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Missile and Penetrating Injury
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Imaging

    • Clinical Issues

      • Diagnostic Checklist

        TERMINOLOGY

        • Synonyms

          • Impalement injury
          • Stabbing injury
        • Definitions

          • Cranial trauma from high-velocity projectile [typically gunshot wound (GSW)] or impalement with sharp object

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Angiographic Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Gascho D et al: Synergy of CT and MRI in detecting trajectories of lodged bullets in decedents and potential hazards concerning the heating and movement of bullets during MRI. Forensic Sci Med Pathol. 16(1):20-31, 2020
                                          2. Kim LH et al: Mortality prediction and long-term outcomes for civilian cerebral gunshot wounds: a decision-tree algorithm based on a single trauma center. J Clin Neurosci. 75:71-9, 2020
                                          3. Loggini A et al: Management of civilians with penetrating brain injury: a systematic review. J Crit Care. 56:159-66, 2020
                                          4. Callcut RA et al: The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg. 86(5):864-70, 2019
                                          5. Deng H et al: Adult firearm-related traumatic brain injury in United States trauma centers. J Neurotrauma. 36(2):322-37, 2019
                                          6. Euteneuer J et al: Evaluation of the backspatter generation and wound profiles of an anatomically correct skull model for molecular ballistics. Int J Legal Med. 133(6):1839-50, 2019
                                          7. Sarani B et al: Wounding patterns based on firearm type in civilian public mass shootings in the United States. J Am Coll Surg. 228(3):228-34, 2019
                                          8. Berger F et al: Retained bullets in the head on computed tomography - get the most out of iterative metal artifact reduction. Eur J Radiol. 103:124-30, 2018
                                          9. Giffen MA Jr et al: Forensic radiology pitfalls: CT imaging in gunshot wounds of the head. J Forensic Sci. 63(2):631-4, 2018
                                          10. Liu R et al: Gunshot penetrating brain injury in children: report of three cases with review of the literature. Childs Nerv Syst. 34(8):1459-63, 2018
                                          11. Maragkos GA et al: Civilian gunshot wounds to the head: prognostic factors affecting mortality: meta-analysis of 1774 patients. J Neurotrauma. 35(22):2605-14, 2018
                                          12. Li XS et al: Nonmissile penetrating head injuries: surgical management and review of the literature. World Neurosurg. 98:873.e9-873.e25, 2017
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Imaging

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Impalement injury
                                                  • Stabbing injury
                                                • Definitions

                                                  • Cranial trauma from high-velocity projectile [typically gunshot wound (GSW)] or impalement with sharp object

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      • Angiographic Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Gascho D et al: Synergy of CT and MRI in detecting trajectories of lodged bullets in decedents and potential hazards concerning the heating and movement of bullets during MRI. Forensic Sci Med Pathol. 16(1):20-31, 2020
                                                                                  2. Kim LH et al: Mortality prediction and long-term outcomes for civilian cerebral gunshot wounds: a decision-tree algorithm based on a single trauma center. J Clin Neurosci. 75:71-9, 2020
                                                                                  3. Loggini A et al: Management of civilians with penetrating brain injury: a systematic review. J Crit Care. 56:159-66, 2020
                                                                                  4. Callcut RA et al: The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg. 86(5):864-70, 2019
                                                                                  5. Deng H et al: Adult firearm-related traumatic brain injury in United States trauma centers. J Neurotrauma. 36(2):322-37, 2019
                                                                                  6. Euteneuer J et al: Evaluation of the backspatter generation and wound profiles of an anatomically correct skull model for molecular ballistics. Int J Legal Med. 133(6):1839-50, 2019
                                                                                  7. Sarani B et al: Wounding patterns based on firearm type in civilian public mass shootings in the United States. J Am Coll Surg. 228(3):228-34, 2019
                                                                                  8. Berger F et al: Retained bullets in the head on computed tomography - get the most out of iterative metal artifact reduction. Eur J Radiol. 103:124-30, 2018
                                                                                  9. Giffen MA Jr et al: Forensic radiology pitfalls: CT imaging in gunshot wounds of the head. J Forensic Sci. 63(2):631-4, 2018
                                                                                  10. Liu R et al: Gunshot penetrating brain injury in children: report of three cases with review of the literature. Childs Nerv Syst. 34(8):1459-63, 2018
                                                                                  11. Maragkos GA et al: Civilian gunshot wounds to the head: prognostic factors affecting mortality: meta-analysis of 1774 patients. J Neurotrauma. 35(22):2605-14, 2018
                                                                                  12. Li XS et al: Nonmissile penetrating head injuries: surgical management and review of the literature. World Neurosurg. 98:873.e9-873.e25, 2017