Need high incidence of suspicion with penetrating trauma (up to 5% of arterial injuries may be missed on the initial CT angiogram in patients with fragmentation wounds) .
CXR
X-ray (location specific) and/or CT
Look for evidence of metallic foreign bodies both near and far from the site of penetrating injury
CT angiogram of the involved extremity, if evidence of extremity foreign body (e.g. diminished or absent pulses)
If there is evidence of intracardiac or intrapulmonary foreign bodies, consider:
CT chest/abdomen/pelvis with IV contrast (to determin missile trajectory, size, and exact location).
2D transesophageal echocardiogram is also recommended for intrathoracic missiles.
Look for evidence of metallic foreign bodies both near and far from the site of penetrating injury
CT angiogram of the involved extremity, if evidence of extremity foreign body (e.g. diminished or absent pulses)
CT chest/abdomen/pelvis with IV contrast (to determin missile trajectory, size, and exact location).
2D transesophageal echocardiogram is also recommended for intrathoracic missiles.
Missile embolus
Missile embolism
Coronary artery dissection
Acute arterial ischemia
Myocardial rupture
Arterial gas embolism
Subclavian steal syndrome
Vertebral and carotid artery dissection