Bullet embolization to the heart: A rare and confounding penetrating cardiac injury case report

Highlights • Hemodynamically stable gunshot wound patients may be managed without retrieval of the bullet. • Nearly 90% of patients with cardiac bullet emboli on initial presentation are hemodynamically stable. • Non-operative management of stable patients includes intensive observation and additional imaging to localize the bullet.
Gunshot wounds to the cardiac region usually result in devastating injuries. However, if bullets embolize into the myocardium without significant damage to the organ, optimal evaluation and management remains unclear. We present the case of a hemodynamically stable gunshot wound patient who presented with a bullet to the heart. Sternotomy revealed that the bullet had embolized through the superior vena cava and embedded into the apex of the right ventricle. The patient was managed without retrieval of the bullet and continues to be well despite a retained intracardiac bullet. We discuss cases of bullet embolization to the heart and the emergence of minimally-invasive approaches for management.