Gunshot injury: chest and left shoulder

Case contributed by Dr Bruno Di Muzio

Presentation

Patient brought after a bullet injury to the chest.

Patient Data

Age: 25
Gender: Male

CT Chest

Modality: CT

There is a focal destruction ("explosion") on the posterior aspect of the left sixth rib associated with a small haemothorax and adjacent pulmonary contusion with added bleb with air fluid levels.  Minimal soft tissue emphysema in the posterior thoracic wall. The bulled is identified anteriorly to the humeral head. There is also fracture and fragmentation of the lateral border of the scapula as well as a haematoma involving and enlarging the subscapular muscle. 

Case Discussion

It is hard to understand the bullet trajectory in this case. The bone lesions are typical of those in gunshot injuries, usually focal and with multiple fragmentation. 

This case also illustrates a pulmonary laceration manifesting as a round cavity with air fluid levels (due to normal pulmonary elastic recoil, lung tissues surrounding a laceration often pull back from the laceration itself). 

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Case Information

rID: 39798
Case created: 21st Sep 2015
Last edited: 21st Sep 2015
Inclusion in quiz mode: Included

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