Finding the missing bullet: A case report of an unusual trajectory from the left scapula into the left orbit

Abstract

Evaluating a traumatically injured patient requires a systematic evaluation that can rapidly detect life threatening injuries. When there is a discrepancy in the number of expected retained bullets, one must re-evaluate the initial work-up. This case consists of an extremely unusual trajectory course of a scapular wound where the ballistic then traversed off the scapula through the neck entering the para-pharyngeal space, travelling through the facial bones, and coming to rest within the left eye, itself. This case herein reinforces the importance for the evaluating provider to quickly recognize when the work-up is inconsistent with the initial assessment. Failure to recognize this discrepancy may lead to an inappropriate work-up with subsequent devastating life-threatening consequences.

Highlights

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  Trajectory delineates anatomic injury.

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  To rapidly detect all injuries, follow the entire pathway of the penetrating object.

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  Aerodigestive & carotid injuries are associated with a high morbidity & mortality.