Imaging of Penetrating Injuries of the Head and Neck:Current Practice at a Level I Trauma Center in the United States

Saito, Naoko; Hito, Rania; Burke, Peter; Sakai, Osamu

doi:10.2302/kjm.2013-0009-re

Cited by 52 publications

(63 citation statements)

References 25 publications

(107 reference statements)

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“…Gracias et al6) have recommended CT scanning as an accurate and rapid method for evaluating the trajectory of penetration and Saito et al12) have reported that CT angiography has high sensitivity and a negative predictive value for vascular injury. However, the artifact generated by the foreign body on CT scan is a major obstacle when trying to determine if the surrounding structures are free from injury, as it was in this case.…”

Section: Discussionmentioning

confidence: 99%

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report

Han

Jung

Hong

et al. 2016

Korean J Neurotrauma

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Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.

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Section: Discussionmentioning

confidence: 99%

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report

Han

Jung

Hong

et al. 2016

Korean J Neurotrauma

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“…Rating Comments RRL CTA neck with IV contrast 9 This procedure is the imaging study of choice. See references [2,5,6,8,[11][12][13][14][15][16][17].…”

Section: Radiologic Proceduresmentioning

confidence: 99%

“…B Arteriography neck 5 This procedure is usually used as a follow up test/treatment to a CTA or MRA. See references [2,6,11,20,21].…”

Section: Us Neckmentioning

confidence: 99%

ACR Appropriateness Criteria ® Penetrating Neck Injury

Neurologic

Imaging

Schroeder

et al. 2017

Journal of the American College of Radiology

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“…Fifty percent of all trauma-related deaths are attributed to traumatic brain injury with 35% of these injuries resulting from gunshot wounds to the head [1-2]. This accounts for approximately 20,000 injuries [3-4]. Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication.…”

Section: Introductionmentioning

confidence: 99%

A Unique Presentation of an Intracranial Abscess Secondary to Retained Projectile after Debridement with Dural Closure

Milton

Awuor

2017

Cureus

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Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication. The most common presentation is a suddenly worsening headache. The most common pathogen identified is staphylococcus. Outcomes are related to adherence of Matson’s tenets.This case study details the presentation of a 19-year-old patient that presented to the neurological surgery clinic without neurologic deficits. Further questioning revealed complaints of intermittent diffuse headaches with bilateral upper extremity shock-like sensation for two weeks. Eight weeks prior he had undergone right craniotomy, after a gunshot wound, for debridement and watertight dural closure. The patient denied symptoms of fever, chills, nausea, vomiting, diarrhea, or seizure. The patient presented with a noncontrast head computed tomography (CT) which revealed retained projectile fragments without clear evidence of abscess. On physical exam, the patient was without any neurological deficit. Laboratory investigation revealed normal white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and negative blood cultures. Head CT with contrast revealed a large intracerebral abscess adjacent to the thalamus. The patient was taken to the operating room for repeat craniotomy with resection of the abscess and removal of the intracranial projectile fragments.Post-operatively, the patient remained neurology intact. Intraoperative cultures were not significant for the growth of any bacteria. In eight weeks time, the patient returned to his employment and his baseline level of activity.This case underscores the importance of thorough assessment in patients with retained intracranial projectiles as well as the need to routine follow-up. The unique presentation of this patient prompted further investigation which elucidated a lesion which correlated to his symptoms although laboratory assessment was without abnormality.

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Imaging of Penetrating Injuries of the Head and Neck:Current Practice at a Level I Trauma Center in the United States

Cited by 52 publications

References 25 publications

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report

ACR Appropriateness Criteria ® Penetrating Neck Injury

A Unique Presentation of an Intracranial Abscess Secondary to Retained Projectile after Debridement with Dural Closure

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