{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:01:04Z","timestamp":1783580464869,"version":"3.55.0"},"reference-count":16,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,2,25]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Vascular injury is a common complication in firearm injuries; however, intravascular missile embolism is relatively rare. There are only 38 documented cases of intravascular missile embolisation to the heart. Bullet embolisms are difficult to diagnose even with multiple diagnostic modalities and even once identified, the most optimal choice of surgical management is debated. Our patient presented with a gunshot wound to the right posterior shoulder. Cardiac focused assessment with sonography for trauma, chest X-ray, CT and echocardiogram were performed, showing missile location adjacent to the right ventricle with inconclusive evidence of pericardial injury. Exploratory median sternotomy was performed, revealing intact pericardium and injury to the superior vena cava (SVC) with bullet embolisation to the right ventricle. The patient became temporarily asystolic secondary to haemorrhage from the SVC injury. Cardiac massage was performed, dislodging the missile into the inferior vena cava. A venotomy was performed to retrieve the bullet and vascular injuries were primarily repaired.<\/jats:p>","DOI":"10.1136\/bcr-2021-247252","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T11:42:58Z","timestamp":1646739778000},"page":"e247252","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Management of intracardiac bullet embolisation and review of literature"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6763-7167","authenticated-orcid":false,"given":"Peter","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Trauma\/Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitsupa","family":"Sirinit","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma\/Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Milia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma\/Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Stephen","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma\/Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"2025082709292198000_15.3.e247252.1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181dbaddf"},{"key":"2025082709292198000_15.3.e247252.2","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jvs.2019.02.004","article-title":"Systematic review of civilian intravascular ballistic embolism reports during the last 30 years","volume":"70","author":"Kuo","year":"2019","journal-title":"J Vasc Surg"},{"key":"2025082709292198000_15.3.e247252.3","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1093\/milmed\/usx191","article-title":"Management of bullet emboli to the heart and great vessels","volume":"183","author":"Yoon","year":"2018","journal-title":"Mil Med"},{"key":"2025082709292198000_15.3.e247252.4","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijscr.2020.06.090","article-title":"Bullet embolization to the heart: a rare and confounding penetrating cardiac injury case report","volume":"73","author":"Daskalaki","year":"2020","journal-title":"Int J Surg Case Rep"},{"key":"2025082709292198000_15.3.e247252.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-018-0337-z","article-title":"Penetrating aortic injury left untreated for 20 days: a case report","volume":"18","author":"Giaquinta","year":"2018","journal-title":"BMC Surg"},{"key":"2025082709292198000_15.3.e247252.6","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.jsurg.2009.04.002","article-title":"Conservative management of retained cardiac missiles: case report and literature review","volume":"66","author":"Lundy","year":"2009","journal-title":"J Surg Educ"},{"key":"2025082709292198000_15.3.e247252.7","first-page":"639","article-title":"Cardiac missiles. 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