The importance of two-dimensional echocardiography in the location of a bullet embolus to the right ventricle.

Bullets which enter a sufficiently large vein may embolize to the right ventricle. This finding is usually determined after the bullet has been removed from the heart. A chest x-ray study cannot, however, differentiate with certainty between localization in the right ventricular cavity, the right ventricular wall, or the pericardium. We recommend echocardiography to document bullet localization in the right ventricular cavity prior to surgical removal.