"Routine" X-rays sometimes tell old tales. I ordered this film on an elderly gentleman with chest pain. Chest films are usually not diagnostic in patients with anginal symptoms, but occasionally one will find a lobar pneumonia or heart failure. One can see sternotomy wires (loop structures over the sternum) which are from a coronary bypass surgery some years prior (and are actually metal so they show up nicely on the film).In this guy though there's another obvious finding on the lower right side of the film (anatomical right). This is buckshot, and when I saw it I went back to talk to the patient to ask.
"Oh yeah, doc, forgot to tell you, I got shot twenty years ago." Not the kind of thing I would omit from my medical history but to each his own.
In this particular case this interesting finding had nothing to do with the patient's chest pain, but I bet it hurt a bit being on the other end of the barrel. I was too busy to get the down and dirty but not too busy to snap this picture.
Sooo, you have ruled out lead poisoning?
ReplyDeleteI thought Huntin' Season was over... 9-11 are you REALLY from the South? even my 14 yr old daughter could tell ya that T'aint Buckshot... Not OO anyways, which is all any real man shoots...
ReplyDeletelooks more like birdshot to me..
Frank
Yup. Looks like # 8 or 9 shot. Was he a hunting partner of Dick Cheney?
ReplyDeleteI would have loved to hear the story behind THAT little mishap...beer or cheap bourbon?
ReplyDeletefrank et al,
ReplyDeleteWhat' eva... I do what I want. So it's not buckshot... Old as this dude was it could have been grape shot from a cannister shell.
Just curious, but not having that information, if you had ordered an MRI for this guy, wouldn't that have caused more problems?
ReplyDeleteDenise, Denise, Denise,
ReplyDeleteany competent phsyician knows that retained Bullets are an ABSOLUTE CONTRINDICATION to MRI Scanning, Unfair I know, surprised the ACLU hasn't filed a lawsuit yet...
Frank
Frank, Frank, Frank
ReplyDeleteI mean what if the doctor, such as in this case, doesn't know in advance? Will the MRI rip that stuff out of you or what? I've never needed more than an a gazillion X-rays (knock on wood) and I'm just curious. Anyway, don't worry... the ACLU is probably still in DC celebrating.
dear denise,
ReplyDeleteyou are correct that certain kinds of metal prohibit MRI scanning. these are ferrous metals, or metals that are attracted to magnets. lead is fine, this patient could have an MRI with birdshot in his RUQ without problems.
Lead shot is being banned by more and more states. One of the replacements is steel shot. Given how long ago this occured it is more than likely lead, but how would you handle it if it was recent or if the patient didn;t know?
ReplyDeletedear doc v,
ReplyDeleteif this pt came in after being shot he would have either gone to the OR or to CT scan. if an MRI were needed later I would defer to the radiologist.
Does lead shot embedded in the tissue cause problems? Or does the lead have to pass through the stomach for it to enter the bloodstream?
ReplyDeletedear chuckr44,
ReplyDeletea toxicologist would be better for this question. my first reaction is to say that this shot will not cause lead poisoning but as far as the whys and wherefores i will hope for smarter people than me to answer. i CAN tell you that you can't getting the shot out is well nigh impossible and the cure would be worse than the disease. it took me thirty minutes to get a BB out from under the skin of a 16 year old girl (mom demanded) and i had an ultrasound probe to help. yes, i'm a hack, but i'm not the worst hack ever. the shot moves around and blood gets in the field and it's just a pain for all concerned. sorry, gotta let this one lie.