Figure 1 - uploaded by Edwardo Ramos
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Cervical spine CT scan. (a, Longitudinal view) Comminuted fracture of the spinous process of the C5 vertebra. (b, Coronal view) The bullet trajectory is noted as areas of emphysema through its path. The trajectory changes its direction as the bullet ricochets when hitting bony surfaces.
Source publication
Introduction:
Central Cord Syndrome (CCS) is the most common of the spinal cord injury syndromes. Few cases have been presented with gunshot wound (GSW) as a cause of a central cord syndrome, and none, to our knowledge, has been presented without any evidence of central canal bullet/bone fragments.
Case presentation:
A 27-year-old male suffered...
Context in source publication
Context 1
... patient is a 27-year-old male who suffered two close-range gunshot wounds (GSW) fired by a handgun, one to the left neck and one to the left shoulder. Computed tomography (CT) of the neck showed C5 spinous process comminuted fracture and posterior paraspinal muscle hemorrhage without evidence of central canal stenosis or bullet/bone fragments (Figure 1). He also had left proximal humeral comminuted diaphyseal fracture. ...
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Citations
... Additionally, kinetic energy is transferred to surrounding tissues, resulting in a circumferential, hydrodynamic wave that causes a secondary shearing injury. [1,2] These so-called "blast injuries" combine penetrating and blunt mechanisms of energy transfer that depend on variables including distance from the projectile origin, projectile type and caliber, type of tissues involved, and trajectory. [3,4] Blast injuries may result in complex patterns of trauma that requires a high index of suspicion to diagnose and treat efficiently. ...
... There are several reports of patients sustaining significant secondary blast injuries affecting the spinal cord, intra-and extra- peritoneal organs, lungs, and heart. [1,[5][6][7][8][9][10][11][12][13] However, there were only two reports describing three total patients with cardiac injuries complicated by hemodynamic compromise due to GSW-associated blast injuries. [5,10] Both reports described early hemopericardium with an intact pericardium resulting in cardiac tamponade. ...
Background
Penetrating injuries are recognized for the direct tissue damage, which is typically evident on physical examination. Secondary injuries resulting from kinetic energy transfer in the case of gunshot wounds (GSWs), often referred to as “blast injuries”, may affect tissues distant to the ballistic trajectory and are often occult. We present a case of delayed cardiac tamponade resulting from secondary blast injury. The patient sustained a thoraco-abdominal GSW with entry adjacent to the cardiac box. An Advanced Trauma Life Support (ATLS)-guided assessment revealed intra-abdominal injuries necessitating operative intervention without evidence of cardiac injury. On post-operative day four, the patient developed chest pain, tachycardia, and shortness of breath. Imaging revealed a large pericardial effusion with cardiac tamponade. Emergent exploration revealed hemopericardium secondary to a bleeding epicardial hematoma without evidence of pericardial violation. Clinicians must maintain a high clinical suspicion for occult, indirect blast injuries which may be life-threatening.
