Left pulmonary artery bullet embolism following a penetrating cardiac gunshot injury

INTRODUCTION: Bullet emboli occur when bullets migrate from an entry point to an abnormal endpoint via blood vessels or bowel. Most result from low-velocity, small calibre civilian gunshots. Although rare, when it does occur, it commonly embolises to the arterial system. Many times, these are amenable to removal and recovery. CASE REPORT: We present a case of a haemodynamically unstable polytrauma patient with a pulmonary artery projectile embolus following a penetrating trans-thoracic cardiac gunshot wound. CONCLUSION: A brief overview of the literature regarding bullet emboli is provided in light of this unusual case, focusing specifically on thoracic bullet emboli. A high index of suspicion should be raised when the number of entry and exit wounds are incongruent, bullet location does not align with anticipated trajectory, or serial radiographs demonstrate missile migration. Radiological evaluation and bullet retrieval are dependent on haemodynamic stability of the patient.