Right Ventricular Pellet Embolization Following Venous Migration After Shotgun Injury: Diagnostic Challenges and Conservative Management of a Rare Case

Abstract

Projectile embolization is a rare but potentially serious complication of firearm injuries, and intracardiac migration of shotgun pellets through the venous system is exceptionally uncommon. We report a 25-year-old male who sustained a shotgun injury to the right shoulder region and was referred to our tertiary trauma center. Thoracic computed tomography demonstrated multiple metallic foreign bodies within the soft tissues of the right shoulder and upper thorax, as well as several pellets located in the right ventricle without evidence of direct cardiac penetration, hemothorax, pneumothorax, pericardial effusion, or myocardial injury. Additional imaging revealed pellets within the right brachial and axillary venous systems, while serial examinations showed positional changes of the intracardiac pellets, strongly suggesting venous migration through the superior vena cava into the right ventricle. Transthoracic echocardiography demonstrated normal ventricular function and no valvular, myocardial, or pericardial abnormalities. Following multidisciplinary evaluation by emergency medicine, cardiology, cardiovascular surgery, and thoracic surgery teams, conservative management with close clinical and radiological follow-up was chosen because the patient remained asymptomatic and hemodynamically stable. This case highlights the importance of considering venous projectile embolization when intracardiac foreign bodies are detected after firearm injuries, as recognition of this rare phenomenon may prevent misdiagnosis and unnecessary surgical intervention.