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A 25 year old man felt a sudden pain in his chest while walking in the park. He observed two youths with an air rifle in the near vicinity. Two days later he presented to the accident and emergency department with continuing chest pains and two episodes of haemoptysis. Examination showed a 5 mm healing left chest wound in the 4th intercostals space. Respiratory and cardiovascular examinations were unremarkable.
A chest radiograph (figs 1 and 2) showed a foreign body within the thoracic cavity but no pneumo/haemothorax.
After admission under the cardiothoracic surgeons a CT scan (fig 3) showed the pellet to be lodged between the aorta and a large pulmonary vein. He was treated conservatively and after three days of observation discharged home.
This case further illustrates that perceived “low velocity” weapons such as air rifles potentially produce life threatening penetrating injuries in adults as well as children.1
Patients may at presentation appear haemodynamically normal with minimal indication of underlying injury.2
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