Gunshot injury - chest and left shoulder
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Patient brought after a bullet injury to the chest.
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There is a focal destruction ("explosion") on the posterior aspect of the left sixth rib associated with a small hemothorax and adjacent pulmonary contusion with added bleb with air-fluid levels. Minimal soft tissue emphysema in the posterior thoracic wall. The bullet is identified anteriorly to the humeral head. There is also fracture and fragmentation of the lateral border of the scapula as well as a hematoma involving and enlarging the subscapular muscle.
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).