CTICasesBullet Embolism
Imaging findings
Chest radiograph and CT show a bullet (approximately 9mm/45 caliber) lodged within a left lower lobe segmental pulmonary artery, causing localized thrombosis. The patient was shot in the flank, with CT showing a right psoas hematoma, vertebral fracture, and trace edema near the inferior vena cava in the liver, indicating the bullet entered the vena cava and embolized.
Key takeaways
Bullet embolism occurs when a projectile penetrates a major blood vessel (such as the inferior vena cava or iliac veins) and is carried hematogenously to the heart or pulmonary vasculature. Patients are often shot at distant sites (e.g., flank, abdomen) and may have no thoracic symptoms. Retrieval can require endovascular snares or open arteriotomy, particularly if the bullet causes arterial thrombosis.
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