Contribution of imaging in the initial management of ballistic trauma

Daghfous, A.; Bouzaïdi, Khaled; Abdelkefi, M.; Rebai, S. Ben; Zoghlemi, A.; Mbarek, Mohamed; Marhoul, L. Rezgui

doi:10.1016/j.diii.2014.02.012

Cited by 22 publications

(7 citation statements)

References 24 publications

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“…(Figure 4). The discrepancy in detecting pneumothorax, where PMCT is reported to be informative [22][23][24], may be explained by the difficulty for forensic pathologists to ascertain the traumatic origin of pneumothorax after opening the chest cavity. The systematic lung retraction when the chest cavity is opened makes it difficult to correlate with a ballistic trajectory.…”

Section: Discussionmentioning

confidence: 99%

Correlations of Autopsy and Postmortem CT in Fatal Ballistic Injuries

et al. 2022

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Purpose: To study the respective contributions and correlations of autopsy and PMCT in fatal ballistic injuries. Methods: A single-center retrospective descriptive study was carried out over a 10-years period (2008–2017) that included cases of fatal ballistic injuries that had undergone unenhanced PMCT followed by autopsy. In addition to demographics, the main data collected independently at autopsy and PMCT were the number of injuries, their trajectory, distances from the sole of the feet of the entry and exit wounds, projectile caliber and gunshot residue, detailed examination of the injuries, and detection of effusions. Results: Initially, 225 cases were included, of which 158 complete records were analyzed. The mean age of the victims was 41.5 years, and 93% were male. PMCT and autopsy findings were concordant concerning the number of injuries, their trajectory, and distance of the entry and exit wounds from the sole of the feet. Findings were not concordant regarding gunshot residues on the skin (autopsy more efficient) or detection of effusions (PMCT more efficient). The limitations of PMCT were the positioning of the limbs outside the field of acquisition and the impossibility of reliably determining the caliber of the projectiles. Some discrepancies were related to occasionally missing autopsy data, particularly the distance from the sole of the feet or measurements of the volume of effusion. Conclusions: This study provides more detailed knowledge of the accordance of autopsy and PMCT in analyzing fatal ballistic injuries.

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Section: Discussionmentioning

confidence: 99%

Correlations of Autopsy and Postmortem CT in Fatal Ballistic Injuries

et al. 2022

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“…Exams with higher diagnostic precision could evaluate injury--related tissue damages before surgery. Literature mentions the use of nuclear magnetic resonance, ultrasound imaging, computerized tomography and computerized tomography with tapered beam as accurate methods to locate projectiles or foreign bodies as a consequence of face wounds 9 . However, these devices are expensive and usually are not available for public health assistance.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of projectile in the infratemporal fossa. Case report

Grossmann¹,

Ferreira²

2016

Revista Dor

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BACKGROUND AND OBJECTIVES:Gunshot wounds may have fatal results. Even when not causing major injuries to soft and hard tissues, there may be other severe problems. This study aimed at reporting the case of a projectile located in the left infratemporal fossa and at discussing treatment, risks and complications. CASE REPORT: Male patient, 18 years old, suffered a gunshot wound which has penetrated the face by the left zygomatic region, and was lodged in the homolateral infratemporal fossa. This has caused jaw function impairment and pain. Foreign body was surgically removed by preauricular access and patient was then submitted to physiotherapy. After treatment, temporomandibular joint function was reestablished and esthetic results were considered excellent without sequelae. CONCLUSION: Management of patients hit by projectiles is more complex when these are located in an area of difficult access and close to noble structures. Radiographic techniques obtained by means of different planes allow the accurate location of the object. There may be major deformity and functional incapacity, especially if the facial nerve is affected during bullet trauma or during surgery. Although there were no nervous injuries, functional impairment of orofacial structures was decisive to indicate the surgical procedure. Surgical removal of the projectile from the infratemporal fossa, combined with postoperative physiotherapy, has shown to be an effective treatment. Keywords: Infratemporal fossa, Projectile, Rehabilitation, Temporomandibular joint. Surgical treatment of projectile in the infratemporal fossa. Case report RESUMO JUSTIFICATIVA E OBJETIVOS:Ferimentos causados por arma de fogo podem ter resultados fatais. Mesmo que a bala não cause grandes lesões para os tecidos moles e duros, outros problemas graves podem ocorrer. O objetivo deste estudo foi relatar o caso de um projétil localizado na fossa infratemporal esquerda, discutir o tratamento cirúrgico, seus riscos e complicações. RELATO DO CASO: Paciente do gênero masculino, 18 anos, sofreu um ferimento por arma de fogo que penetrou na face pela região zigomática esquerda, alojando-se na fossa infratemporal homolateral. Esse ocasionou comprometimento da função mandibular e dor. O corpo estranho foi removido cirurgicamente por meio do acesso pré-auricular e o paciente foi posteriormente submetido a sessões de fisioterapia. Após o tratamento, foi reestabelecida a função da articulação temporomandibular, a dor desapareceu e os resultados estéticos foram considerados excelentes, sem sequelas. CONCLUSÃO: O manuseio dos pacientes acometidos por projétil torna-se mais complexo quando esse está localizado em uma área de difícil acesso e ao lado de estruturas nobres. Técnicas radiográficas, obtidas por meio de diferentes planos, permitem uma localização precisa do objeto. Grande deformidade e incapacidade funcional podem ocorrer, especialmente, se o nervo facial é afetado durante o trauma balístico ou durante o ato cirúrgico. Apesar de não haver lesões nervosas, o comprometime...

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“…Computed tomography (CT) is the most sensitive and specific modality with which to identify and evaluate ballistic injuries. 24 It is fast and provides excellent spatial resolution, allowing identification of all but the most subtle injuries. In stable and semistable patients, CT is the gold standard of evaluation.…”

Section: Imaging Assessmentmentioning

confidence: 99%

Imaging Ballistic Injuries

2020

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Here in Canada, we often think of gun violence as confined to conflict zones, terrorism, and more of a problem for our southern neighbor. However, in recent years, it has also become a Canadian problem with increased gun violence related to criminal activity presenting in daily practice. Radiologists play a critical role in the evaluation of ballistic trauma and must therefore be familiar with both the common and uncommon patterns of ballistic injury. In this article, we review the mechanisms of ballistic trauma as well as their resultant injury patterns in order to guide image interpretation.

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Contribution of imaging in the initial management of ballistic trauma

Abstract: The CT-scan is very useful in the initial care of stable patients with gunshot wounds as regards the haemodynamics and helps objectify the path of the bullet and obtain a precise assessment of the damage. Conventional x-rays are unavoidable for wounds to the legs and spine.

Cited by 22 publications

References 24 publications

Correlations of Autopsy and Postmortem CT in Fatal Ballistic Injuries

Correlations of Autopsy and Postmortem CT in Fatal Ballistic Injuries

Surgical treatment of projectile in the infratemporal fossa. Case report

Imaging Ballistic Injuries

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