{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T20:55:59Z","timestamp":1777496159469,"version":"3.51.4"},"reference-count":11,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,7,28]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>A male patient in his late 40s presented after a single high-velocity gunshot injury to the left shoulder. He was haemodynamically unstable on arrival with no evidence of neurological deficit. CT of the thorax and abdomen showed multiple bullet fragments throughout the posterior left thorax with evidence of an acute aortic injury. Following resuscitation, the patient stabilised, and his aortic injury was managed conservatively. Two days postinjury, postextubation, the patient reported a homonymous hemianopia. CT brain and angiography showed a subacute left posterior cerebral artery (PCA) territory infarct. A metallic bullet fragment was identified within the lumen of the left PCA vessel segment, compatible with an arterial bullet fragment embolus causing occlusion of the left PCA. The patient was managed conservatively. Full head to toe (scout) imaging should be considered during initial work-up of low- and high-velocity firearm injuries to exclude distant embolisation of bullet fragments.<\/jats:p>","DOI":"10.1136\/bcr-2025-266601","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T04:10:26Z","timestamp":1755144626000},"page":"e266601","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Bullet fragment embolisation to posterior cerebral artery from a gunshot wound to the left shoulder"],"prefix":"10.1136","volume":"18","author":[{"given":"Lara","family":"Toerien","sequence":"first","affiliation":[{"name":"Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5077-5520","authenticated-orcid":false,"given":"Bibi Ayesha","family":"Bassa","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland"},{"name":"Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Power","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Gibney","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"2025081321102032000_18.8.e266601.1","article-title":"Embolic Shotgun Pellet to the Left Middle Cerebral Artery Causing Hemiplegia and Aphasia With Near Complete Clinical Recovery on Nonoperative Management","volume":"12","author":"Mingo","year":"2020","journal-title":"Cureus"},{"key":"2025081321102032000_18.8.e266601.2","doi-asserted-by":"crossref","DOI":"10.1186\/1752-2897-8-19","article-title":"Look away: arterial and venous intravascular embolisation following shotgun injury","volume":"8","author":"Vedelago","year":"2014","journal-title":"J Trauma Manag Outcomes"},{"key":"2025081321102032000_18.8.e266601.3","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2022-018751"},{"key":"2025081321102032000_18.8.e266601.4","doi-asserted-by":"crossref","first-page":"E119","DOI":"10.1093\/ons\/opy312","article-title":"Open Surgery for Extraction of an Embolized Pellet in the Middle Cerebral Artery From a Shotgun Injury","volume":"17","author":"Monterey","year":"2019","journal-title":"Operative Surg"},{"key":"2025081321102032000_18.8.e266601.5","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2017-000873"},{"key":"2025081321102032000_18.8.e266601.6","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1007\/BF02426469","article-title":"Peripheral vascular gunshot bullet embolus migration to the cerebral circulation","volume":"32","author":"Dadsetan","year":"1990","journal-title":"Neuroradiology"},{"key":"2025081321102032000_18.8.e266601.7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-015301","article-title":"Intracranial pellet embolization: an endovascular endeavor","volume":"12","author":"Hassan","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2025081321102032000_18.8.e266601.8","first-page":"261","article-title":"Shotgun pellet embolization to the posterior cerebral circulation","volume":"27","author":"da Costa","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025081321102032000_18.8.e266601.9","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":"2025081321102032000_18.8.e266601.10","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jvs.2011.07.091","article-title":"Shotgun wound and pellet embolism to the intracranial carotid artery","volume":"55","author":"Vaquero-Puerta","year":"2012","journal-title":"J Vasc Surg"},{"key":"2025081321102032000_18.8.e266601.11","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s10140-020-01781-6","article-title":"MR imaging in the presence of ballistic debris of unknown composition: a review of the literature and practical approach","volume":"27","author":"Ditkofsky","year":"2020","journal-title":"Emerg Radiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266601","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T04:10:27Z","timestamp":1755144627000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":11,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,13]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bcr-2025-266601"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266601","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}