Riddle of a Bullet: Transmediastinal or Unilateral Chest Injury?

Abstract

Thoracic gunshot injuries are relatively rare in Western European Trauma Departments. In the case of a thoracic gunshot wound it is vital to establish if mediastinal structures are damaged. Non-mediastinal injuries often only require tube-thoracostomy followed by close observation. We report a case were the localisation of the gunshot wound together with the initial X-ray were suggestive of a transmediastinal injury pattern. A helical CT-scan could exclude this. A forensic reconstruction was performed retrospectively; the most likely chain of events and injury pattern is explained.