Aortocaval fistulas are most commonly the result of spontaneous rupture or erosion of an abdominal aortic aneurysm into the inferior vena cava (80-90%). The remaining 10-20% of aortocaval fistulas are usually the result of penetrating or iatrogenic trauma from gunshot or stab wounds. We report the case of a 19-year-old male, status post multiple gunshot wounds. To our knowledge, this is the first case report of bullet embolization to the right ventricle from a traumatic aortocaval fistula. We discuss pertinent imaging findings and management of both aortocaval fistulas and bullet emboli.
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