case_images: PMC10894020_01
case_images: Admission plain skull computed tomography.. (a) The image on the left shows bilateral parieto-occipital subarachnoid hemorrhage (arrow), and the image in the center (b) (arrow), and on the right depicts intra and extracranial projectiles (c) (arrow).
case_images: cureus-0016-00000052910-i01.jpg
case_images: PMC10894020_01_cureus-0016-00000052910-i01.jpg
case_images: FIG1
case_images: Subsequently, a plain skull computed tomography (CT) scan is conducted (Figure 1), revealing a left laminar subdural hematoma, traumatic subarachnoid hemorrhage (Figure 1a), with multiple metallic fragments embedded in the skull, and some penetrating the galeal sinus, with perilesional bleeding (Figures 1b-1c).
case_images: Chest computed tomography at admission.. (a) The image on the left reveals a non-thrombotic embolism of metal fragments in the pulmonary artery for the apical segment of the left upper lobe and right intraventricular regions (arrow). (b) On the right, cardiac chambers of normal size are observed with metal fragments inside the right ventricular cavity (arrow).
case_images: cureus-0016-00000052910-i02.jpg
case_images: PMC10894020_01_cureus-0016-00000052910-i02.jpg
case_images: FIG2
case_images: Transthoracic echocardiogram.. (a) The image on the left shows the ventricle without hemodynamic alterations or changes in contractility. (b) On the right, in the subvalvular apparatus toward the interventricular septum, a hyperechoic image of 3 mm is observed (arrow).
case_images: cureus-0016-00000052910-i03.jpg
case_images: PMC10894020_01_cureus-0016-00000052910-i03.jpg
case_images: FIG3
case_images: Considering the cardiac finding, a transthoracic echocardiogram is performed (Figure 3), revealing a left ventricle with diastolic diameter within normal parameters and normal wall thickness (Figure 3a), an estimated ejection fraction by volumetric 2D and Simpson's method at 60 +- 5%. An echogenic image of 3 mm is observed in the subvalvular apparatus toward the interventricular septum (Figure 3b).
case_images: Skull tomography on the second day after admission.. (a) On the left image, subarachnoid hemorrhage and bilateral parieto-occipital intraparenchymal hematomas are observed (arrow). (b) On the right, parieto-occipital epicranial hematomas with metallic shrapnel and projectiles are visible (arrow).
case_images: cureus-0016-00000052910-i04.jpg
case_images: PMC10894020_01_cureus-0016-00000052910-i04.jpg
case_images: FIG4
case_images: On the second day of ICU monitoring, the patient experiences neurological deterioration, leading to a plain skull CT scan (Figure 4), which identifies signs of cerebral edema and parieto-occipital epidural hematomas with metallic fragments and projectiles.