CLINIPICS – December 2011

A rotating bullet in the mediastinum

Muhammad Faisal Khan, MCPS, FCPS*, Hameedullah, FCPS**

* Senior Registrar, Department of Critical Care, King Khalid University, Riyadh (KSA)

** Aga Khan University, Karachi (Pakistan)

Correspondence: Dr. Muhammad Faisal Khan,MCPS, FCPS, Senior Registrar, Department of Critical Care King Khalid University, Riyadh (KSA); e-mail: mfkdr.icu@gmail.com

A previously healthy male of 41 years was admitted in ICU after a gunshot injury at the back of his neck. The injury was complicated with left haemopneumothorax, left lung contusion and post traumatic paraplegia. Chest X-ray films, routinely taken daily in our ICU, showed the rotation of the bullet in a clockwise direction apparently in the mediastinum. These X-rays were taken on different days during his period of admission. It raised the concern of exact position of the bullet. A CT scan was ordered, which ruled out any emergent situation and determined the exact position.

Figure : Head of bullet at 3 o’clock positon

Figure : Head of bullet at 2 o’clock position

Figure : Head of bullet at 1o’clock position

Figure : Head of bullet again at 8 o’clock position with no chest tube

Figure : A slice of MRI shows the exact location of the bullet