CTICasesWandering Pleural Bullet
Imaging findings
Initial chest radiography and computed tomography in a gunshot wound victim reveal subcutaneous emphysema, a bullet fragment deflected superiorly in the left upper chest, and a linear lung laceration with surrounding contusion in the left upper and lower lobes. The tract also shows diaphragmatic and hepatic lacerations. Serial follow-up imaging over several years demonstrates a retained bullet fragment migrating freely within the left pleural space, ending up posterior to the spleen.
Key takeaways
Retained projectiles in the pleural space can act as wandering foreign bodies that change position over time due to gravity, respiration, and pleural fluid dynamics. The current location of a bullet on imaging may be distant from its original entry tract or initial resting place.
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