AIR RIFLE PELLET INJURY TO THE HEART WITH RETROGRADE CAVAL MIGRATION

Great emphasis is placed on the lethality of modern high-powered stree t weapons, and their impact on mortality from firearm injuries. Presen ted is a case of an air rifle BB injury to the chest, resulting in a p enetrating injury of the right heart, with apparent retrograde emboliz ation to the inferior vena cava. Although no clinical evidence of peri cardial tamponade was present 4 hours following injury, 150 mL of peri cardial blood was encountered at median sternotomy, secondary to a rig ht atrial appendage entry wound. This case exemplifies three important principles regarding penetrating chest trauma and air guns: (1) Moder n air rifles, capable of muzzle velocities as high as 900 fps, are int rinsically lethal weapons; (2) missiles within the cardiovascular syst em have a propensity for embolization, and often follow an intuitively unexpected course; and (3) young healthy patients with potentially le thal penetrating cardiac injuries, particularly those caused by low ve locity firearms, may appear stable and minimally injured in the emerge ncy room. A strong suspicion of cardiac injury and prompt intervention should be extended to airgun injuries of the thorax.