PMC4885112_01
Gunshot wound situated in the middle third of chest bone.
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A gunshot wound was evident in the lower third of the sternum (Fig. 1) and surprisingly the projectile was felt on deep palpation at the level of the right 9th rib paravertebrally.
CT scan: moderate hemopericardium(13 mm) and huge right hemothorax (65 mm).
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Chest and abdominal CT scan revealed a moderate volume hemopericardium ( 13 mm), a huge right hemothorax and a metallic projectile located in thebody of the right paravertebral muscles at the level of the fractured the 9th rib (Fig. 2, Fig. 3).
Right ventricle and right atrium free wall shot injury. Bicaval cannulation for extracorporeal circulation.
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Due to the complex nature of the cardiac injury and profuse bleeding from inferior vena cava, the injuries were repaired on extracorporeal circulation with bicaval cannulation without cardiac arrest (Fig. 4).