Presentation
Patient brought after a bullet injury to the chest.
Patient Data
There is focal destruction ("explosion") of the posterior aspect of the left sixth rib associated with a small hemothorax and adjacent pulmonary contusion and laceration containing an air-fluid level. Minimal soft tissue emphysema in the posterior thoracic wall. The bullet is identified anteriorly to the humeral head. There is also fracture and fragmentation of the lateral border of the scapula as well as a hematoma involving and enlarging the subscapular muscle.
Case Discussion
The bullet has entered the posterior chest wall shattering the rib and impacting the scapula and humerus leaving small metallic fragments. The bone lesions are typical of those in gunshot injuries, usually focal and with multiple fragmentation.
This case also illustrates a pulmonary laceration manifesting as a round cavity with an air-fluid level. Due to normal pulmonary elastic recoil, lung tissue pulls away from a laceration creating a cavity.
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