Penetrating thoracic trauma

Dr Henry Knipe et al.

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. 

Pathology

Penetrating thoracic trauma most commonly affects the chest wall, pleura and lungs (up to 97%) with praecordial 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. 

Radiographic features

Plain radiograph

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:

CT

In the 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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Article information

rID: 41174
Systems: Chest, Trauma, Forensic
Section: Pathology
Synonyms or Alternate Spellings:
  • Penetrating chest trauma
  • Penetrating thoracic injury
  • Penetrating thoracic injuries
  • Penetrating chest injury
  • Penetrating chest injuries

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Cases and figures

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    Case 1: stabbing
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    Case 2: aortic injury (stabbing)
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    A linear consolid...
    Case 3: gunshot wound
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    Case 4: stabbing
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    Case 5: pseudoaneurysm
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    Case 6: pulmonary laceration from stabbing
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