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GSW to right shoulder

Patterson RAP - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: GSW to right shoulder

History: 21 y/o AD 2ID male in Ramadi standing guard with local heard and felt GS to right shoulder. Evaluated in Iraq with chest tube placement and wound debridement. Transferred to Landstuhl and then to WRAMC. Does not recall if he has had operative procedures. Patient doing well on admission. No LOC at scene. Patient began eating regular food, had regular diet at Andrews, as well as a bowel movement. On evaluation, patient had good pain control, but had complaints of decreased ROM.

Findings: PA and lateral views of the chest demonstrate stable right-sided chest tube without significant pneumothorax. Multiple, small, metallic fragments projecting over the right shoulder and mid-lung noted. Right mid-lung opacity is likely due to a contusion injury. No focal consolidation or effusion. The imaged osseous structures are unremarkable. Axial and coronal reformatted images were obtained through the right shoulder at 1.25- and 0.4-mm collimation, respectively. No intravenous contrast was administered. Metallic fragments throughout the anterior portion of the shoulder, with a small fragment within the lung parenchyma and anterior portion of the glenohumeral joint. A metallic fragment is visualized within the joint itself. Area of hypodensity just lateral to the metallic fragment in the humeral head may represent beam hardening versus small fracture lucency.

Ddx: GSW to right shoulder Right mid-lung contusion injury Beam hardening versus small fracture lucency

Dxhow: NA

Exam: Vital Signs: SBP-137, DBP-66, BPM-90, HR-72, RR-16, Temp-100.4 Wt-83.77kg, Ht: 177.80cm General Appearance: Well-nourished, well-developed Mental Status: Awake, responsive, alert and oriented x 3 Head/Neck: Normocephalic. Supple without masses. Eyes: PERLA Throat/Mouth/Teeth: Normal Chest/Lungs: Equal breath sounds anteriorly. Minimally decreased at post apex. Chest tube with minimal respiratory variation. No air leak. Heart: No gallops, rubs or mumurs. Abdomen: Soft, nontender, normal BS, no organomegaly. Rectal/Prostate: Normal tone; prostate normal size, smooth/sym; Hemoccult negative. Back: No exit wounds. Pulses: All pulses 2+ palpable, equal. Neuro: CN 2-12 intact, motor/sensation intact, no pathological reflexes. Good strength in lower arm, difficult with abduction at shoulder secondary to pain Extremities: 10x8cm wound on right shoulder. No exposed bone. Clean. 6.1> 11.1/31.8 <255 142/4.0/101/31/15/1.0<88 Ca-7.7, Mg-2.1, Phos-3.1 PT-13.8, INR-1, APTT-30.8

No MeSH data available.


PA and lateral views of the chest demonstrate stable right-sided chest tube without significant pneumothorax.  Multiple, small, metallic fragments projecting over the right shoulder and mid-lung noted.  Right mid-lung opacity is likely due to a contusion injury.  No focal consolidation or effusion.  The imaged osseous structures are unremarkable.
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MPX1273_synpic24378: PA and lateral views of the chest demonstrate stable right-sided chest tube without significant pneumothorax. Multiple, small, metallic fragments projecting over the right shoulder and mid-lung noted. Right mid-lung opacity is likely due to a contusion injury. No focal consolidation or effusion. The imaged osseous structures are unremarkable.


GSW to right shoulder

Patterson RAP - MedPix

PA and lateral views of the chest demonstrate stable right-sided chest tube without significant pneumothorax.  Multiple, small, metallic fragments projecting over the right shoulder and mid-lung noted.  Right mid-lung opacity is likely due to a contusion injury.  No focal consolidation or effusion.  The imaged osseous structures are unremarkable.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1273&req=5

MPX1273_synpic24378: PA and lateral views of the chest demonstrate stable right-sided chest tube without significant pneumothorax. Multiple, small, metallic fragments projecting over the right shoulder and mid-lung noted. Right mid-lung opacity is likely due to a contusion injury. No focal consolidation or effusion. The imaged osseous structures are unremarkable.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: GSW to right shoulder

History: 21 y/o AD 2ID male in Ramadi standing guard with local heard and felt GS to right shoulder. Evaluated in Iraq with chest tube placement and wound debridement. Transferred to Landstuhl and then to WRAMC. Does not recall if he has had operative procedures. Patient doing well on admission. No LOC at scene. Patient began eating regular food, had regular diet at Andrews, as well as a bowel movement. On evaluation, patient had good pain control, but had complaints of decreased ROM.

Findings: PA and lateral views of the chest demonstrate stable right-sided chest tube without significant pneumothorax. Multiple, small, metallic fragments projecting over the right shoulder and mid-lung noted. Right mid-lung opacity is likely due to a contusion injury. No focal consolidation or effusion. The imaged osseous structures are unremarkable. Axial and coronal reformatted images were obtained through the right shoulder at 1.25- and 0.4-mm collimation, respectively. No intravenous contrast was administered. Metallic fragments throughout the anterior portion of the shoulder, with a small fragment within the lung parenchyma and anterior portion of the glenohumeral joint. A metallic fragment is visualized within the joint itself. Area of hypodensity just lateral to the metallic fragment in the humeral head may represent beam hardening versus small fracture lucency.

Ddx: GSW to right shoulder Right mid-lung contusion injury Beam hardening versus small fracture lucency

Dxhow: NA

Exam: Vital Signs: SBP-137, DBP-66, BPM-90, HR-72, RR-16, Temp-100.4 Wt-83.77kg, Ht: 177.80cm General Appearance: Well-nourished, well-developed Mental Status: Awake, responsive, alert and oriented x 3 Head/Neck: Normocephalic. Supple without masses. Eyes: PERLA Throat/Mouth/Teeth: Normal Chest/Lungs: Equal breath sounds anteriorly. Minimally decreased at post apex. Chest tube with minimal respiratory variation. No air leak. Heart: No gallops, rubs or mumurs. Abdomen: Soft, nontender, normal BS, no organomegaly. Rectal/Prostate: Normal tone; prostate normal size, smooth/sym; Hemoccult negative. Back: No exit wounds. Pulses: All pulses 2+ palpable, equal. Neuro: CN 2-12 intact, motor/sensation intact, no pathological reflexes. Good strength in lower arm, difficult with abduction at shoulder secondary to pain Extremities: 10x8cm wound on right shoulder. No exposed bone. Clean. 6.1> 11.1/31.8 <255 142/4.0/101/31/15/1.0<88 Ca-7.7, Mg-2.1, Phos-3.1 PT-13.8, INR-1, APTT-30.8

No MeSH data available.