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Ann Thorac Surg 1998;66:562-564
© 1998 The Society of Thoracic Surgeons

Case Reports

Paradoxical embolism of a shotgun pellet

John S. Ikonomidis, MD, PhDa, Steven J. Nisco, MDa, David H. Liang, MD, PhDb, Robert C. Robbins, MDa

a Department of Cardiothoracic Surgery, Stanford Health Services, Stanford, California, USA
b Department of Cardiovascular Medicine, Stanford Health Services, Stanford, California, USA

Accepted for publication February 28, 1998.

Address reprint requests to Dr Robbins, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford Health Services, Stanford, CA 94305-5247
e-mail: (robbins{at}leland.stanford.edu)

Paradoxical embolism of a projectile from the venous to arterial system is a rare occurrence, which can cause diagnostic confusion. We present a case of venous embolism of a shotgun pellet from the left upper extremity to the noncoronary sinus of the aortic valve across a secundum-type atrial septal defect. Prevention of distal embolism of the pellet was presumably a result of its containment by flow vortices created within the sinuses of Valsalva.




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