Use of photon-counting CT and three-dimensional printing for an intra-thoracic retained ballistic fragment in a 9-year-old.

Retained ballistic fragments from gunshot wounds pose diagnostic and management challenges for radiologists and surgeons alike. Imaging and clinical decision-making regarding removal warrant comprehensive risk/benefit discussions, considering anatomic location, complexity of surgical removal, and risk of long-term complications of bullet migration and potential lead toxicity. Herein, we describe a 9-year-old with a retained intra-thoracic para-aortic ballistic fragment causing elevated lead levels. Photon-counting detector computed tomography (PCD-CT) was used to create a 3D-printed anatomic model, critical for multidisciplinary pre-operative planning and as an educational tool with the patient and family, ultimately leading to successful surgical bullet removal. Since spectral CT imaging offers superior metal artifact reduction capabilities than conventional CT, cutting-edge technologies such as PCD-CT and 3D-printing should be considered in anatomically challenging cases.