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Weekly Chest CasesArchive of Old Cases

Case No : 1194 Date 2020-09-09

  • Courtesy of Minji Song, Young Hun Jeon, Jin Young Yoo / Chungbuk National University Hospital
  • Age/Sex 88 / M
  • Chief ComplaintIncidental finding
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Gunshot injuries in lung
Radiologic Findings
Fig 1-4. Contrast-enhanced chest CT reveals the presence of a metallic object in left upper lobe with surrounding pleuroparenchymal bands and consolidation.

This patient had a history of participation in the Korean war in 1950s and was injured by the penetrating trauma due to gunshot injuries.

Postero-anterior chest radiograph reveals evident bullet shaped metallic object surrounding fibrotic change in left upper lung field.
Brief Review
Penetrating wounds of the thorax caused by a gunshot or explosion are rare in Korea; most cases are related to injuries sustained during the Korean War.
Gunshot injuries often require imaging assessment, and this evaluation has both clinical relevance (assessment of organ damage, surgical planning and prognostication), and often also forensic implications. The mechanism of gunshot injuries is determined by several contributing factors such as the type of firearm, projectile characteristics, and the inherent characteristics of the wounded tissue. The primary objectives of imaging for gunshot injury are to determine the path of the projectile or projectiles, assess which tissues have been injured, estimate the severity of injury, and determine what additional studies are needed.
Complications associated with the presence of metallic foreign bodies in the thorax include atelectasis, obstructive pneumonitis, and pneumothorax or hemothorax. The delayed complication of calcific fibrothorax can occur as a result of previous hemothorax. A foreign body in the pleural cavity may cause chronic empyema, while malignant neoplasm associated with this condition and caused by a metallic foreign body has also been reported in the literature.
References
1. Wilson AJ. Gunshot injuries: what does a radiologist need to know? Radiographics. 1998 (5): 1358-68.
2. Baharloo F, Veykermans F, Francis R, et al. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999;115:1357-1362.
Keywords

No. of Applicants : 64

▶ Correct Answer : 19/64,  29.7%
  • - , Japan HIROAKI ARAKAWA
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Korea (South) JIN YOUNG LEE
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Suita Tokushukai Hospital , Japan JUNKO OCHI
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Yeungnam University Medical Center , Korea (South) CHOI SOOYOUNG
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , India VIGNESH K
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Correct Answer as Differential Diagnosis : 2/64,  3.1%
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Korea (South) AHYUN KIM
▶ Semi-Correct Answer : 20/64,  31.3%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Mayo Clinic , Japan HIROAKI TAKAHASHI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - , Japan HIROAKI ARAKAWA
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Private sector , Greece VASILIOS TZILAS
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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