Cardiac Gunshot Injury :  A Serendipitous Miss!

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Abstract

Penetrating cardiac injuries carry a grave prognosis. We present a rare case of thoracic gunshot injury where the bullet ricocheted and lodged in the pericardium without causing damage to the adjacent cardiac structures. Multimodality imaging helped in localizing the bullet, assessing damage, and planning safe surgical removal without cardiopulmonary bypass. ( Level of Difficulty: Beginner.)

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Most cited references 5

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Emergency operation for penetrating thoracic trauma in a metropolitan surgical service in South Africa.

Jessica D. Clarke, Muhammed A Quazi, Ashvini Reddy … (2011)

This audit examines our total experience with penetrating thoracic trauma. It reviews all the patients who were brought alive to our surgical service and all who were taken directly to the mortuary. The group of patients who underwent emergency operation for penetrating thoracic trauma is examined in detail. A prospective trauma registry is maintained by the Pietermaritzburg Metropolitan Complex. This database was retrospectively interrogated for all patients requiring an emergency thoracic operation for penetrating injury from July 2006 till July 2009. A retrospective review of mortuary data for the same period was undertaken to identify patients with penetrating thoracic trauma who had been taken to the forensic mortuary. Over the 3-year period July 2006 to July 2009, a total of 1186 patients, 77 of whom were female, were admitted to the surgical services in Pietermaritzburg with penetrating thoracic trauma. There were 124 gunshot wounds and 1062 stab wounds. A total of 108 (9%) patients required emergency operation during the period under review. The mechanism of trauma in the operative group was stab wounds (n = 102), gunshot wound (n = 4), stab with compass (n = 1), and impalement by falling on an arrow (n = 1). Over the same period 676 persons with penetrating thoracic trauma were taken to the mortuary. There were 135 (20%) gunshot wounds of the chest in the mortuary cohort. The overall mortality for penetrating thoracic trauma was 541 (33%) of 1603 for stab wounds and 135 (52%) of 259 for gunshot wounds of the chest. Among the 541 subjects with stab wounds from the mortuary cohort, there were 206 (38%) with cardiac injuries. In the emergency operation group there were 11 (10%) deaths. In 76 patients a cardiac injury was identified. The other injuries identified were lung parenchyma bleeding (n = 12) intercostal vessels (n = 10), great vessels of the chest (n = 6), internal thoracic vessel (n = 2), and pericardial injury with no myocardial injury (n = 2). Most patients reached the hospital within 60 minutes of sustaining their injury. A subset of 12 patients had much longer delays of 12 to 24 hours. Surgical access was via median sternotomy in 56 patients and lateral thoracotomy in 52. The overall mortality for penetrating cardiac trauma in our series was 217 (76%) of 282. Penetrating thoracic trauma has a high mortality rate of 30% for subjects with stab wounds and 52% for those with gunshot wounds. Less than a quarter of patients with a penetrating cardiac injury reach the hospital alive. Of those who do and who are operated on, about 90 percent will survive. Other injuries necessitating emergency operation are lung parenchyma, intercostal vessels and internal thoracic vessels, and great vessels of the thorax. Gunshot wounds of the thorax remain more lethal than stab wounds. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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Transmediastinal gunshot wounds in a mature trauma centre: changing perspectives.

Obi Okoye, Peep Talving, Pedro Teixeira … (2013)

Transmediastinal gunshot wounds are associated with a high mortality and frequently require operative intervention. The purpose of this study was to identify the diagnostic and therapeutic challenges of these injuries in a mature trauma system with decreasing prehospital time intervals.

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Innocuous cardiac gunshot that proved fatal: A bitter lesson learned

Biplab Mishra, Mohit Kumar Joshi, Subodh Kumar … (2017)

The management of hemodynamically normal patients with retained intra-pericardial foreign body remains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bodies. We report our experience of a hemodynamically normal patient with a retained intra-pericardial pellet from a firearm injury. He initially received successful non-operative management but developed fatal hemopericardium 21 days after injury. In this paper, we discussed the pitfalls in the management of such injuries in light of the available literature and summarized the clinical experience.

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Author and article information

Contributors

H.S. Isser

Journal

Journal ID (nlm-ta): JACC Case Rep

Journal ID (iso-abbrev): JACC Case Rep

Title: JACC Case Reports

Publisher: Elsevier

ISSN (Electronic): 2666-0849

Publication date PMC-release: 25 November 2020

Publication date Collection: January 2021

Publication date (Electronic): 25 November 2020

Volume: 3

Issue: 1

Pages: 16-19

Affiliations

[1]Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Author notes

[∗ ] Address for correspondence: Dr. H.S. Isser, Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India. drhsisser@ 123456gmail.com

[∗]

Drs. Jain and Bhasin have contributed equally to this work and are joint first authors.

Article

Publisher Item ID: S2666-0849(20)31321-8

DOI: 10.1016/j.jaccas.2020.06.049

PMC ID: 8305087

PubMed ID: 34317461

SO-VID: 005e8cc5-2565-4d42-9141-7da10b79eab1

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 20 March 2020

Date revision received : 1 June 2020

Date accepted : 10 June 2020

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