Chest
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A bullet migrated from the heart to the left femoral artery in a youth ten days after he sustained a gunshot wound to the right chest. The bullet apparently traversed the pulmonary venous system at the time of the injury and lodged in the interior of the left ventricle. The production of an embolism in the systemic circulation was a delayed and unanticipated event.
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Systemic air embolism following penetrating injuries of the lung has not been widely recognized clinically. Experimental studies designed to reproduce the phenomenon in dogs have been at variance, although none has taken into consideration the often high intrabronchial pressures created during resuscitative efforts in such patients. Twelve patients with systemic air embolism following penetrating traumatic injuries to the lung have been seen at our hospital. ⋯ Penetrating injuries of the lung were created in mongrel dogs, and the animals were ventilated with pressures reaching 90 mm Hg. All dogs unequivocally developed systemic air embolism, with air visualized in the coronary arteries. It would appear that systemic air embolism following penetrating injury to the lung may result when increased intrabronchial pressure, such as found during manual ventilatory assistance, forces air through traumatic bronchovenous fistulae into the systemic circulation.
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Echocardiographic studies demonstrated abnormalities of motion of the pulmonary valve, the aortic root and valve, the mitral and tricuspid valves, the left ventricle, and the left atrium in two patients with second-degree atrioventricular block. During Wenckebach 3:2 atrioventricular conduction, ventricular beats exhibited alternately long and short periods of systolic opening of the pulmonary and aortic valves and alternately large and small left ventricular stroke volumes. During 4:3 and 3:2 Wenckebach atrioventricular conduction, the left ventricular stroke volume was directly proportional to the preceding end-diastolic volume. During 2:1 atrioventricular conduction, the blocked atrial contractions may produce movements of the left atrial wall, thereby revealing the true atrial rate when the blocked P waves are obscured in the electrocardiogram by their superimposition on preceding T waves.