Unusual Case of Meandering Bullet in the Pericardial Cavity: Surgical Management and Clinical Considerations

Abstract

Foreign bodies of the pericardium are rare and are most commonly associated with significant trauma. With no associated injury in the myocardium, the finding of a meandering bullet alone in the pericardial cavity is rare. This is a case of an 18-year-old patient who came to the emergency room of 48 Model Hospital with a penetrating chest trauma associated with hemothorax and pneumothorax. The patient complained of dyspnea and chest pain during the presentation. Tube thoracostomy was performed on the day of admission. CT, fluoroscopy, and echocardiography show pericardial effusion and bullets are floating in the pericardial space. On the sixth day of admission, the patient underwent Lt thoracotomy and pericardiotomy with bullet removal. The patient was discharged on the 10th postoperative day. Despite reports supporting conservative management, surgical removal of the foreign body is recommended in cases of free bullets in the pericardial sac due to the high risk of developing clinical manifestations, pericarditis, and potential complications such as cardiac tamponade. The potential risks and damage caused by the foreign body should be carefully considered, outweighing the uncertain outcomes and complications associated with conservative treatment.