case_images: PMC8571419_01
case_images: Computer tomography scans of the brain showing the left occipital entry wound (a), displaced bony fragments from the bullet (b), and the subsequent traumatic subarachnoid, subdural, and intraparenchymal hemorrhage with metallic fragment related artifact (c).
case_images: SNI-12-491-g001.jpg
case_images: PMC8571419_01_SNI-12-491-g001.jpg
case_images: F1
case_images: CT of the head, neck, full spine, chest, abdomen, and pelvis as well as CT angiography of the carotids. CT demonstrated penetrating injury to the left occipital bone with comminuted fractures extending to the mastoid temporal bone, right occipital condyle, bilateral carotid canals, and sphenoid sinuses [Figure 1a]. Intracranial bone fragments were noted [Figure 1b]. Diffuse traumatic subarachnoid hemorrhage, a moderate-volume intraventricular hemorrhage, subdural hemorrhage, epidural hemorrhage, and a 1.5 cm x 0.6 cm x 0.5 cm left lateral pontine intraparenchymal hemorrhage was found [Figure 1c].
case_images: Computer tomography scans of the brain showing the metallic bullet fragment lodged in the jugular foramen.
case_images: SNI-12-491-g002.jpg
case_images: PMC8571419_01_SNI-12-491-g002.jpg
case_images: F2
case_images: Multiple bullet fragments were present in the left cerebellar hemisphere, along the left petrous apex and otic capsule, into the jugular foramen [Figure 2].
case_images: Computer tomography scan and chest radiograph showing the migrated bullet fragment. The radiograph is intentionally windowed to visualize the bullet fragment. The bullet fragment measured 2 mm on cross-section.
case_images: SNI-12-491-g003.jpg
case_images: PMC8571419_01_SNI-12-491-g003.jpg
case_images: F3
case_images: CT of the chest demonstrated a small metallic fragment within the right ventricle, without any other penetration or associated injuries to the chest or abdomen [Figure 3]. Follow-up chest X-ray was performed shortly after the scan confirming the presence of a metallic fragment in the right ventricle, which was not previously appreciated, measuring 2 mm in diameter [Figure 3].
case_images: PMC8571419_02