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 11/30/2007, sarfile commented:
please clarify....type of bullet...bullet still in thoracic cavity behind desending aorta?....which vertebral body fracture i mean number?
On 02/28/2008, venuejack commented:
I have a Question as into the pt age an to what degree did the pt present in the field . I am a emt student an would like to learn from this .