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  • Title: Hepatic vein bullet embolus as a complication of left thoracic gunshot injury.
    Author: Wallace KL, Slovis CM.
    Journal: Ann Emerg Med; 1987 Jan; 16(1):102-4. PubMed ID: 3800059.
    Abstract:
    The case of a patient with a hepatic vein bullet embolus complicating a left ventricular gunshot injury is described. The patient presented hypotensive with a left midaxillary entrance wound. Initial radiographs showed a bullet fragment below the right hemidiaphragm. Emergency open thoracotomy was performed with release of a tense pericardial effusion and repair of a left ventricular penetrating wound. Surgical exploration failed to reveal direct penetrating injury to the diaphragm or abdominal viscera. After a hepatic venogram localized the bullet fragment in a branch of the right lobe hepatic vein, a periscopically directed catheter extraction of the fragment was successfully performed. A discussion of missile embolization, its pathology, clinical presentation, diagnosis, and management is presented.
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