Thoracic gunshot wound
A young man was brought to emergency department with a bullet injury to the chest.
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There is a metallic object in the right hemithorax. Bilateral pleural effusion and thickening and a chest tube in the right pleural space are noted.
A linear consolidation is noted. The lesion is consistent with pulmonary laceration and hemorrhage in the trajectory of the bullet. Subcutaneous emphysema is visible in the right chest wall.
In the setting of gunshot wound to the lung, the missile injury is readily visible because of the difference in the tissue characteristics of injured lung with the remaining healthy lung tissue. Because of the elastic recoil feature of the pulmonary parenchyma, the laceration area is commonly reformed to a round area of consolidation and it is unusual to see the lineal missile track on imaging.
Pulmonary lacerations are classified into four types:
- Compression-rupture laceration: it is the most common type of laceration that usually occurs as a 2-8 cm lesion in the central lung.
- Compression shear: occurs after sudden compression of the lower chest when the lung suffers from a shear injury to the spine.
- Rib penetration laceration: occur with a penetrating fractured rib. These lesions are commonly multiple.
- Adhesion tears: occurs in sudden injuries of the chest wall where prior pleuropulmonary adhesions had been created.