RT Journal Article
SR Electronic
T1 Prediction of major vascular injury in patients with gunshot wounds to the neck.
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 161
OP 167
VO 17
IS 1
A1 W R Nemzek
A1 S T Hecht
A1 P J Donald
A1 R A McFall
A1 V C Poirier
YR 1996
UL http://www.ajnr.org/content/17/1/161.abstract
AB PURPOSE To determine whether plain film and CT findings help predict the presence and severity of vascular trauma.METHODS The records of 65 patients with gunshot wounds of the neck were reviewed. There were 58 men and 7 women ranging in age from 2 to 72 years. All had angiography of the cervical vessels; in addition, 64 had plain radiography, 22 had CT, and 14 had a barium swallow. The results of plain films, barium swallow, and CT scans were correlated.RESULTS Eighteen patients (28%) had major vascular injury, which included 10 pseudoaneurysms, six vascular occlusions, four intimal injuries, and one arteriovenous fistula. Ten patients had prevertebral soft-tissue swelling (sensitivity, 59%; specificity, 77%), 14 had a bullet fragment close to a vessel (sensitivity, 78%; specificity, 36%), and 13 had missile fragmentation (sensitivity, 72%; specificity, 45%).CONCLUSION Prevertebral soft-tissue swelling, missile fragmentation, and missiles adjacent to major vessels are useful but nonspecific radiographic signs and are present in many patients with normal angiographic findings. A knowledge of the physical findings, including the entry and exit wounds, plus the results of plain radiography and CT can help define bullet trajectories and guide angiographic evaluation.