Penetrating wood injury to axilla
Motorbike accident into tree
This case featured in our 2016 Trauma Radiology Course which is now available to view online.
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A 4cm diameter tree branch penetrates through the left upper arm / pectoral region and passes through the left axilla where it has split at its mid section around the axillary neurovascular bundle before continuing through the sub scapular region before almost exiting the back of the body. The axillary artery is kinked by the wood but remains patent without obvious injury. The left axillary vein is focally compressed by the wood and probably completely obstructed. Near complete left lower lobe collapse is evident. No bony injury.
The low density of wood on CT (in this case somewhere between that of fat and air) can mean that it is not infrequently mistaken for air on standard soft-tissue windows by the inexperienced reader. It is important to use lung or bone windows to help differentiate between air and wood.