CTICasesRetained Bullet Embolism
Imaging findings
Serial chest radiographs obtained years apart in a patient with a history of gunshot wound show a bullet fragment lodged in the left pulmonary artery. The bullet has changed its orientation (flipped 180 degrees) between the two studies, but remains asymptomatic, without secondary thrombosis or pulmonary infarction.
Key takeaways
A retained bullet fragment in the pulmonary vasculature can remain asymptomatic for years. While bullet emboli can cause immediate occlusion and infarction, stable, non-occlusive fragments can stay free-floating within the pulmonary artery lumen, showing changes in orientation on sequential radiographs due to respiratory motion and cardiac pulsation, and are typically managed conservatively.
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