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A 65-year-old man underwent routine chest radiography before undergoing cardiac catheterization. The images (Panels A and B) revealed the presence of many little spheres in the posterior thoracic wall. On inquiry, the patient reported that he had been shot accidentally by a colleague while hunting 20 years earlier. At that time, he had been admitted to the hospital for a few days and had recovered uneventfully. The patient had normal liver and kidney function; the serum concentration of free lead was within the normal range (16 µg per deciliter [0.8 µmol per liter]). The hemoglobin level was 14.8 g per deciliter (9.2 mmol per liter), and the mean corpuscular volume was 86 µm3.
The damage caused by a gunshot depends on the location of the wound. If the projectiles do not penetrate internal organs or cause either infection or lead intoxication, they can be left in situ.
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