The use of CT angiography for preoperative evaluation of large foreign body retention following penetrating trauma.

Ihedioha U, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219648 DESCRIPTION A 31-year-old man presented to the accident and emergency department with a penetrating injury to his left posterolateral chest wall. He was haemodynamically stable, and there was no significant bleeding from the entry point. Plain anterior radiography (figure 1) of the chest revealed a knife embedded within the extrathoracic tissues extending through the scapula, posterior to the clavicle with the tip lying in the left anterior triangle of the neck. A CT angiogram with three-dimensional reconstruction was performed, given the proximity to important neurovascular structures. This revealed the anterior edge of the knife was related posteriorly to the subclavian vessels and the tip was entering the carotid sheath. None of the important neurovascular structures appeared to be injured (figures 2 and 3). Operative exploration was performed with the aim of removing the knife safely. The tip of the knife was identified with no discernible injury to the contents of the carotid sheath. The inferior aspect of the incision was extended laterally to expose the body of the knife and the subclavian vessels. Further access was required, therefore a clavicular osteotomy was performed. The knife was found to abut the posterior wall of the subclavian artery but had not penetrated it. The knife was carefully slid The use of CT angiography for preoperative evaluation of large foreign body retention following penetrating trauma Ugochukwu Ihedioha, Richard P Stevenson, Nigel Raby, David B Kingsmore Images in...