Now look at CXR 2. Where is the pellet? It could be almost anywhere. Most importantly it could be below the diaphragm.
You get another X-ray, a little lower on the patient, and with less penetration. This is shown below and clearly demonstrates the pellet. But it could still be in the chest or abdomen!
In the event the echo showed a pericardial effusion. As he was haemodynamically stable he had a CT of the thorax and abdomen. This confirmed the pericardial effusion, also right lung contusion, but most importantly that the pellet was above the diaphragm and that there was no evidence of an abdominal injury. He then went for a sternotomy.
