Pulmonary vein to systemic artery missile embolus.

Pulmonary vein to artery missile embolus is extremely rare. Only one other case could be found in the world's literature and the present case appears to be the only reported survivor. The key in the safe management of missile embolus is in the prompt and proper care of the primary wound. Extraction of the foreign body is secondary and becomes an absolute necessity only when it interferes with distal perfusion. Catheter embolectomy is contraindicated because of possible intimal damage, so that direct arteriotomy is preferred.