Penetrating thoracic trauma

Last revised by Craig Hacking on 23 Apr 2024

Penetrating thoracic trauma, namely gunshot and stab injuries, vary widely in incidence globally but nevertheless result in high mortality and serious morbidity. CT is the modality of choice in imaging these patients and can reduce the need for surgical exploration. 

Penetrating thoracic trauma most commonly affects the chest wall, pleura and lungs (up to 97%) with precordial and periclavicular injuries less common 1. Accurate identification of the entry site(s) is important, although it should be noted that the wound tract can appear remote due to respiratory motion. 

In the typical trauma setting a supine AP radiograph is acquired. Despite the inherent limitations of this technique, many pathologies can be easily identified 2:

In a stable patient, contrast-enhanced CT is the modality of choice to assess for thoracic injuries. CT can be used to delineate the wound track and identify any foreign bodies (e.g. bullets). 

In addition to injuries seen on plain radiography, CT is more sensitive in assessing for 1,3:

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