Bullet Embolus to the Thoracic Aorta with Successful Endovascular Snare Retrieval

(a) Contrast-enhanced axial chest CT shows bullet (arrow) at the base of the heart near the aortic root, but not believed to be intraluminal at the time. This was reportedly at the same location on presentation to an outside institution 1 week earlier (image not available). (b) Arch arteriogram obtained 1 day after chest CT shows a pigtail catheter located in the ascending aorta, adjacent to the bullet (arrow), which was not believed to be intraluminal given its stable position for over one week's time. Note the pigtail thoracostomy tube (arrowhead) in the right chest. (c) Position of bullet (arrow) immediately after completion of the angiogram. This appeared to remain in a relatively stable position in the mid-descending thoracic aorta. (d) Snare retrieval of the bullet. The loop snare (arrow) successfully engages the projectile in the proximal descending thoracic aorta. This was then withdrawn to the tip of the sheath at the proximal right common femoral artery, permitting removal after surgical femoral cutdown.