PMC3912650_01
(a) Admission head computed tomography demonstrates a metallic foreign body projecting in the region of the right transverse sinus (arrow) (b) the bullet previously seen in the right transverse sinus is no longer evident on the follow-up head computed tomography angiography
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F1
A head computed tomography (CT) demonstrated the trajectory of the bullet, which had ruptured his left globe, travelled along the skull base fracturing his carotid canals bilaterally, and was located in the right transverse sinus [Figure 1a]. Post-operatively, contrast enhanced computed tomography angiography of the head was performed, which demonstrated occlusion of the left internal carotid artery [Figure 1b].
Chest radiograph obtained at admission (a) demonstrates no cardiopulmonary abnormality. A follow-up chest radiograph (b) shows a 5 mm round metallic foreign body projecting over the left hilum (open arrow) with interval development of a wedge shaped pulmonary opacity a the left lung base (arrow head)
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F2
At admission, a portable chest radiograph had been unremarkable [Figure 2a]. Approximately 2.5 h later, a repeat post-operative chest radiograph showed a new round foreign body resembling a BB that projected over the left hilum with interval development of a wedge shaped pulmonary opacity silhouetting the left hemidiaphragm [Figure 2b].
Lung and bone windows (3a and 3b respectively) again show the 5 mm rounded metallic foreign body in the left lower lobe with an associated pulmonary infarct. A small left anterior pneumothorax and pneumomediastinum are also seen
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F3
Chest CT confirmed that the bullet was now located in a left lower lobe with an associated pulmonary infarct, a small left-sided pneumothorax, and extensive pneumomediastinum [Figure 3a and 3b].