Prediction of major vascular injury in patients with gunshot wounds to the neck.
OBJECTIVE
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%).


CONCLUSIONS
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.
Nemzek
W R
WR
Department of Radiology, University of California at Davis, Sacramento 95817, USA.
Hecht
S T
ST
Donald
P J
PJ
McFall
R A
RA
Poirier
V C
VC
D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging; D001466:Barium Sulfate; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply; D019838:Neck Injuries; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging*
D001466:Barium Sulfate