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(Circulation. 2001;104:e40.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Acute Total Occlusion of the Right Coronary Artery by a Pellet

Luigi La Vecchia, MD; Andrea Rubboli, MD; Mariemma Paccanaro, MD; Leonardo Varotto, MD; Alessandro Fontanelli, MD

From the Catheterization Laboratory, Department of Cardiology, S. Bortolo Hospital, Vicenza, Italy.

Correspondence to Luigi La Vecchia, MD, Catheterization Laboratory, Department of Cardiology, S. Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy. E-mail luigilavecchia{at}katamail.com

A 78-year-old man was hospitalized because of chest pain that had started 2 hours earlier while rifle shooting. On admission, he was alert and his vital signs were normal. Physical examination revealed no abnormalities, except for a wound at the jugular notch, presumably due to the entrance of a pellet. No exit wounds were found. The ECG showed marked ST-segment elevation in the inferior leads. Chest roentgenogram disclosed a radiopaque round foreign body, presumably a pellet, at the margin of the cardiac silhouette.

Subsequent thoracic aortography showed no signs of extravasated blood, but coronary angiography showed amputation of the right coronary artery by the pellet (Figure). Removal of the pellet, percutaneously or surgically, was not attempted, because the patient was hemodynamically stable and because the risk of catastrophic hemorrhage was great.

View larger version (117K): [in this window] [in a new window]   Angiography of the right coronary artery in the left anterior oblique (A) and right anterior oblique (B) projections showing total occlusion of the vessel by a pellet.

The patient experienced an uncomplicated inferior myocardial infarction and was discharged 10 days later with no ongoing problems.

Footnotes

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 the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by La Vecchia, L. Articles by Fontanelli, A. Search for Related Content PubMed PubMed Citation Articles by La Vecchia, L. Articles by Fontanelli, A. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC Acute myocardial infarction