Ultrasound with needle guiding exploration as a real-time modality for exploration of air rifle bullet close to cervical spine: A case report

INTRODUCTION AND IMPORTANCE: Surgical exploration of retained air rifle bullet at the neck region is challenging because it is difficult to find bullets during exploration and prevent damage to vital structures. A bedside real-time imaging technique is needed to determine the retained bullet's location to the surrounding structures and guiding exploration. CASE PRESENTATION: A 19-year-old male patient was admitted to the emergency department with neck pain after being shot by an air rifle. The patient's vital signs were stable. A small entry wound to the right lateral side of the neck without exit wound was found without neurological symptoms. The cervical X-ray showed the bullet at the third cervical vertebrae level. Surgical exploration was performed with needle-guiding ultrasonography. The bullet is a one-centimeter anterior transverse process of the third cervical vertebra marked by a hyperechoic object. Exploration was done by tracing the needle. Postoperative neurological evaluation was conducted, and no abnormalities were found. CLINICAL DISCUSSION: Preoperative imaging modalities are crucial before the surgical exploration of a retained air rifle bullet. X-ray and CT-scan are imaging modalities that are often used as an initial assessment of retained foreign bodies. However, ultrasonography provides advantages over X-ray and CT scan to provide real-time imaging that supports the surgeon while performing surgical exploration. Ultrasonography with needle guiding exploration increases the precise location of a retained air rifle bullet. CONCLUSION: Ultrasonography was a simple and precise real-time imaging modality for identifying and guiding the exploration of a retained air rifle bullet in the neck area.