PMC4414003_01
Lateral scout CT head and neck image at presentation.
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PMC4414003_01_13032_2014_92_Fig1_HTML.jpg
Fig1
The CT head lateral scout revealed a single intracranial pellet, projected over the pterion (Figure 1 arrow).
Axial image from non-contrast CT brain at presentation.
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PMC4414003_01_13032_2014_92_Fig2_HTML.jpg
Fig2
Non-contrast CT demonstrated early signs of an acute MCA infarct with loss of the insula ribbon grey-white matter differentiation and subtle hypoattenuation within the putamen and globus pallidus (Figure 2 white oval).
CT angiography at 24 hours post presentation.
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PMC4414003_01_13032_2014_92_Fig3_HTML.jpg
Fig3
Follow-up CT angiography performed 24 hours after arrival showed complete reperfusion of the right middle cerebral artery (Figure 3) with the shot fragment seemingly unchanged in position (arrow).
Axial images CT carotid and Circle of Willis angiogram.
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PMC4414003_01_13032_2014_92_Fig4_HTML.jpg
Fig4
CT angiography of the neck revealed a focal dissection (Figure 4 arrow) and linear focus of thrombus within the right common carotid artery 5 cm inferior to the bifurcation, at the presumed arterial entry point of the embolised pellet.
PMC4414003_02
CT scout view pelvis and upper thigh.
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PMC4414003_02_13032_2014_92_Fig5_HTML.jpg
Fig5
A 2 mm rounded metallic shot fragment was seen to lie within the proximal right iliolumbar vein, with the pellet projected over the sacrum on the AP supine radiograph and CT scout images (Figure 5 arrow).
Axial post contrast CT image.
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PMC4414003_02_13032_2014_92_Fig6_HTML.jpg
Fig6
The pellet was seen to lie within the left iliolumbar vein (Figure 6 arrow), distant to the site of penetrating firearm trauma.