Skip to main content
SpringerLink
Log in

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

  • ETHICS AND FORENSIC RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

The main cause of severe civilian trauma is not the same all over the world; while in Europe the majority of cases are due to blunt traumatic injury, in the United States, penetrating gunshot wounds are the most common. Penetrating wounds can be classified into two different entities: gunshot wounds, or more technically ballistic traumas, and sharp penetrating traumas, also identifiable with non-ballistic traumas. Sharp penetrating injuries are mainly caused by sharp pointed objects such as spears, nails, daggers, knives, and arrows. The type of injuries caused by sharp pointed objects depends on the nature and shape of the weapon, the amount of energy in the weapon or implement when it strikes the body, whether it is inflicted upon a moving or a still body, and the nature of the tissue injured. In the assessment of hemodynamically stable patients with sharp penetrating wounds, the main imaging procedure is Multidetector Computed Tomography (MDCT), especially used in complicated cases of penetrating injuries with an important impact on the final therapeutic choice. The diagnostic approach has been changed by MDCT due to its technical improvements, in particular, faster data acquiring and upgraded image reconstructions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Compton C, Rhee R (2005) Peripheral vascular trauma. Perspect Vasc Surg Endovasc Ther 17:297–307

    Article  PubMed  Google Scholar 

  2. de Vries CS, Africa M, Gebremariam FA, van Rensburg JJ, Otto SF, Potgieter HF (2010) The imaging of stab injuries. Acta Radiol 51:92–106

    Article  PubMed  Google Scholar 

  3. Hijaz TA, Cento EA, Walker MT (2011) Imaging of head trauma. Radiol Clin N Am 49:81–103

    Article  PubMed  Google Scholar 

  4. Offiah C, Twigg S (2009) Imaging assessment of penetrating craniocerebral and spinal trauma. Clin Radiol 64:1146–1157

    Article  CAS  PubMed  Google Scholar 

  5. Peacock WJ, Shrosbree RD, Key AG (1977) A review of 450 stab wounds of the spinal cord. S Afr Med J 51:961–964

    CAS  PubMed  Google Scholar 

  6. Georgiadou D, Zografos GN, Vaidakis D, Avlonitis S, Katopodi A, Tzirakis EN et al (2010) Swordfish bill injury involving abdomen and vertebral column: case report and review. BMC Surg 10:30

    Article  PubMed Central  PubMed  Google Scholar 

  7. Friedman D, Flanders A, Thomas C et al (1995) Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. Am J Roentgenol 164:443–447 (Discussion 448–449)

    Article  CAS  Google Scholar 

  8. Jallo GI (1997) Neurosurgical management of penetrating spinal injury. Surg Neurol 47:328–330

    Article  CAS  PubMed  Google Scholar 

  9. White ML, El-Khoury GY (2002) Neurovascular injuries of the spinal cord. Eur J Radiol 42:117–126

    Article  PubMed  Google Scholar 

  10. Kitchel SH (2003) Current treatment of gunshot wounds to the spine. Clin Orthop Relat Res 408:115–119

    Article  PubMed  Google Scholar 

  11. Heary RF, Vaccaro AR, Mesa JJ, Balderston RA (1996) Thoracolumbar infections in penetrating injuries to the spine. Orthop Clin North Am 27:69–81

    CAS  PubMed  Google Scholar 

  12. Munera F, Soto JA, Nunez D (2004) Penetrating injuries of the neck and the increasing role of CTA. Emerg Radiol 10:303–309

    PubMed  Google Scholar 

  13. Kendall JL, Anglin D, Demetriades D (1998) Penetrating neck trauma. Emerg Med Clin North Am 16:85–105

    Article  CAS  PubMed  Google Scholar 

  14. McIntyre WB, Ballard JL (1998) Cervicothoracic vascular injuries. Semin Vasc Surg 11:232–242

    CAS  PubMed  Google Scholar 

  15. Asensio JA, Valenziano CP, Falcone RE, Grosh JD (1991) Management of penetrating neck injuries: the controversy surrounding zone II injuries. Surg Clin North Am 71:267–296

    CAS  PubMed  Google Scholar 

  16. Munera F, Danton G, Rivas LA, Henry RP, Ferrari MG (2009) Multidetector row computed tomography in the management of penetrating neck injuries. Semin Ultrasound CT MRI 30:195–204

    Article  Google Scholar 

  17. Obeid FN, Haddad GS, Horst HM et al (1985) A critical reappraisal of a mandatory exploration policy for penetrating wounds of the neck. Surg Gynecol Obstet 160:517–522

    CAS  PubMed  Google Scholar 

  18. Golueke PJ, Goldstein AS, Sclafani SJ et al (1984) Routine versus selective exploration of penetrating neck injuries: a randomized prospective study. J Trauma 24:1010–1014

    Article  CAS  PubMed  Google Scholar 

  19. James CA (1997) Magnetic resonance angiography in trauma. Clin Neurosci 4:137–145

    CAS  PubMed  Google Scholar 

  20. Parbhoo AH, Govender S, Corr P (2001) Vertebral artery injury in cervical spine trauma. Injury 32:565–568

    Article  CAS  PubMed  Google Scholar 

  21. Von Oppell UO, De Groot M (2000) Penetrating thoracic injuries: what have we learned? Thorac Cardiov Surg 48:55–61

    Article  Google Scholar 

  22. Oparah SS, Mandal AK (1976) Penetrating stab wounds to the chest: experience with 200 consecutive cases. J Trauma 16:868–872

    Article  CAS  PubMed  Google Scholar 

  23. Schatz DV, de la Pedraja J, Erbella J, Hameed M, Vail SJ (2000) Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs 6-hour radiographs of the chest. J Emerg Med 20:281–284

    Article  Google Scholar 

  24. Wagner RB, Crawford WO Jr, Schimpf PP (1988) Classification of parenchymal injuries to the lung. Radiology 167:77–82

    Article  CAS  PubMed  Google Scholar 

  25. Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L (1997) Value of computed thoracic tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 43:405–411

    Article  CAS  PubMed  Google Scholar 

  26. Neff MA, Monk JS Jr, Peters K, Nikhilesh A (2000) Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients. J Trauma 49:281–285

    Article  CAS  PubMed  Google Scholar 

  27. Rhea JT, Novelline RA, Lawrason J, Sacknoff R, Oser A (1989) The frequency and significance of thoracic injuries detected on abdominal CT scans in multiple trauma patients. J Trauma 29:502–509

    Article  CAS  PubMed  Google Scholar 

  28. Asensio JA, Roldan G, Petrone P, Forno W, Rowe V, Salim A (2001) Cardiac trauma. Trauma 3:69–77

    Article  Google Scholar 

  29. Demetriades D, van der Veen BW (1983) Penetrating injuries to the heart: experience over two years in South Africa. J Trauma 23:1034–1041

    Article  CAS  PubMed  Google Scholar 

  30. de Lutio di Castelguidone E, Merola S, Pinto A, Raissaki M, Gagliardi N, Romano L (2006) Esophageal injuries: spectrum of multidetector row CT findings. Eur J Radiol 59:344–348

    Article  PubMed  Google Scholar 

  31. Pinto A, Muzj C, Gagliardi N, Pinto F, Setola FR, Scaglione M et al (2012) Role of imaging in the assessment of impacted foreign bodies in the hypopharynx and cervical esophagus. Semin Ultrasound CT MRI 33:463–470

    Article  Google Scholar 

  32. Sliker CW (2006) Imaging of diaphragmatic injuries. Radiol Clin N Am 44:199–211

    Article  PubMed  Google Scholar 

  33. Athanassiadi K, Kalavrouziotis G, Athanassiou M, Vernikos P, Skrekas G, Poultsidi A et al (1999) Blunt diaphragmatic rupture. Eur J Cardiothorac Surg 15:469–474

    Article  CAS  PubMed  Google Scholar 

  34. Degiannis E, Levy RD, Sofianos C, Potokar T, Florizoone MG, Saadia R (1996) Diaphragmatic herniation after penetrating trauma. Br J Surg 83:88–91

    Article  CAS  PubMed  Google Scholar 

  35. Feliciano DV, Cruse PA, Mattox KL, Bitondo CG, Burch JM, Noon GP et al (1988) Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma 28:1135–1144

    Article  CAS  PubMed  Google Scholar 

  36. Killeen KL, Mirvis SE, Shanmuganathan K (1999) Helical CT of diaphragmatic rupture caused by blunt trauma. Am J Roentgenol 173:1611–1616

    Article  CAS  Google Scholar 

  37. Maldjian PD, Zurlo JV, Sebastiano L (1997) Role of abdominal computed tomography in the evaluation and management of stab wounds to the back and flank. Emerg Radiol 4:340–345

    Article  Google Scholar 

  38. Pinto A, Scaglione M, Giovine S, Romano S, Lassandro F, Grassi R et al (2004) Comparison between the site of multislice CT signs of gastrointestinal perforation and the site of perforation detected at surgery in forty perforated patients. Radiol Med 108:208–217

    PubMed  Google Scholar 

  39. Scaglione M, Romano L, Bocchini G, Sica G, Guida F, Pinto A et al (2012) Multidetector computed tomography of pancreatic, small bowel, and mesenteric traumas. Semin Roentgenol 47:362–370

    Article  PubMed  Google Scholar 

  40. Hafez HM, Woolgar J, Robbs JV (2001) Lower extremity arterial injuries: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 33:1212–1219

    Article  CAS  PubMed  Google Scholar 

  41. Mattox KL, Feliciano DV, Burch J, Beall AC Jr, Jordan GL Jr, De Bakey ME (1989) Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Ann Surg 209:698–707

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Caps MT (1998) The epidemiology of vascular trauma. Semin Vasc Surg 11:227–231

    CAS  PubMed  Google Scholar 

  43. Rozycki GS, Treamblay LN, Feliciano DV, McClelland WB (2003) Blunt vascular trauma in the extremity: diagnosis, management, and outcome. J Trauma 55:814–824

    Article  PubMed  Google Scholar 

  44. Bhootra BL (2007) Retained intra cranial blade—medicolegal perspectives. 14:31–34

  45. Venara A, Jousset N, Airagnes G Jr, Arnaud JP, Rougé-Maillart C (2013) Abdominal stab wounds: self-inflicted wounds versus assault wounds. J Forensic Leg Med 20:270–273

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Author information

Authors and Affiliations

  1. Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 12, 80138, Naples, Italy

    Alfonso Reginelli, Giovanni Fontanella, Claudia Rossi & Alessandra Del Prete

  2. Department of Radiology, Cardarelli Hospital, Naples, Italy

    Antonio Pinto

  3. Department of Radiology, S. G. Moscati Hospital, Aversa, Italy

    Anna Russo & Alfredo D’Andrea

  4. Department of Radiology, University of Foggia, Scientific Institute Hospital ‘Casa Sollievo della Sofferenza’, San Giovanni Rotondo, Foggia, Italy

    Giuseppe Guglielmi

  5. Department of Health Science, University of Molise, Campobasso, Italy

    Marcello Zappia & Luca Brunese

Authors
  1. Alfonso Reginelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Fontanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudia Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandra Del Prete
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcello Zappia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alfredo D’Andrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giuseppe Guglielmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Luca Brunese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alfonso Reginelli.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reginelli, A., Pinto, A., Russo, A. et al. Sharp penetrating wounds: spectrum of imaging findings and legal aspects in the emergency setting. Radiol med 120, 856–865 (2015). https://doi.org/10.1007/s11547-015-0553-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-015-0553-x

Keywords

Search

Navigation