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January 8, 1973

An Intrapericardial Tumbling Bullet

Author Affiliations

San Francisco General Hospital San Francisco

JAMA. 1973;223(2):196. doi:10.1001/jama.1973.03220020062034

To the Editor.—  A bullet that enters the pericardium usually passes somewhat centrally, entering cardiac muscle or intracardiac chambers and severely damaging the heart.1-4 Some bullets come to rest within the pericardial space per se, and little, if any, cardiac damage results.5 A case in which a bullet entered the pericardial space, only minimally traumatizing the myocardial wall, is reported herein. This case was unusual in that the bullet was not anchored by structures adjacent to the pericardium and, thus, frequently changed its position and orientation within the cardiac silhouette. A continuous change in the position of the bullet, observed by fluoroscopy and sequential chest roentgenograms proved to be the diagnostic key to the location of the missile.

Report of a Case.—  A 23-year-old motorcyclist was admitted to the San Francisco General Hospital on Aug 28, 1971, following a Saturday night brawl in which he sustained four gunshot