Successful Transcatheter Retrieval of an Air Gun Pellet and Adherent Thrombus From a Pulmonary Artery Branch
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.
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.)
- Copyright © 1998 by American Heart Association