Stable patients Previously every stable patient that suffered a TMGSW received extensive evaluation that included chest radiography, oesophagography, esophagoscopy, angiography, bronchoscopy, cardiac ultrasound. Grossman et al.<unk>  evidence that the trajectory of the bullet can be delineated with the use of Computed Tomographic Scan (CT). Subsequently other studies demonstrated the use of CT as a screening tool for stable patients who suffered TMGSW is a reliable tool for ruling out, diagnosing and avoiding missed injuries. For example Stassen et al. showed data of 22 stable patients who were screened with CT, chest x ray and abdominal ultrasound; seven patients showed a positive CT scan and required additional evaluation, and of these seven patients, three required surgical management. Additionally the work of Burack et al., whose evaluation of stable patients with penetrating injuries to the mediastinum — this time including stab<unk> s — relied mostly on CT and ultrasound, showed similar results. The work of Ibirogba et al. did so as well. Recent data suggests that the use of CT scan with some additional noninvasive techniques, such as ultrasound and chest roentgenogram are reliable screening tools to decide whether patients need further evaluation. Unstable patients The criteria to define a patient as stable or unstable could have variations from institution to institution. For example, Burack et al. used a list of 6 criteria in his paper that defined an unstable hemodynamic state: # Traumatic cardiac arrest or near arrest and an EDT # Cardiac tamponade # Persistent ATLS class III shock despite fluid resuscitation (blood loss 1500–2000 mL, pulse rate greater than 120, blood pressure decreased) # Chest tube output greater than 1500 mL of blood on insertion # Chest tube output greater than 500 mL/hour for the initial hour # Massive hemothorax after chest tube drainage One common criteria<unk>  in literature is a sustained systolic blood pressure of less than 100 mmHg, but this can be an oversimplification. Patients with clinical evidence of possible TMGSW that are considered unstable receive no further evaluation and are taken to surgery immediately.
Transmediastinal gunshot wound
Thoracic aorta injury
Pulmonary laceration
Mediastinal lymphadenopathy
Tracheoinnominate fistula
Esophageal rupture
Exercise-induced laryngeal obstruction
Retropharyngeal abscess