PURPOSE: Bullet fragment embolization is a rare but potentially fatal complication of traumatic gunshot injury. Herein, we present a case of a patient who demonstrated migration of a bullet fragment from the lower chest into the left common iliac vein. Continual identification of foreign bodies on trauma imaging is of the utmost importance. Identifying and treating this rare entity can help vascular interventionalists improve patient outcomes.

CASE REPORT: Our patient presented to the emergency room after sustaining 2 gunshot wounds to the right axilla. Initial imaging demonstrated 2 bullet fragments: one in the right axilla and another in the lower chest overlying the heart. A subsequent trauma computed tomography was performed 13 minutes later and demonstrated a bullet fragment in the left common iliac vein, which had embolized from the original location in the lower chest. Interventional radiology was consulted to perform foreign body removal. A transcutaneous approach was utilized, and the bullet embolus was removed successfully without complication.

CONCLUSION: Bullet fragment embolization is a rare entity with complications ranging from critical limb ischemia to venous thrombosis or obstruction. This case helps to demonstrate the importance of identifying and accounting for bullet fragments in gunshot trauma imaging.