Bullet emboli

Case contributed by Jayanth Keshavamurthy
Diagnosis certain


ICU chest radiograph.

Patient Data

Age: 70 years
Gender: Male

Endotracheal tube is demonstrated 5 cm above the carina. A left internal jugular central line is demonstrated with the tip at the SVC. A right-sided PICC line is demonstrated with the tip at the cavoatrial junction. Heart is normal size. Thoracic aorta is partially calcified.


Right greater than left pleural effusion.

Right lower lobe alveolar opacity.

Artefact from the bullet in the IVC-RA junction trapped in the Eustachian valve.

Case Discussion

Actually, on the CT the resident thought the linear artefact as a retained pacemaker wire.

A metallic density is identified within the inferior aspect of the right atrium, which is favored to represent a small segment of retained pacer lead. Results have been communicated by radiology to the primary team regarding this small fragment of a retained pacer lead.

It is important not forget to review the scout.

CT obtained in a beating heart and see how the computer generates a line on sagittal and coronal images and will fool you.

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