Skip to main content
SpringerLink
Log in

Transcavitary Penetrating Trauma—Comparing the Imaging Evaluation of Gunshot and Blast Injuries of the Chest, Abdomen, and Pelvis

  • The Military Perspective (M Martin and M Schreiber, Section Editors)
  • Published:
Current Trauma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This article will review the mechanisms of gunshot- and blast-related injuries, highlighting both similarities and differences in injury patterns and imaging evaluation with a focus on injuries of the chest, abdomen, and pelvis.

Recent Findings

Advances in the types of weapons and targets of terror-related attacks, as well as the use of body armor, have led to a change in frequency and distribution of both blast- and gunshot-related injuries, a sizable portion of which involves the chest, abdomen, and pelvis.

Summary

This article reviews requisite knowledge required by both radiologists and surgeons to evaluate gunshot- and blast-related injuries in the twenty-first century.

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

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wilson AJ. Gunshot injuries: what does a radiologist need to know? Radiographics: a review publication of the Radiological Society of North America, Inc. 1999;19(5):1358–68.

    Article  CAS  Google Scholar 

  2. Pinto A, Russo A, Reginelli A, Iacobellis F, Di Serafino M, Giovine S, et al. Gunshot wounds: ballistics and imaging findings. Semin Ultrasound CT MR. 2019;40(1):25–35.

    Article  PubMed  Google Scholar 

  3. Fackler ML. Wound ballistics. A review of common misconceptions. Jama. 1988;259(18):2730–6.

    Article  CAS  PubMed  Google Scholar 

  4. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Gunshot wounds: 1. Bullets, ballistics, and mechanisms of injury. AJR Am J Roentgenol. 1990;155(4):685–90.

    Article  CAS  PubMed  Google Scholar 

  5. Lozano JD, Munera F, Anderson SW, Soto JA, Menias CO, Caban KM. Penetrating wounds to the torso: evaluation with triple-contrast multidetector CT. Radiographics: a review publication of the Radiological Society of North America, Inc. 2013;33(2):341–59.

    Article  Google Scholar 

  6. Dreizin D, Munera F. Multidetector CT for penetrating torso trauma: state of the art. Radiology. 2015;277(2):338–55.

    Article  PubMed  Google Scholar 

  7. Fackler ML. Effects of small arms on the human body. Presidio of San Francisco, California: Wound Ballistics Laboratory, Letterman Army Institute of Research; 1988.

  8. Hanna TN, Shuaib W, Han T, Mehta A, Khosa F. Firearms, bullets, and wound ballistics: an imaging primer. Injury. 2015;46(7):1186–96.

    Article  PubMed  Google Scholar 

  9. Clark KR. Imaging assessment of gunshot injuries. Radiol Technol. 2016;87(6):627–44.

    PubMed  Google Scholar 

  10. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Gunshot wounds: 2. Radiology. AJR Am J Roentgenol. 1990;155(4):691–702.

    Article  CAS  PubMed  Google Scholar 

  11. Dreizin D, Munera F. Blunt polytrauma: evaluation with 64-section whole-body CT angiography. Radiographics: a review publication of the Radiological Society of North America, Inc. 2012;32(3):609–31.

    Article  Google Scholar 

  12. Singh AK, Ditkofsky NG, York JD, Abujudeh HH, Avery LA, Brunner JF, et al. Blast injuries: from improvised explosive device blasts to the Boston Marathon bombing. Radiographics: a review publication of the Radiological Society of North America, Inc. 2016;36(1):295–307.

    Article  Google Scholar 

  13. de Vries CS, Africa M, Gebremariam FA, van Rensburg JJ, Otto SF, Potgieter HF. The imaging of stab injuries. Acta radiologica (Stockholm, Sweden : 1987). 2010;51(1):92–106.

    Article  Google Scholar 

  14. Graham RN. Battlefield radiology. Br J Radiol. 2012;85(1020):1556–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Okoye OT, Talving P, Teixeira PG, Chervonski M, Smith JA, Inaba K, et al. Transmediastinal gunshot wounds in a mature trauma centre: changing perspectives. Injury. 2013;44(9):1198–203.

    Article  PubMed  Google Scholar 

  16. Samson PPaBFM. Mediastinal anatomy and mediastinoscopy. In: Sellke PJdN FW, Swanson MD SJ, editors. Sabiston and Spencer surgery of the chest. 9th ed. Philadelphia: Elsevier; 2016. p. 698–710.

    Google Scholar 

  17. Co SJ, Yong-Hing CJ, Galea-Soler S, Ruzsics B, Schoepf UJ, Ajlan A, et al. Role of imaging in penetrating and blunt traumatic injury to the heart. Radiographics: a review publication of the Radiological Society of North America, Inc. 2011;31(4):E101–15.

    Article  Google Scholar 

  18. Demetriades D, van der Veen BW. Penetrating injuries of the heart: experience over two years in South Africa. J Trauma. 1983;23(12):1034–41.

    Article  CAS  PubMed  Google Scholar 

  19. Lewis JD, Starnes SL, Pandalai PK, Huffman LC, Bulcao CF, Pritts TA, et al. Traumatic diaphragmatic injury: experience from a level I trauma center. Surgery. 2009;146(4):578–83 discussion 83-4.

    Article  PubMed  Google Scholar 

  20. Bodanapally UK, Shanmuganathan K, Mirvis SE, Sliker CW, Fleiter TR, Sarada K, et al. MDCT diagnosis of penetrating diaphragm injury. Eur Radiol. 2009;19(8):1875–81.

    Article  PubMed  Google Scholar 

  21. Dreizin D, Borja MJ, Danton GH, Kadakia K, Caban K, Rivas LA, et al. Penetrating diaphragmatic injury: accuracy of 64-section multidetector CT with trajectography. Radiology. 2013;268(3):729–37.

    Article  PubMed  Google Scholar 

  22. Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tomlinson G. Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology. 2008;249(2):524–33.

    Article  PubMed  Google Scholar 

  23. Munera F, Morales C, Soto JA, Garcia HI, Suarez T, Garcia V, et al. Gunshot wounds of abdomen: evaluation of stable patients with triple-contrast helical CT. Radiology. 2004;231(2):399–405.

    Article  PubMed  Google Scholar 

  24. Srinivasa RN, Akbar SA, Jafri SZ, Howells GA. Genitourinary trauma: a pictorial essay. Emerg Radiol. 2009;16(1):21–33.

    Article  CAS  PubMed  Google Scholar 

  25. Wolf SJ, Bebarta VS, Bonnett CJ, Pons PT, Cantrill SV. Blast injuries. Lancet (London, England). 2009;374(9687):405–15.

    Article  Google Scholar 

  26. Cullis IG. Blast waves and how they interact with structures. J R Army Med Corps. 2001;147(1):16–26.

    Article  CAS  PubMed  Google Scholar 

  27. DePalma RG, Burris DG, Champion HR, Hodgson MJ. Blast injuries. N Engl J Med. 2005;352(13):1335–42.

    Article  CAS  PubMed  Google Scholar 

  28. • Yazgan C, Aksu NM. Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey. Br J Radiol. 2016;89(1062):20160063 Excellent descriptive study of blast injury patterns.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hunter J. The problem of blast injuries: (sections of surgery and pathology). Proc R Soc Med. 1941;34(3):171–92.

    Google Scholar 

  30. Dick EA, Ballard M, Alwan-Walker H, Kashef E, Batrick N, Hettiaratchy S, et al. Bomb blast imaging: bringing order to chaos. Clin Radiol. 2018;73(6):509–16.

    Article  CAS  PubMed  Google Scholar 

  31. Scott TE, Kirkman E, Haque M, Gibb IE, Mahoney P, Hardman JG. Primary blast lung injury - a review. Br J Anaesth. 2017;118(3):311–6.

    Article  CAS  PubMed  Google Scholar 

  32. Rodriguez UA, Zeng Y, Deyo D, Parsley MA, Hawkins BE, Prough DS, et al. Effects of mild blast traumatic brain injury on cerebral vascular, histopathological, and behavioral outcomes in rats. J Neurotrauma. 2018;35(2):375–92.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Courtney A, Courtney M. The complexity of biomechanics causing primary blast-induced traumatic brain injury: a review of potential mechanisms. Front Neurol. 2015;6:221.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cho SI, Gao SS, Xia A, Wang R, Salles FT, Raphael PD, et al. Mechanisms of hearing loss after blast injury to the ear. PLoS One. 2013;8(7):e67618.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Bala M, Rivkind AI, Zamir G, Hadar T, Gertsenshtein I, Mintz Y, et al. Abdominal trauma after terrorist bombing attacks exhibits a unique pattern of injury. Ann Surg. 2008;248(2):303–9.

    Article  PubMed  Google Scholar 

  36. Bala M, Shussman N, Rivkind AI, Izhar U, Almogy G. The pattern of thoracic trauma after suicide terrorist bombing attacks. J Trauma. 2010;69(5):1022–8 discussion 8-9.

    Article  PubMed  Google Scholar 

  37. Lichtenberger JP, Kim AM, Fisher D, Tatum PS, Neubauer B, Peterson PG, et al. Imaging of combat-related thoracic trauma - blunt trauma and blast lung injury. Mil Med. 2018;183(3–4):e89–96.

    Article  PubMed  Google Scholar 

  38. Cancio LC, Sheridan RL, Dent R, Hjalmarson SG, Gardner E, Matherly AF, et al. Guidelines for burn care under austere conditions: special etiologies: blast, radiation, and chemical injuries. Journal of burn care & research: official publication of the American Burn Association. 2017;38(1):e482–e96.

    Article  Google Scholar 

  39. Chai JK, Liu W, Deng HP, Cai JH, Hu QG, Zou XF, et al. A novel model of burn-blast combined injury and its phasic changes of blood coagulation in rats. Shock (Augusta, Ga). 2013;40(4):297–302.

    Article  Google Scholar 

  40. Peleg K, Aharonson-Daniel L, Stein M, Michaelson M, Kluger Y, Simon D, et al. Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239(3):311–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Fischer TV, Folio LR, Backus CE, Bunger R. Case report highlighting how wound path identification on CT can help identify organ damage in abdominal blast injuries. Mil Med. 2012;177(1):101–7.

    Article  PubMed  Google Scholar 

  42. Konwinski RR, Singh A, Soto J. Imaging of lower extremity trauma from Boston Marathon bombing. Emerg Radiol. 2016;23(5):433–7.

    Article  PubMed  Google Scholar 

  43. Smith S, Devine M, Taddeo J, McAlister VC. Injury profile suffered by targets of antipersonnel improvised explosive devices: prospective cohort study. BMJ Open. 2017;7(7):e014697.

    Article  PubMed  PubMed Central  Google Scholar 

  44. •• Eskridge SL, Macera CA, Galarneau MR, Holbrook TL, Woodruff SI, MacGregor AJ, et al. Injuries from combat explosions in Iraq: injury type, location, and severity. Injury. 2012;43(10):1678–82 Compelling meta-analysis on the epidemiology of blast injury.

    Article  PubMed  Google Scholar 

  45. Turegano-Fuentes F, Caba-Doussoux P, Jover-Navalon JM, Martin-Perez E, Fernandez-Luengas D, Diez-Valladares L, et al. Injury patterns from major urban terrorist bombings in trains: the Madrid experience. World J Surg. 2008;32(6):1168–75.

    Article  PubMed  Google Scholar 

  46. Edwards DS, McMenemy L, Stapley SA, Patel HD, Clasper JC. 40 years of terrorist bombings - a meta-analysis of the casualty and injury profile. Injury. 2016;47(3):646–52.

    Article  CAS  PubMed  Google Scholar 

  47. Gunn ML, Clark RT, Sadro CT, Linnau KF, Sandstrom CK. Current concepts in imaging evaluation of penetrating transmediastinal injury. Radiographics: a review publication of the Radiological Society of North America, Inc. 2014;34(7):1824–41.

    Article  Google Scholar 

  48. Steenburg SD, Sliker CW, Shanmuganathan K, Siegel EL. Imaging evaluation of penetrating neck injuries. Radiographics: a review publication of the Radiological Society of North America, Inc. 2010;30(4):869–86.

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all previous investigators who have dedicated their careers to building the foundational knowledge of gunshot- and blast-related injuries.

Author information

Authors and Affiliations

  1. Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA

    Matthew Grant, Joshua Ladner, Chris Marenco & Eric Roberge

Authors
  1. Matthew Grant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua Ladner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chris Marenco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric Roberge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew Grant.

Ethics declarations

Conflict of Interest

The authors declare they have no undisclosed conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimer

The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on The Military Perspective

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grant, M., Ladner, J., Marenco, C. et al. Transcavitary Penetrating Trauma—Comparing the Imaging Evaluation of Gunshot and Blast Injuries of the Chest, Abdomen, and Pelvis. Curr Trauma Rep 6, 83–95 (2020). https://doi.org/10.1007/s40719-020-00192-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40719-020-00192-9

Keywords

Search

Navigation