A 44-year-old male was admitted to the emergency department with a pellet gunshot wound 1 day ago. He was conscious and had ecchymosis in the back skin and presented with backache, palpitation, and short breath. His whole-body X-ray (Fig. 1) image showed grainy high-density shadows in the chest and abdomen. A computed tomography (CT) scan revealed those high-density shadows in areas of the lower lobe of the left lung, descending aorta, post-mediastinum, lower esophagus, left twelfth ante-rib, post-duodenum, adjacent lower thoracic vertebrae, back skin, and soft tissues (Fig. 2). Furthermore, a CT scan found an ascending aortic aneurysm with a diameter of 4.69 cm. Because of hematomas in the post-mediastinum and some bullets adjacent to the descending aorta, surgery was necessary. We took out the bullets that were fatal to the aorta without cardiopulmonary bypass and cleared the mediastinal hematomas. The patient was clinically well and was safely discharged.
Figure 1.
X-ray image showing grainy high-density shadows in the chest and abdomen
Figure 2.
CT image revealing the sites of those pellets, especially those near the descending aorta (arrows)