Anterograde venous bullet embolism from the left facial vein to the right ventricle

A young man presented to the emergency department reporting he had been recently shot in the face and chest with an unknown weapon. Initial physical examination only found bruising by the left hemimandible, but CT angiography of the thorax revealed a BB in the right ventricle. A subsequent CT angiography of the head and neck showed no major arterial injury but noted stranding and irregularity of the left facial vein directly deep to the injury site. The findings favoured anterograde venous bullet embolism from the left facial vein to the right ventricle. To our knowledge, this is the first report of a relatively small diameter and superficial vein of the face resulting in this phenomenon.