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Spinal injury in a 49-year-old man with quadriplegia after facial and transcervical gunshot wounds. (a) Axial image from CT angiography shows a comminuted fracture of the C5 spinous process (arrowhead) with bone fragments displaced into the spinal canal (arrow). No metallic ballistic fragments are seen. (b) Sagittal short τ inversion-recovery MR image shows spinal cord enlargement and abnormal increased signal intensity spanning C1-2 through C5 (arrowhead), findings consistent with contusion.
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Penetrating neck injuries are a significant source of morbidity and mortality. Diagnostic imaging plays an integral role in the diagnosis and management of these injuries. Although clinical management of penetrating injuries to the neck remains controversial, many institutions have shifted away from mandatory surgical exploration of most penetratin...
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... First, different models must be developed for each existing imaging modality. Second, the diversity of objects causing penetrating injuries, coupled with the multitude of potential locations on the body that an object can penetrate, require large, standardized datasets to train a potential model [43]. Furthermore, some penetrating objects may splinter within the body or may induce bone fragments, which can have varied trajectories as secondary projectiles [43]. ...
... Second, the diversity of objects causing penetrating injuries, coupled with the multitude of potential locations on the body that an object can penetrate, require large, standardized datasets to train a potential model [43]. Furthermore, some penetrating objects may splinter within the body or may induce bone fragments, which can have varied trajectories as secondary projectiles [43]. Other challenges involve cases where penetrating objects have left the body. ...
... Other challenges involve cases where penetrating objects have left the body. Thus, it is difficult for AI models to ascertain the penetrating object's tract within the body and the subsequently injured tissues [43]. However, even if not directly involved in the identification of the object's track or injured tissues, AI models still have the potential to augment such clinical workflows through image enhancement or reconstruction. ...
Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.
... Gunshots, stabbings, bomb blast, and other assorted traumas are the most common etiologies of PNIs [4] . The site of the entry wound has been used to divide PNI into three anatomical zones of the neck. ...
... Evidence of the presence of prevertebral air on cervical or thoracic radiography, profile incidence, or the extravasation of a contrast agent may confirm a suspicion of digestive perforation with sensitivity ranging from 48 to 100%, with inferior results for the hypopharynx [16][17][18]. In our study, the use of cervical or chest radiographs had a sensitivity and specificity in the range of 58-75%, with data being consistent with existing studies. ...
... Furthermore, C.T.A. can demonstrate damage to structures separate from the arterial shaft, such as the aerodigestive tract. The trajectory resulting from a penetrating cervical trauma caused by a stabbing device can also often be viewed on a C.T.A. scan to further elucidate the structures that may be exposed to the risk of injury, and, therefore, further investigation is required [18]. ...
Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a public health concern, there is a pressing need for epidemiological research and the implementation of preventative measures. The purpose of this research is to establish the profile of the predictable impact factors that determine the prognosis of patients with complex cervical trauma. Methods and Methods: The study group consisted of 106 patients with complex cervical trauma pathology developed by various mechanisms such as car accidents, home-related accidents, aggression, gunshot wounds, and self-inflicted attempts, resulting in hospitalization in the E.N.T. Clinic at “St. Spiridon” Iași Hospital, from 2012 to 2016; medical records were the source of the collected data. Results: Hemodynamic instability upon admission associated with age, muscle and laryngeal injuries, and anemia were identified as negative prognostic factors. Additionally, the utilization of imaging-based paraclinical investigations for diagnosing traumatic lesions emerged as a positive prognostic factor in managing this pathology. The management of penetrating cervical trauma remains a subject of debate, with some advocating for surgical exploration beyond the platysma layer in all cases, while others argue for a more selective conservative approach due to a high rate of negative explorations. Conclusions: The statistical evaluation of epidemiological, clinical, lesion, paraclinical, and therapeutic parameters is needed to establish predictable risk factors in the prognosis of complex aerodigestive cervical trauma.
... CT and CTA delineate the path of the wound, thereby determining the damaged organs. [14] With 100% sensitivity, CTA assists in revealing the injuries and localizing the source of bleeding through direct and indirect signs, as described in further sections of this article [ Table 2]. [14][15][16] ...
... [14] With 100% sensitivity, CTA assists in revealing the injuries and localizing the source of bleeding through direct and indirect signs, as described in further sections of this article [ Table 2]. [14][15][16] ...
... MRA has been proposed as an alternative to CTA; however, if the patient has retained metallic fragments, they are prohibited from entering the MRI suite safely. [14,[20][21][22] In addition, MRA takes longer to obtain appropriate sequences and is not readily available in all emergency departments. ...
In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.
... Виділяють висококінетичний механізм травми, наприклад, вогнепальні поранення та поранення від снарядів, а також низькокінетичний механізм, наприклад, колото-різані рани. Низькокінетичні механізми проникаючої травми зазвичай спричинені прямим ушкодженням об'єкта, що проникає вздовж ранового каналу, тоді як висококінетичні механізми -ушкодженням за межами ранового каналу через розсіювання ударних хвиль або енергії [10]. ...
Traumatic cerebrovascular injuries following blunt or penetrating trauma are common and carry a high risk of permanent disability or death. Proper screening, diagnosis, and treatment of these lesions is essential to improve patient outcomes. Advances in imaging continue to improve the accuracy of non-invasive diagnosis of these injuries while new clinical data provide better evidence for optimal management, whether medical or invasive. Here, we review screening, diagnosis, and treatment of traumatic cerebrovascular injuries.
... e arterial injuries happen secondary to shock waves or cavitation from the kinetic energy transfer of the penetrating object. [19] e AVF (86%) is the most common imaging sign in PBI, followed by the pseudoaneurysm (12%), occlusion (2.4%), and transection (2.4%). [14] Risk factors of intracranial vascular injury include bi-hemispheric trajectory, entry wound located over the fronto-baso-parietal area, trajectory adjacent to the circle of Willis, and intraventricular hemorrhage (IVH) and IVH score, and subarachnoid hemorrhage (SAH) and SAH score. ...
Penetrating vascular injury has become the topic of interest with increased gun violence in the United States. The radiologist plays a crucial role in establishing and systemizing the signs of vascular injury such as intimal flap, dissection, pseudoaneurysm, rupture, and arteriovenous fistula. Various imaging techniques such as ultrasound Doppler, computed tomographic angiography (CTA), magnetic resonance angiography, and conventional angiography are being employed based on clinical recommendations. Of all the techniques, CTA has been shown to embrace a promising role in identifying vascular injuries with superior sensitivity, specificity, and accuracy. An acquaintance of the imaging features has been shown to improve the approach to trauma patients in clinical settings. This article details the imaging modalities and the features of the head-and-neck penetrating vascular injury.
... This will allow for the most accurate determination of trajectory and permit optimal evaluation for vascular injuries despite streak artifacts from metal. Any structure in the direct path of the bullet should be considered as injured 47 and a low threshold for endoscopically evaluating injuries to the esophagus should be maintained. ...
Understanding the pathophysiology of a disease allows physicians to make a diagnosis, alter its natural course, and develop and implement appropriate preventative and management strategies. With ballistic injuries, an understanding of how the mechanism of injury translates to the injuries observed makes it possible to make sense of what can, at times be a complex imaging appearance and mitigate against the long-term complications of gunshot wounds. In this article, the authors describe the different types of ballistic projectiles, their mechanism of injury as well as the injury patterns they cause. In addition, both lead arthropathy and MR imaging safety in patients with retained ballistic debris are discussed.
... We described a rare case of a penetrating neck injury by a crossbow bolt. Many cases of penetrating neck injury by a foreign body such as gunshot have been reported, 1,[9][10][11][12] but there were only four cases of penetrating neck injury by a crossbow bolt in the literature (Table 1). 3,[5][6][7] The neck injury in the present case was caused by an attempt to homicide. ...
Penetrating neck injury by a crossbow bolt is extremely rare and can be life-threatening. When removing a crossbow bolt from the neck, it is necessary to protect against fatal bleeding from the carotid vessels. We report removing a crossbow bolt penetrating the neck, with an endovascular approach. A 49-year-old woman was shot in the neck by a crossbow and was transferred to our hospital. On presentation, the crossbow bolt totally penetrated the neck from right to left. Her level of consciousness was clear, with no significant neurological deficits except for right peripheral facial palsy. Neck contrast-enhanced computed tomography revealed the crossbow bolt in contact with bilateral external and internal carotid arteries and that the bolt caused dissection of the left main trunk of the external carotid artery. Under general anesthesia, the crossbow bolt was removed under fluoroscopy with the assistance of an endovascular approach. First, we performed coil embolization for the dissected external carotid artery. Second, we prepared for fatal bleeding from the carotid arteries during crossbow bolt removal under protection using guiding catheters placed in bilateral common carotid arteries. The bolt was removed successfully without significant bleeding, and no complications occurred during the procedure. We report the successful removal of a crossbow bolt penetrating the neck. When removing a crossbow bolt penetrating the neck, endovascular assistance may be feasible to protect against fatal bleeding from the carotid arteries.
... Some authors thought that there is a weak correlation between the location of the external wound and the lesions of the internal structures [27]. These factors challenged the whole basis of the traditional zonal approach, according to which the majority of vital structures are located in the anterior triangle of the neck [28]. We adopted the non-zonal or selective approach to penetrating neck stab wounds, where the entire neck was assessed as a single entity. ...
... 5,6,11 En la exploración física se puede observar equimosis, hematoma, edema, heridas cervicales, dolor y crepitación a la palpación, aplanamiento de la prominencia laríngea, desviación de la laringe, alteraciones en la movilidad cordal y enfisema subcutáneo. [7][8][9][10]12 Diagnóstico El diagnóstico se basa en la historia clínica y debe incluir el mecanismo de lesión, 13 es importante recal-car que dada la baja incidencia de este tipo de lesiones se requiere de un alto nivel de sospecha. 6 Una vez que la vía aérea ha sido estabilizada como parte de los protocolos de manejo del paciente traumatizado (ATLS), 5 el siguiente paso es la toma de una radiografía de tórax y cuello, que nos puede mostrar la presencia de neumotórax, neumomediastino, enfisema subcutáneo o desviación traqueal. ...
... La tomografía computarizada de tórax y cuello está indicada en los pacientes estables y puede diagnosticar la mayoría de las fracturas y dislocaciones, además del daño a estructuras asociadas, siendo el esófago el sitio más común; asimismo permite realizar reconstrucción multiplanar en 2D y reconstrucción 3D. [13][14][15] También está indicada la angiotomografía si se sospecha de daño vascular, la carótida es el vaso que con más frecuencia se lesiona. ...
... Actualmente la clasificación que se considera de más utilidad y la más aceptada es la de Schaefer, esta clasificación permite tomar decisiones de manejo basadas en la severidad del daño (Tabla 1). [6][7][8][9][10][11][12][13][14] Tratamiento Dentro de la atención inicial del paciente con trauma se encuentra en primer lugar la evaluación y protección de la vía aérea. 17,18 Al momento de realizar el triage del paciente en el departamento de urgencias, si encontramos lesión o compromiso en la vía aérea se debe priorizar de inmediato el tratamiento del paciente por el riesgo que conlleva. ...
