Ventilation-perfusion mismatch secondary to arterial bullet embolism

A 19-year-old man who was brought to the emergency department after a gunshot injury was referred to the radiology department to obtain computed tomography (CT). His CT findings revealed the appearance of a bullet in the truncus arteriosus, and he was urgently sent for operation. However, the bullet was not found during the operation and his control CT and chest x-ray detected a bullet in his right pulmonary artery and a very dense opacity in the lower zone of the right lung. He was then referred to our department for ventilation-perfusion scintigraphy. Ventilation-perfusion imaging revealed a large segmental ventilation perfusion mismatched defect in the lateral basal segment of the right lower lobe. © 2007 Lippincott Williams & Wilkins, Inc.