Penetrating traumatic gastric and diaphragm laceration

Small volume pneumoperitoneum and moderate volume low density (25-30 HU) free fluid demonstrated in the paracolic gutters, hepatorenal space, right subphrenic space and predominately in the pelvis.

Penetrating injury wound site is identified in the left upper quadrant at the level of 7th rib anteriorly, which is marked by two skin markers superiorly and inferiorly, and is associated with subcutaneous emphysema. There is an upward trajectory with an oblique defect identified at the left rectus abdominus muscle extending into the peritoneum and the greater curvature of the stomach as well as the left hemidiaphragm. This is associated with small volume left hemothorax (50 HU) with a tiny pneumothorax at the left apex. No contrast extravasation on arterial phase of imaging to suggest active arterial bleed.

Unremarkable appearance of the liver, gallbladder, pancreas, spleen, adrenal glands and the kidneys bilaterally. Bladder is moderately distended which otherwise appears unremarkable. No obvious injury demonstrated at the splenic flexure. Unremarkable appearance of the small bowel.

Aberrant origin of the left vertebral artery, normal variant. Normal opacification of the aorta and its main branches. No abdominal or pelvic lymphadenopathy by CT size criteria. Portal vein and hepatic veins are patent.

Central tracheobronchial tree is patent. Slight motion artefact degrades image quality at the left lung, within this limitation there is small left hemothorax with associated passive atelectasis. No right pneumothorax or pleural effusion.

No pneumomediastinum or mediastinal hematoma. No central pulmonary thromboembolism. Esophagus is mildly distended.

No acute fracture, specifically involving the left ribs.

Impression

Deep penetrating injury in the left upper quadrant as described above with involvement of the greater curvature of the stomach and left hemidiaphragm. Associated small volume pneumoperitoneum and low density fluid within the abdomen (possibly a hemoperitoneum) as well as small left hemopneumothorax. No arterial blush to suggest active arterial bleed.

The intercostal wound and gastric perforation do not line up, indicating the stomach has moved in relation to the penetrating wound since the injury. This is common, especially in the chest when the lung is injured, as breathing causes structures to move at different rates.