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