30 year old male: Single gun shot wound to the right thigh. Isolated injury.
Patient alert; in pain; vitals stable and normal. Routine trauma CXR is performed
click images to enlarge
Describe and interpret this CXR, femur XR and subsequent Chest CT
CHEST X-RAY INTERPRETATION
There is a 5.56 bullet projected over the lower left lung field lateral to the heart.
* There is no evidence of any injury to the chest or lungs*
*There is destruction to the right distal femur from a high velocity projectile.
Multiple fragmentation of bone and perhaps metal.
There is a bullet lodged in the left inferior pulmonary artery.
The bullet is thought to have migrated up the femoral vein, through the IVC and right heart and into its resting place in the left inferior pulmonary artery.
Anything goes with trauma! Expect the unexpected.