Radically invasive projectile injury - thorax

Case contributed by Hillel S. Maresky


Patient was brought to the ED after gunshot wound to the chest.

Patient Data

Age: 25 year
Gender: Male

RIP round injury in young male


Radically invasive projectile (RIP) round ballistic fragments seen within the right upper thorax of a young male following ballistic injury. Note the round base of the bullet and 8 separate "trocars" resembling "nail clippings" scattered throughout the ballistic tract.

Photograph of RIP projectile


RIP projectile with base and trocars attached.

Case Discussion

RIP rounds present a challenge to thoracic imaging, as an injury from one RIP bullet creates 9 separate penetrating injuries with 9 separate tracts. The base of the bullet travels the farthest at it is the heaviest of the frangible bullet, and the 8 trocars splay into seemingly random directions, usually clustered along the entrance site. The base of the bullet is rounded and appears like a button battery and the trocars, once deposited into the patient demonstrate a signature "nail clippings" appearance.

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