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Gopireddy DR, Kee-Sampson JW, Vulasala SSR, Stein R, Kumar S, Virarkar M. Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds. J Clin Imaging Sci 2023; 13:1. [PMID: 36751564 PMCID: PMC9899476 DOI: 10.25259/jcis_99_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Joanna W. Kee-Sampson
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sai Swarupa Reddy Vulasala
- Department of Internal Medicine, East Carolina University Health Medical Center, Greenville, North Carolina, United States.,Corresponding author: Sai Swarupa Reddy Vulasala, Department of Internal Medicine, East Carolina University Health Medical Center, Greenville, United States.
| | - Rachel Stein
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
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Naija S, Yacoub A, Barhoumi M, Akkeri K, Chebbi G. [Ballistic trauma of the face: A new scourge in Tunisia]. ANN CHIR PLAST ESTH 2021; 66:210-216. [PMID: 33838955 DOI: 10.1016/j.anplas.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ballistic trauma of the face has aroused growing interest since the proliferation of conflicts in the world and particularly in the fight against terrorism. Their polymorphous and disfiguring character, their particular evolution and prognosis due to the ballistic aetiology, differentiate them from classic maxillofacial trauma. Tunisia did not escape this scourge after the revolution of 2011, and must therefore face the challenge of ballistic trauma in general and of the face in particular. MATERIALS AND METHODS We conducted a descriptive retrospective study on 30 patients who were victims of ballistic trauma of the face in the otolaryngology and maxillofacial surgery and ophthalmology departments of the Main Military Hospital of Tunis during the period from January 2011 to April 2018. Our objective was to assess the prevalence of these traumas in Tunisia after the revolution, and to assess their clinical and therapeutic aspects. RESULTS Our results showed a clear upward trend in these traumas, mainly caused by the opposition of our armed forces to the terrorist threat. The discussion of our results was therefore descriptive, comparing them to the literature. CONCLUSION Currently, it is imperative to develop a strategy for precise and effective management of ballistic trauma of the face due to the increase of armed conflicts, attacks and terrorist acts. Likewise, technological advances to develop soldier protection systems must be implemented.
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Affiliation(s)
- S Naija
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
| | - A Yacoub
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie.
| | - M Barhoumi
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
| | - K Akkeri
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
| | - G Chebbi
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
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Setiawan E, Shofwan S, Anwar SL, Ovaditya SZ, Rizaldy R, Janitra G. Ultrasound with needle guiding exploration as a real-time modality for exploration of air rifle bullet close to cervical spine: A case report. Int J Surg Case Rep 2021; 81:105730. [PMID: 33714003 PMCID: PMC7957148 DOI: 10.1016/j.ijscr.2021.105730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
Real-time imaging modalities are needed while performing surgical exploration of retained foreign body. Ultrasonography offered an ability to visualize retained foreign body in a real-time. Needle guiding ultrasonography is a technique that allows surgeon to extracts the retained foreign body precisely. The combination of a needle guided ultrasonography, and other imaging studies may increase the accuracy of exploration.
Introduction and importance Surgical exploration of retained air rifle bullet at the neck region is challenging because it is difficult to find bullets during exploration and prevent damage to vital structures. A bedside real-time imaging technique is needed to determine the retained bullet's location to the surrounding structures and guiding exploration. Case presentation A 19-year-old male patient was admitted to the emergency department with neck pain after being shot by an air rifle. The patient's vital signs were stable. A small entry wound to the right lateral side of the neck without exit wound was found without neurological symptoms. The cervical X-ray showed the bullet at the third cervical vertebrae level. Surgical exploration was performed with needle-guiding ultrasonography. The bullet is a one-centimeter anterior transverse process of the third cervical vertebra marked by a hyperechoic object. Exploration was done by tracing the needle. Postoperative neurological evaluation was conducted, and no abnormalities were found. Clinical discussion Preoperative imaging modalities are crucial before the surgical exploration of a retained air rifle bullet. X-ray and CT-scan are imaging modalities that are often used as an initial assessment of retained foreign bodies. However, ultrasonography provides advantages over X-ray and CT scan to provide real-time imaging that supports the surgeon while performing surgical exploration. Ultrasonography with needle guiding exploration increases the precise location of a retained air rifle bullet. Conclusion Ultrasonography was a simple and precise real-time imaging modality for identifying and guiding the exploration of a retained air rifle bullet in the neck area.
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Affiliation(s)
- Eko Setiawan
- Department of Surgery, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Said Shofwan
- Department of Anesthesiology, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Sumadi Lukman Anwar
- Department of Surgery - Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada / Dr Sardjito Hospital, Yogyakarta, 55281, Indonesia.
| | - Shafira Zahra Ovaditya
- Department of Biomedical Science, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Rheza Rizaldy
- Department of Biomedical Science, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Grady Janitra
- Department of Anesthesiology, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
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Pesce A, Palmieri M, Frati A, Rustia A, Marrocco L, Caruso R, Santoro A, Wierzbicki V. A Forgotten Tale from the Great War: General Lorenzo Bonomo and the Birth of Italian War Neurosurgery. World Neurosurg 2020; 140:338-346. [PMID: 32540288 DOI: 10.1016/j.wneu.2020.05.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022]
Abstract
Little is known of the advances in battlefield medicine achieved in Italy before and during the Great War. Some deserve wider recognition; this is especially true for the field of neurosurgery. There are a limited number of historical records currently available, fewer still in English, and most of the systematic investigations on field surgery have been in the form of monographs within science history reviews, which obviously lack a strictly clinical perspective. Together with shell shock, the gunshot-related traumatic brain injury (GrTBI) is considered one of the typical, or signature, lesions of the Great War. It was intrinsically linked to trench and mountain warfare: to view the battlefield from a trench/hiding area, soldiers' heads and necks were repeatedly exposed, therefore making them the most likely target for snipers. Military physicians therefore focused their efforts in the clinical and experimental treatment of GrTBI. Among notable contributions of the military surgeons of the time, there is a volume of selected war-surgery lectures conserved in the archives of the Library of the Italian National Academy of Military Medicine. These lectures shed light over the work of General Dr. Lorenzo Bonomo. His incredibly advanced and modern ideas had unfortunately been forgotten. He pioneered research in the ballistic and forensic medical fields, building on first-hand experience, as he performed surgeries himself before the conflict and even while on the frontline, actively working to improve the chances of survival for the Italian troops fighting in the Great War.
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Affiliation(s)
- Alessandro Pesce
- IRCCS, Neuromed, Pozzilli (IS), Italy; Human Neurosciences Department, Sapienza University, Roma, Italy
| | - Mauro Palmieri
- Human Neurosciences Department, Sapienza University, Roma, Italy.
| | | | | | - Luigi Marrocco
- Rome Army Hospital Celio, Neurosurgery Division, Roma, Italy
| | - Riccardo Caruso
- Human Neurosciences Department, Sapienza University, Roma, Italy
| | - Antonio Santoro
- Human Neurosciences Department, Sapienza University, Roma, Italy
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Abstract
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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Affiliation(s)
- Noah G Ditkofsky
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
| | - Hillel Maresky
- Department of Radiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shobhit Mathur
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
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Pinto A, Russo A, Reginelli A, Iacobellis F, Di Serafino M, Giovine S, Romano L. Gunshot Wounds: Ballistics and Imaging Findings. Semin Ultrasound CT MR 2019; 40:25-35. [DOI: 10.1053/j.sult.2018.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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An Algorithmic Approach to the Management of Ballistic Facial Trauma in the Civilian Population. J Craniofac Surg 2018; 29:2010-2016. [PMID: 30028401 DOI: 10.1097/scs.0000000000004741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Annual incidence of non-fatal ballistic civilian has been increasing for the last decade. The aim of the present study was to clarify the optimal reconstructive management of civilian ballistic facial injuries. A systematic review of PubMed was performed. Articles were evaluated for defect type and site, reconstructive modality, complications, and outcomes. A total of 30 articles were included. Most common region of injury was mandibular with a 46.6% incidence rate. All-cause complication rate after reconstruction was 31.0%. About 13.3% of patients developed a postoperative infection. Gunshot wounds had overall lower complication rates as compared with shotgun wounds at 9.0% and 17.0%. By region, complications for gunshot wounds were 35% and 34% for mandible and maxilla, respectively. Immediate surgical intervention with conservative serial debridement is recommended. However, for patients with pre-existing psychiatric disorders, secondary revisions should be delayed until proper psychiatric stabilization. When there is extensive loss of soft tissue in the midface, aesthetic outcomes are achieved with a latissimus dorsi or anterolateral thigh free flap. Radial forearm flap is favored for thin lining defects. Open reduction is suggested for bony-tissue stabilization. The fibula flap is recommended for bony defects >5 cm in both midface and mandible. For bony defects, <5 cm bone grafting was preferred. Delaying bone grafting does not worsen patient outcomes. Surgical treatment of ballistic facial trauma requires thorough preparation and precise planning. An algorithm that summarizes the approach to the main decision points of surgical management and reconstruction after ballistic facial trauma has been presented in this study.
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Abstract
OBJECTIVE The aim of this article is to provide an overview of newer techniques and postprocessing tools that improve the potential impact of CT in forensic situations. CONCLUSION CT has become a standard tool in medicolegal practice. Postmortem CT is an essential aid to the pathologist during autopsies. Advances in technology and software are constantly leading to advances in its performance.
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An unusual intracardiac foreign body following penetrating thoracic injury. Diagn Interv Imaging 2017; 98:901-902. [PMID: 29097145 DOI: 10.1016/j.diii.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/30/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
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Tuchtan L, Gorincour G, Kolopp M, Massiani P, Léonetti G, Piercecchi-Marti MD, Bartoli C. Combined use of postmortem 3D computed tomography reconstructions and 3D-design software for postmortem ballistic analysis. Diagn Interv Imaging 2017; 98:809-812. [DOI: 10.1016/j.diii.2017.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022]
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Garetier M, Deloire L, Dédouit F, Dumousset E, Saccardy C, Ben Salem D. Postmortem computed tomography findings in suicide victims. Diagn Interv Imaging 2017; 98:101-112. [DOI: 10.1016/j.diii.2016.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/05/2023]
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Izaaryene JJ, Soussan J, Chaumoitre K, Bartoli JM, Vidal V, Gaubert JY. Posttraumatic hemothorax with active bleeding: A dual origin from intercostal and pulmonary arteries should be considered. Diagn Interv Imaging 2017; 98:443-445. [PMID: 28087199 DOI: 10.1016/j.diii.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/16/2016] [Indexed: 11/17/2022]
Affiliation(s)
- J J Izaaryene
- Department of radiology, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Department of radiology, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - J Soussan
- Department of radiology, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Department of radiology, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - K Chaumoitre
- Department of radiology, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - J-M Bartoli
- Department of radiology, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - V Vidal
- Department of radiology, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - J-Y Gaubert
- Department of radiology, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Department of radiology, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
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Patil R, Jaiswal G, Gupta TK. Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:149-57. [PMID: 26692690 PMCID: PMC4660489 DOI: 10.4103/0974-8237.167855] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Penetrating spine injury (PSI) forms the third most common cause of spine injury, only next to road traffic accidents and fall. Gunshot wound (GSW) forms the major bulk of PSI. Due to easy availability of firearms and antisocial behavior, GSW which were predominant in military population is now increasingly seen in civilized society. Here, we present a detail case review of unique case of civilian GSW indirectly causing complete spinal cord injury due to shock wave generated by the bullet, along with its systematic management.
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Affiliation(s)
- Rahul Patil
- Department of Neurosurgery, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Gaurav Jaiswal
- Department of Neurosurgery, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Tarun Kumar Gupta
- Department of Neurosurgery, R.N.T. Medical College, Udaipur, Rajasthan, India
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