Question:

Which of the following answer choices are true?
1. Venous emboli are often asymptomatic.
2. Embolization to the pulmonary artery accounts for 25% of intravascular bullet emboli.
3. Embolization to the heart accounts for 50% of intravascular bullet emboli.
4. Paradoxical embolization (embolization from the venous system to the arterial system via the heart, for example through a patent foramen ovale) accounts for 20% of bullet emboli.
5. Embolization to peripheral arteries rarely occurs.





Answer:

The correct answers for the question "Which of the following answer choices are true?" are:

1. Venous emboli are often asymptomatic.

2. Embolization to the pulmonary artery accounts for 25% of intravascular bullet emboli.



Explanation
1.  Venous emboli are often asymptomatic.  [In contrast to arterial emboli, venous emboli are often asymptomatic and may not be recognized until later, if and when they result in vascular injury or obstruction.]  

2.  Embolization to the pulmonary artery accounts for 25% of intravascular bullet emboli.  [Mattox et al report 28 cases of intravascular bullet emboli.  Of these, 36% were from the thoracic or abdominal aorta to a peripheral artery, 25% were from peripheral veins to the pulmonary artery, 18% were from peripheral veins to the heart, 11% were from the heart to a peripheral artery, and 7% were from the heart to the hepatic or renal vein via the inferior vena cava.]  

3.  Embolization to the heart accounts for about 18% of emboli.  [Mattox et al report 28 cases of intravascular bullet emboli.  Of these, 36% were from the thoracic or abdominal aorta to a peripheral artery, 25% were from peripheral veins to the pulmonary artery, 18% were from peripheral veins to the heart, 11% were from the heart to a peripheral artery, and 7% were from the heart to the hepatic or renal vein via the inferior vena cava.]  

4.  Paradoxical embolization accounts for about 4% of embolization.  [Mattox et al report 28 cases of intravascular bullet emboli.  Of these, 36% were from the thoracic or abdominal aorta to a peripheral artery, 25% were from peripheral veins to the pulmonary artery, 18% were from peripheral veins to the heart, 11% were from the heart to a peripheral artery, and 7% were from the heart to the hepatic or renal vein via the inferior vena cava. One case (4%) was paradoxical from the inferior vena cava to the right atrium, then to the left atrium and thereafter into the abdominal aorta.]  

5.  Embolization to peripheral arteries is relatively common.  [Mattox et al report 28 cases of intravascular bullet emboli.  Of these, 36% were from the thoracic or abdominal aorta to a peripheral artery, 25% were from peripheral veins to the pulmonary artery, 18% were from peripheral veins to the heart, 11% were from the heart to a peripheral artery, and 7% were from the heart to the hepatic or renal vein via the inferior vena cava.]



From the manuscript:
Bilateral shotgun pellet pulmonary emboli
Radiology Case. 2012 Apr; 6(4):1-10


This article belongs to the Chest section.




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From the manuscript

Bilateral shotgun pellet pulmonary emboli

Free full text article: Bilateral shotgun pellet pulmonary emboli

Abstract
Intravascular migration of bullets and other foreign bodies is a rare but known complication of penetrating trauma. Missile embolization can represent a diagnostic challenge because it may present in various and unexpected ways. We present the case of a 54-year-old female who sustained shotgun pellet emboli to the pulmonary arteries following a left upper extremity gunshot wound and related vascular surgery. The case illustrates bilateral embolization, and the embolic events occurred following surgery. Embolization should be considered in evaluating patients with gunshot wounds, particularly if there are anomalous symptoms or the projectile is not found in the original, or expected, location. Close attention to the location of the foreign bodies on serial radiographs may reveal the diagnosis of intravascular embolization.






References



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