Bullet emboli to the pulmonary artery: a report of 2 patients and review of the literature.

Bullet embolization to the pulmonary artery is a rare event. The purpose of this study is to report our experience with 2 patients and to review the 15 patients reported in the literature, with special emphasis on a rather peculiar complication that has occurred in 4 of the 9 patients who underwent bullet embolectomy: dislodgment of the missile during the surgical procedure and migration to the down-side lung, for which a second thoracotomy was required in 3 of those patients. The usual untoward effects of foreign bodies in the vascular system were seen in this series: embolization with thrombosis, sepsis, erosion and hemorrhage, and vascular occlusion with infarction. This review suggests that operative removal of a bullet in the pulmonary artery is necessary. The operation is safe and uncomplicated if precautions are taken to prevent the missile from migrating during manipulation of the lung.