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"Shot to the Heart": Case Report and Concise Review of Cardiac Gunshot Injury.

ABSTRACT: Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial effusion with tamponade, and arrhythmias of which gunshot injury is a chief culprit. We report a case of a suspected acute coronary syndrome after a cardiac gunshot injury that was conservatively managed.

SUBMITTER: Kawall T

PROVIDER: S-EPMC7444102 | biostudies-literature | 2020 Jan-Dec

REPOSITORIES: biostudies-literature

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"Shot to the Heart": Case Report and Concise Review of Cardiac Gunshot Injury.

Kawall Tiffany T Seecheran Rajeev Virender RV Seecheran Valmiki Krishna VK Persad Sangeeta Anjali SA Jagdeo Cathy-Lee CL Seecheran Naveen Anand NA

Journal of investigative medicine high impact case reports 20200101

Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial effusion with tamponade, and arrhythmias of which gunshot injury is a chief culprit. We report a case of a suspected acute coronary syndrome after a cardiac gunshot injury that was conservatively managed. ...[more]

PMID: 32815420

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Traumatic femoral arteriovenous fistula following gunshot injury: Case report and review of literature.

Project description:IntroductionVascular injuries account for approximately 2-4% of trauma admissions with only 2.5% of these being traumatic arteriovenous fistulas (AVFs). We offer a case report of a traumatic AVF and review of the literature.Presentation of caseA 40-year-old male presented following 4 gunshot wounds, 2 in the forearm and 2 in the left upper thigh. The patient had decreased range of motion and paresthesia of the left lower extremity with palpable pulses and adequate capillary refill in all extremities. A CT angiogram demonstrated a left traumatic AVF involving the left deep femoral artery and left common femoral vein with an adjacent bullet fragment. The patient was taken to the operating room and underwent an exploration of the left groin, repair of the traumatic AVF, and removal of bullet fragment. The venous aspect had a grade IV injury and was ligated. The arterial defect was debrided to healthy tissue and repaired primarily. The patient recovered from his injuries with adequate ambulation and resolution of lower extremity edema. He was discharged home on postoperative day 4 on aspirin and a compression stocking.DiscussionTraumatic AVFs are rare, with up to 70% diagnosed in a delayed fashion. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this injury to avoid potential morbidity and mortality.ConclusionDespite literature accounts of surgeons' experience, this pathology is lacking level one evidence-based standardized surgical management algorithms. Controversy exists regarding venous repair methods.

| S-EPMC7272506 | biostudies-literature

A shot through the heart: a case report on retained bullet causing cardiac tamponade.

Project description:BackgroundAs a rare complication of penetrating chest trauma, one can occasionally find foreign bodies inside the pericardium. Even rarer is finding an intact bullet inside the pericardial cavity following the gunshot injury.Case summaryA 17-year-old male presented to the emergency department as a Level 1 trauma for multiple gunshot wounds. Upon arrival, the patient was tachycardic but normotensive. Physical exam was notable for several penetrating wounds to the chest and right clavicle. The initial chest X-ray demonstrated a metallic foreign body consistent with a bullet overlying the cardiac silhouette. Approximately 24 h into the hospital course, ST-segment elevation was noted on telemetry. An electrocardiogram demonstrated sinus tachycardia with diffuse ST-segment elevation in all leads, consistent with acute pericarditis. Over the following several hours, the patient gradually developed tamponade physiology, prompting a more emergent median sternotomy.DiscussionAlthough penetrating cardiac injury carries a high mortality rate, management of these patients and complications that may arise during their hospital course are rarely explained. The diagnosis of projectile chest trauma starts with history and physical examination. The primary diagnostic modalities are the X-ray, computed tomography scan of the chest, electrocardiogram, and echocardiogram. Management of a patient with cardiac gunshot depends largely on haemodynamic status. As in our case, a patient with haemodynamic instability is managed with emergency exploration and removal of the foreign body.

| S-EPMC11647594 | biostudies-literature

Cardiac Gunshot Injury: A Serendipitous Miss!

Project description:Penetrating cardiac injuries carry a grave prognosis. We present a rare case of thoracic gunshot injury where the bullet ricocheted and lodged in the pericardium without causing damage to the adjacent cardiac structures. Multimodality imaging helped in localizing the bullet, assessing damage, and planning safe surgical removal without cardiopulmonary bypass. (Level of Difficulty: Beginner.).

| S-EPMC8305087 | biostudies-literature

Small RNAs report early heart injury after cardiac surgery

Project description:Study aims to identify circulating small RNAs that report early heart injury after cardiac surgery with a view to translating them to the early diagnosis of myocardial infarction

2023-12-25 | GSE146203 | GEO

Familial Multiple Trichodiscomas: Case Report and Concise Review.

Project description:Familial multiple trichodiscomas is a condition characterized by multiple asymptomatic skin papules. The inheritance pattern has not been established. The skin lesions usually appear in childhood. The diagnosis of the cutaneous papules is established by pathologic evaluation. Birt-Hogg-Dubé syndrome is excluded by not detecting any aberration in the folliculin gene locus. Including our patient, 15 index individuals and their families are described. There is no systemic organ involvement or associated malignancies in individuals with this condition.

| S-EPMC5652887 | biostudies-literature

Percutaneous removal of air-bullet gunshot: case report and literature review.

Project description:BACKGROUND:Cardiac air bullet injuries are rare but can be associated with significant morbidity and mortality. CASE PRESENTATION:We are presenting a young male child who sustained an accidental injury to the chest by an air rifle. Bullet entered the right ventricle from the anterior part of the chest and was identified in the RV side of the interventricular septum by echocardiography and chest CT scan. There was mild pericardial effusion but no valvular injury. The bullet was removed in the cath lab, and the patient was discharged home on the second day. CONCLUSIONS:It is reasonable to try foreign body removal in the cath lab, for certain cases, and avoid cardiac surgery.

| S-EPMC7198657 | biostudies-literature

Gunshot Pellet Migration to the Right Ventricle: a Case Report and Literature Review.

Project description:The diagnosis and management of injuries of the heart or the great vessels continues to be a major surgical challenge in the past and now. This case study introduces the conservative management of a patient who developed a venous bullet embolus after being shot in the lower extremities. In this case report, we aim to review some of the literature on bullet emboli and to raise awareness of its existence. It was concluded that for bullets left in the limbs, bullet position in relation with peripheral vessels should be evaluated carefully to treat and avoid the bullets moving along with the bloodstream.

| S-EPMC5386942 | biostudies-literature

Recovery of volitional movement with epidural stimulation after “complete” spinal cord injury due to gunshot: A case report and literature review

Project description:Background: Epidural spinal cord stimulation (eSCS) restores volitional movement and improves autonomic function after nonpenetrating and traumatic spinal cord injury (SCI). There is limited evidence of its utility for penetrating SCI (pSCI). Case Description: A 25-year-old male sustained a gunshot wound (GSW) resulting in T6 motor/sensory paraplegia and complete loss of bowel and bladder function. Following eSCS placement, he regained partial volitional movement and has independent bowel movements 40% of the time. Conclusion: A 25-year-old pSCI patient who, following a GSW resulting in T6-level paraplegia, sustained marked recovery of volitional movement and autonomic function following eSCS placement.

| S-EPMC9990798 | biostudies-literature

Treatment and molecular analysis of bullous pemphigoid with tofacitinib: a case report and review of current literature

Project description:Bullous pemphigoid (BP) is a rare, life-threatening autoimmune blistering disease with pruritus and tension blisters/bullous as the main clinical manifestations. Glucocorticosteroids are the main therapeutic agents for it, but their efficacy is poor in some patients. Tofacitinib, a small molecule agent that inhibits JAK1/3, has shown incredible efficacy in a wide range of autoimmune diseases and maybe a new valuable treatment option for refractory BP. To report a case of refractory BP successfully treated with tofacitinib, then explore the underlying mechanism behind the treatment, and finally review similarities to other cases reported in the literature. Case report and literature review of published cases of successful BP treatment with JAK inhibitors. The case report describes a 73-year-old male with refractory BP that was successfully managed with the combination therapy of tofacitinib and low-dose glucocorticoids for 28 weeks. Immunohistochemistry and RNA sequencing were performed to analyze the underlying mechanism of tofacitinib therapy. A systematic literature search was conducted to identify other cases of treatment with JAK inhibitors. Throughout the 28-week treatment period, the patient experienced clinical, autoantibody and histologic resolution. Immunohistochemical analysis showed tofacitinib significantly decreased the pSTAT3 and pSTAT6 levels in the skin lesions of this patient. RNA sequencing and immunohistochemical testing of lesion samples from other BP patients identified activation of the JAK-STAT signaling pathway. Literature review revealed 17 previously reported cases of BP treated with four kinds of JAK inhibitors successfully, including tofacitinib (10), baricitinib (1), upadacitinib (3) and abrocitinib (3). Our findings support the potential of tofacitinib as a safe and effective treatment option for BP. Larger studies are underway to better understand this efficacy and safety.

2024-11-13 | GSE278926 | GEO

Using Urethroplasty as an immediate treatment for gunshot-induced penis injury during the Syrian war: Case report.

Project description:Introduction and importanceWars and armed conflicts often result in gunshot injuries, including penile trauma, in military personnel or civilians. Urinary system damage occurs in 0.5-4.2 % of cases involving harm to all organs and systems during combat conflicts. We report the immediate Urethroplasty for gunshot-induced penile injury.Case presentationA 25-year-old Syrian soldier presented to the emergency department with difficulty urinating due to a gunshot wound to the penis. Physical examination showed bruising on the scrotum and penis. Computed tomography scan confirmed a gunshot injury to the bulbar urethra. Under general anesthesia, a circumcised incision was made and it was observed a significant loss of 14 cm of the penile and bulbar urethra on the ventral side. The bullet was removed. The urethral plate was suspended, sutures were placed on the dorsal side, and a graft was taken from the dermis of the left Iliac skin for ventral urethroplasty. A follow-up retrograde urethrogram showed normal results.Clinical discussionInjuries of genitourinary from trauma, particularly involving the penis, are uncommon. Generally, gunshot wounds to the penis can cause various injuries, ranging from superficial to deep. The trauma team and urologists should stay alert in evaluating the patient for additional injuries outside the genitourinary system, particularly rectum, colon, and/or small bowel injuries, which were present in over 50 % of the major non-genitourinary injuries observed.ConclusionAlthough urinary and reproductive system injuries are uncommon, their management is important for every urologist and emergency physician because they have physical and psychological effects on the patient.

| S-EPMC11600014 | biostudies-literature

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