Gunshot injury: bullet in spinal canal

Case contributed by Dr Alexandra Stanislavsky

Presentation

Accidental injury.

Patient Data

Age: 30
Gender: Male

Signs of lower ribs fractures on the right, drained pleural effusion on the right and bullet fragments projected over a lower thoracic vertebral body.

Selected CT images showing the bullet in the spinal canal. The trajectory of the bullet had fractured a rib on the right and resulted in a pulmonary hemorrhage and hemopneumothorax. 

Case Discussion

Gunshot injury to the right chest wall.  Final positioning of the bullet is within the thoracic vertebral canal, with minimal vertebral bony injury.  The likely trajectory is through the right neural exit foramen.

Imaging findings include:

  • right lateral rib fracture denoting the entry site
  • lung parenchymal hematoma indicating the approximate bullet path
  • hemopneumothorax with some bullet fragments floating, and others layering dependently within the pleural fluid 
  • gas and metallic fragments present in the spinal canal superior to bullet
  • bullet deformation

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