Gunshot injury to chest

Case contributed by Dr Heather Pascoe

Presentation

Gunshot wound right chest.

Patient Data

Age: 25 years
Gender: Male
CT

Chest

  • Bullet entry site inferior to the right scapula with associated intramuscular hematoma and small locules of gas. No scapular fracture.
  • Bullet fragments (likely to have shattered with multiple paths after hitting right 8th rib) - lodged into the inferior aspect of the right 8th lateral rib; right lobe of liver; right pericardium overlying right ventricle; right lower lobe of lung.
  • Moderate hemopericardium. No right ventricular compression to suggest tamponade.
  • Right hemopneumothorax.
  • Right pulmonary hematomas in the lower and middle lobes with pneumatoceles in the path of the bullet fragments. 
  • Delayed images were obtained of the chest to ensure there was no active bleeding from the right 8th intercostal artery. No bleeding was identified.

Upper abdomen

  • Superior right lobe liver laceration (ASST Grade III).

Case Discussion

The aim of imaging of gunshot wounds is to: determine the path of the projectile/s; determine which tissues have been injured; estimate the severity of the injuries; identify any retained bullets and determine if any further investigations are required. Active hemorrhage must always be assessed for.

The final location of the projectile should be sought for. If it cannot be identified, then an exit wound should be inspected for. Alternatively the projectile may be outside the field of view and further imaging may be required to identify it.

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