(Circulation. 1998;97:1755-1756.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Successful Transcatheter Retrieval of an Air Gun Pellet and Adherent Thrombus From a Pulmonary Artery Branch
Joselyn C. R. Lee, MD;
Raymond H. Dominici, MD;
Fred A. Crawford, Jr, MD;
; Wolfgang A. K. Radtke, MD
From the South Carolina Children's Heart Center, Medical University
of South Carolina, Charleston, and Clarendon Memorial Hospital (R.H.D.),
Manning, SC.
With his
toy gun, a 9-year-old boy inflicted a high-velocity pellet gun shot to
his own right thigh, with entry in the upper anterolateral aspect. The
initial radiograph in the local emergency room showed the gun pellet in
his left posterior pelvic region. He was asymptomatic
except for pain in the right groin and thigh. The patient was placed on
intravenous fluids and antibiotics and was admitted for
observation. A repeat radiograph of his pelvis after 17 hours did not
show the pellet. A subsequent chest radiograph located the pellet in
the right lower medial lung field. The pellet had presumably migrated
through the bloodstream into a right lower-lobe branch
of the pulmonary artery. His examination remained normal except
for pain when he moved his right thigh. The patient was referred for
further treatment and was taken to the pediatric cardiac
catheterization laboratory the same day, where he
underwent successful transcatheter retrieval of the pellet
with a 5F Teflon four-wire basket through a check-flow III blue
Mullins 8F sheath via a 12F side-arm sheath in the left femoral
vein.
A right pulmonary
arteriogram (Figure 1a
) by hand
injection through the Mullins sheath showed the 4.5-mm-diameter pellet
lodged in a right lower lobe pulmonary artery branch, resulting
in decreased flow distal to the pellet. A small radiolucent thrombus
was seen adjacent to the pellet. The wire basket was manipulated into
the same branch and alongside the pellet (Figure 1b). The basket was
rotated around the pellet, and Figure 1c shows the pellet in the wire
basket at the distal tip of the catheter and sheath being removed from
the patient. Figure 2 shows the gun pellet with adherent thrombus after
removal from the patient inside the wire basket (a) and released from
the basket (b).
There were no complications. Fluoroscopy time was 20:05 minutes. The
patient was observed for 11/2 days after the procedure to rule
out perforation of pelvic or abdominal organs and then was discharged
home in good condition.
Footnotes
Reprint requests to Wolfgang A.K. Radtke, MD, South Carolina Children's Heart Center, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030. (Circulation. 1998;97:1755-1756.)
