AN UNUSUAL CASE OF FOREIGN BODY PULMONARY EMBOLUS: CASE REPORT AND REVIEW OF
PENETRATING TRAUMA AT A PEDIATRIC TRAUMA CENTER
Laura A. Boomer, MD*, Daniel J. Watkins, MD, Julie O’Donovan, MD, Brian D. Kenney, MD, Andrew R.
Yates, MD, Gail E. Besner, MD
Nationwide Children’s Hospital
Departments of Pediatric Surgery, Radiology and Cardiology
700 Children’s Place, Columbus, OH 43206
Background: Penetrating thoracic trauma is relatively rare in the pediatric population, accounting for
only 10-20% of all pediatric thoracic trauma. Embolization of foreign bodies from penetrating trauma is
very uncommon. We present a case of a 6 year old boy with a penetrating foreign body from a projectile
thrown from a lawn-mower with embolization to a pulmonary artery branch.
Objective: The purpose of this study was to describe a rare case of foreign body pulmonary embolus
and to review the pediatric patients presenting with penetrating thoracic trauma at a large pediatric
trauma and tertiary care center.
Methods: We reviewed the penetrating thoracic trauma patients in our trauma registry between
1/1/03 and 12/31/12, including the details of the specific case presented in more detail. Data collected
included demographic data, procedures performed, complications and outcome. Patients with low
velocity wounds (i.e., knife stab wounds) were compared to those with high velocity wounds (i.e.,
gunshot wounds).
Results: A 6 year old male presented to the trauma center after sustaining a penetrating injury to his
chest from a projectile thrown from the underside of a lawn-mower. The patient presented with
pericardial tamponade requiring pericardial tube drainage. Imaging demonstrated a foreign body that
embolized to the left pulmonary artery. Seventy patients were initially identified in the trauma
database, 65 of whom were included for review after confirming the presence of penetrating trauma to
the chest. Fourteen of the patients (21.5%) had low velocity penetrating trauma and 51 (78.5%) had high
velocity injuries from gunshot wounds. Seven fatalities occurred, all of which were from high velocity
wounds (p=0.331). Patients with high velocity injuries were more likely to be older (12.9 vs. 9.5 years
old; p=0.018) and less likely to be Caucasian (p=0.002). There were no statistically significant differences
between patients with low velocity injuries and those with high velocity injuries regarding injury severity
score (ISS), combined total abbreviated injury score (AIS), Glasgow Coma Scale (GCS) at initial
presentation, length of stay (LOS), intensive care unit (ICU) LOS, or days requiring mechanical
ventilation. There were no statistically significant differences in procedures required between patients
with low velocity wounds versus those with high velocity wounds. This review demonstrates that
penetrating trauma with foreign body embolization may be able to be treated non-operatively.
Laura Boomer
Nationwide Children’s Hospital, Department of Pediatric Surgery
700 Children’s Place, Columbus, OH 43205
Ph: 614-722-3879
Fax: 614-722-3903
laura.boomer@nationwidechildrens.org
Figure 1. A.) Chest radiograph demonstrating a linear, metallic density at the level of the right hilum.
This radiograph was performed at 23:35 on the day of admission. B.) Repeat chest X-ray performed 30
minutes later demonstrating the foreign body overlying the left cardiac silhouette, concerning for
possible intracardiac migration. C.) Maximum intensity projection (MIP) coronal image (10 mm
thickness) from CT scan performed 8 hours after initial presentation, demonstrating the foreign body
lodged in the distal left pulmonary artery (arrow). The other density visualized is a naso-gastric tube.
A.
B.
C.
Table 1. Demographics of patients with penetrating chest trauma. High velocity wounds were from
firearms whereas low velocity wounds included all other penetrating wounds. All values represented as
number (%) except for age which is shown in years. P-values compare low velocity vs. high velocity
values.
Number of
Patients
Age, mean (range)
Sex
Male
Female
Race
White
Black
Asian/PI
2 or more
other
Insurance
Private
Medicaid
None
All Patients
65
Low Velocity
14 (21.5%)
High Velocity
51 (78.5%)
p-value
12.16 (1.33-20)
9.53 (2.42-16)
12.89 (1.33-20)
p=0.018*
53 (81.5%)
12 (18.5%)
10 (71.4%)
4 (26.6%)
43 (84.3%)
8 (15.7%)
p=0.271
27 (41.5%)
28 (43.1%)
6 (9.2%)
2 (3.1%)
2 (3.1%)
12 (85.7%)
1 (7.1%)
0 (0%)
0 (0%)
1 (7.1%)
15 (29.4%)
27 (52.9%)
6 (11.8%)
2 (3.9%)
1 (2.0%)
20 (30.8%)
25 (38.5%)
20 (30.8%)
5 (35.7%)
5 (35.7%)
4 (28.6%)
15 (29.4%)
20 (39.2%)
16 (31.4%)
p=0.002*
p=0.903
Laura Boomer
Nationwide Children’s Hospital, Department of Pediatric Surgery
700 Children’s Place, Columbus, OH 43205
Ph: 614-722-3879
Fax: 614-722-3903
laura.boomer@nationwidechildrens.org
Table 2. Severity of Injury. All data represent mean  standard deviation (range). ISS = injury severity
score; AIS = abbreviated injury score; GCS = Glasgow Coma Score; LOS = length of stay; ICU = intensive
care unit
ISS
Total AIS
Initial GCS
LOS
ICU LOS
Ventilator Days
All Patients
17 + 14 (1-75)
10 + 7 (1-36)
13 + 4 (3-15)
6.3 + 9.0 (1-45)
1.4 + 4.5 (0-36)
0.5 + 1.6 (0-12)
Low Velocity
12 + 7 (1-26)
7 + 5 (1-17)
14 + 3 (3-15)
3.6 + 2.2 (1-9)
0.6 + 0.7(0-2)
0.1 + 0.4 (0-1)
Laura Boomer
Nationwide Children’s Hospital, Department of Pediatric Surgery
700 Children’s Place, Columbus, OH 43205
Ph: 614-722-3879
Fax: 614-722-3903
laura.boomer@nationwidechildrens.org
High Velocity
18 + 16 (1-75)
11 + 7 (1-36)
13 + 4 (3-15)
7.1 + 9.9 (0-45)
1.6 + 5.1 (0-36)
0.6 + 1.8 (0-12)
p-value
p=0.331
p=0.090
p=0.637
p=0.640
p=0.356
p=0.152