A BULLET NUCLEUS MOBILE WITH CARDIAC CYCLE

We hereby report a case of atypical chest pain after a firearm injury occurring 20 years ago, which remained asymptomatic throughout the years. The patient had a positive treadmill exercise test and his coronary angiographic examination revealed plaque lesions and a bullet embedded in the myocardium. The bullet could not be localized clearly by echocardiography or computerised tomography due to the shiny nature of the metal. Penetrating gun traumas are quite frequent in developed countries and in countries in war, with most of the cases ending with death. A situation similar to our case was reported only once in the medical literature. Firearm injuries lead to free mural perforations, fistulisations between cardiac spaces and pericardial tamponade. Usually the patients die before reaching the hospital. But in asymptomatic patients, the bullet may be found as embedded in the myocardium.