Gunshot Wounds to the Chest with Arterial Bullet Embolization

This report describes two cases involving small-caliber gunshot wounds to the chest with embolization of the bullet (.22 long rifle). In the first patient, hemodynamic status permitted additional imaging before surgery. Findings demonstrated embolization of the bullet into the right external carotid artery after penetration into the left ventricle. In the second patient, emergency thoracotomy was required to perform hemostasis following perforation of the pulmonary artery with massive hemothorax. Bullet embolization into the left hypogastric artery through an acquired aortopulmonary fistula suspected during thoracic exploration was diagnosed after the procedure. Postoperative recovery was uneventful in both cases. The bullet in the hypogastric artery was not extracted, with no complications being observed after a follow-up period of 3 years.