E1325. MDCT Injuries Spectrum of Wounds Produced by Firearms
In Argentina and especially in Rosario, the care of patients with multiple types of traumatic injuries is very frequent, among them those who suffer injuries by firearms. Due to the massive amount of kinetic energy that the projectile acquires as it leaves the barrel, which is largely conserved when reaching the person’s body, the magnitude of the damage caused by gunshots is extensive. Multidetector computed tomography (MDCT) has been the first tool for the evaluation of patients with gunshot wounds due to its wide availability in emergency departments.
Educational Goals / Teaching Points
Review the mechanisms of injuries by firearms. Discuss the study algorithm by using MDCT. Characterize the findings by MDCT in penetrating wounds.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In our institutions, images are acquired after administration of 100–120 mL of intravenous contrast material and multidetector CT is performed with a 0.8 mm configuration, 3.0-mm reconstruction interval, and radiation modulation devices to adjust the tube current based on each patient’s phenotype. Decision to use oral contrast is based on the clinical parameters of hemodynamic stability and the evaluation of conservative treatment.
Vascular injuries from penetrating thoracic trauma most commonly occur in the ascending aorta, aortic arch, and the great vessels. Findings that can be seen with penetrating cardiac injury include hemopericardium, pneumopericardium, intracardiac foreign bodies and vascular injury. Pneumothorax and hemopneumothorax are the most frequent finding in penetrating chest trauma. Pulmonary lacerations can be helpful in establishing the trajectory of the shot.
The three most common types of parenchymal solid-organ injuries seen at CT are lacerations, hematomas, and active extravasation. Vascular injuries may be identified at CT by either direct or indirect signs of vascular injury. Direct signs of vascular injury are considered diagnostic and include active bleeding, pseudoaneurysm, and posttraumatic arteriovenous fistula.
Knowing the wide spectrum of injuries that are associated with this type of accident is imperative because the appearance of multiple types of injuries in the same patient is highly common, whether it is of solid, hollow organs or vascular structures, in order to properly protocolize the study methodology.