The imaging of stab injuries

Abstract

In the trauma unit of the Bloemfontein Academic Complex, the total number of stab wounds seen represents approximately 70.5% of penetrating injuries, which is 6.4% of 5004 trauma cases seen in a period of 1 year. The other cases are gunshot wounds and pedestrian or motor vehicle accidents. Specific guidelines and protocols are followed for penetrating trauma management. All imaging modalities are utilized, with chest radiography the mainstay of thoracic imaging in patients having sustained sharp penetrating chest injuries. Computed tomography (CT) is being used more frequently as the primary imaging modality in the evaluation of hemodynamically stable patients with penetrating injuries. The improved speed of data acquisition and superior image reconstruction of multidetector CT (MDCT) has further driven this change in imaging approach. Although digital subtraction angiography (DSA) has been the reference standard for the diagnosis of traumatic vascular injuries, it is giving way to faster, less invasive, and less personnel-intensive imaging techniques, e.g., MDCT angiography. Given the fact that we work in an academic environment and that we have a dedicated interventional unit, arteriography is still frequently performed and still has its place as the "gold standard" in the diagnosis of vascular injuries. Penetrating chest injuries suspected of traversing the mediastinum or extending near the posterior mediastinal structures dictate esophageal and tracheal evaluation. Although radiology has a role to play, direct visualization (esophagoscopy, bronchoscopy) remains the most reliable method of excluding injuries to these structures. Transthoracic ultrasound (echocardiography) has become indispensable in helping to evaluate injuries to the heart and the ascending and descending aortas. More recent work has demonstrated that ultrasonography can also be used to detect hemothoraces and pneumothoraces with accuracy.

Chi-chen CHANG,1 Hung-jung LIN,1 Ning-ping FOO,2 Kuo-tai CHEN1

“…In addition, the foreign bodies may migrate away from the wounds due to the exerted force from the trauma or may be pushed by the contracture of the muscles surrounding the object; further, the foreign bodies may be overlooked or misinterpreted as objects outside the patient's body. [2,3] In our case, the wound on the patient's back was small and the knife had penetrated deep along the chest wall, which caused it to be missed upon exploration of the wound. In addition, the patient arrived in a state of shock; therefore, the wound was covered to stop the bleeding as soon as possible instead of ensuring that a cautious examination was performed.…”

“…Previous studies suggest that the trauma surgeons should pay attention to the clinical history and trauma mechanisms, as well as to the radiologic findings. [1,2] However, the retained foreign bodies may be small or radiolucent in character and thus difficult to discover on the plain film. In addition, the foreign bodies may migrate away from the wounds due to the exerted force from the trauma or may be pushed by the contracture of the muscles surrounding the object; further, the foreign bodies may be overlooked or misinterpreted as objects outside the patient's body.…”

“…The CT images provide information about the course of the penetrating object, the involved organs and the severity of organ injuries. [1,2] Most importantly, the CT image helps the trauma surgeons discover the retained foreign bodies and arrange for their proper removal. [2,3,5] Eylül -September 2012 Ulus Travma Acil Cerrahi Derg …”

Sharp penetrating wounds: spectrum of imaging findings and legal aspects in the emergency setting

“…MDCT using soft tissue and bone details is the primary imaging option in the assessment of a patient with penetrating head injury ( Fig. 1), in spite of the expected streak artifacts which are due to the metallic foreign bodies [2]. Radiologist should identify the presence of the entry wounds, which are multiple in many cases, fragmented and non-fragmented bone lesions, foreign bodies, pneumocephalus, and intracerebral or even intraventricular bleeding.…”

“…Penetrating wounds can be classified into two different entities: gunshot wounds, or more technically ballistic traumas due to high-speed or low-speed projectiles, and sharp penetrating traumas, also known as non-ballistic traumas [2]. Among the spectrum of sharp pointed objects that can determine a penetrating wound, the majority of stab wounds are caused by knives, but they may also be caused by other sharp instruments or objects.…”