A retained bullet lodged in or near a joint can cause both arthropathy in that joint and systemic lead poisoning. The bullet become fragmented due to a combination of mechanical forces and dissolution in acidic synovial fluids.
Clinical features:
(1) history of a gunshot wound in or near a joint, with retained fragments
(2) painful, swollen joint with proliferative synovitis
(3) variable signs of lead poisoning (neuropathy, anemia, other)
Imaging studies may show
(1) bullet fragments in and around the joint (diffuse small lead deposits may be referred to as a "plumbogram")
(2) destructive arthritis
Laboratory testing may show elevation of blood lead levels.
A biopsy of synovium may show:
(1) synovial hypertrophy
(2) chronic inflammation with focal foreign body reaction
(3) fibrosis
(4) hemosiderin deposition
(5) calcifications
To read more or access our algorithms and calculators, please log in or register.
