Intracranial Bullet Migration Causing Brain Abscess

Ramazan Kutlu, MD; Ayhan Kocak, MD; Suleyman Cayli, MD; Alpay Alkan, MD; Ahmet Sigirci, MD; Kaya Sarac, MD

Disclosures

Appl Radiol. 2004;33(8) 

In This Article

Case Summary

A 54-year-old man was admitted to the emergency department after being shot with a handgun. Physical examination revealed a single entry wound in the upper jaw near the left second premolar tooth with no observed exit wound. There was periorbital edema and ecchymosis on the left. Neurologic examination revealed normal findings except for a mild right hemiparesis. Lateral cranial roentgenography (Figure 1) and computed tomography (CT) (Figure 2) were performed. On the third day after admission, control roentgenogram (Figure 3) and CT (Figure 4) examinations were repeated. Ten days later, a cranial CT (Figure 5) was performed.

Plain film lateral view of cranium shows the bullet in the parietal region.

Axial cranial CT slices, (A) parenchyma window and (B) bone window, show the hyperdense bullet causing metallic artifacts in deep parietal location.

Axial cranial CT slices, (A) parenchyma window and (B) bone window, show the hyperdense bullet causing metallic artifacts in deep parietal location.

Control roentgenogram shows migration of the bullet to the occipital region.

Control axial cranial CT slices—(A) parenchyma window and (B) bone window—show the new location of the migrated bullet in the left occipital region near torcular Herophili.

Control axial cranial CT slices—(A) parenchyma window and (B) bone window—show the new location of the migrated bullet in the left occipital region near torcular Herophili.

Contrast-enhanced cranial axial CT slice shows abscess formation in the left frontoparietal region.

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