indications for bullet removal are few, as complications from bullets left in the body are extremely rare. Surgical attempts to find and remove these bullets usually cause more harm than good, and may not be successful. In this case, surgery would have been particularly morbid and hazardous. There are a few recognized indications for bullet removal.

Comments

On 05/29/2015, José Enrique Gómez Cárdenas commented:

I think it was the best decision by the treating physician. Treat the pneumothorax and avoid surgery to remove the bullet. The risk of a complication to remove the bullet was very high and probably not cause any pathology to leave it there.

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