 Introduction/Background Penetrating torso trauma occurs when a foreign body disrupts the skin and enters the patient. The anatomical boundaries of the torso begin cranially at the thoracic inlet and caudally at the inferior margins of the greater trochanters, excluding the appendicular skeletal structures. Penetrating trauma most commonly occurs from gunshots and stabbings, although any object can impale the patient. High rates of mortality and morbidity are associated with gunshot wounds, with approximately 42,222 deaths in 2020 or 13.7 deaths per 100,000 people [1]. Stab wounds are much more common, estimated at 434,259 injuries annually; however, these wounds rarely result in death. According to the Centers for Disease Control and Prevention, between 2003 and 2019, a total number of 6,015 deaths were reported in the United States from stab injuries [1]. Special Imaging Considerations Imaging, in particular multidetector CT, plays a central role in guiding management in patients with penetrating trauma. Contrast-enhanced CT with multiplanar reformations is the standard imaging tool in the evaluation of patients with penetrating trauma due to its fast acquisition and excellent resolution [2,3]. Single versus multiphasic protocols vary depending upon both institutional protocols and clinical presentation. Multiphasic protocols that include an arterial phase may improve the identification and characterization of vascular injuries, whereas the assessment of solid organs in the abdomen and pelvis is best performed during the portal venous phase [6]. Furthermore, the American Association for the Surgery of Trauma recommends dual-phase CT (arterial and venous phases) for accurate diagnosis of vascular injuries of the solid organs including the spleen, liver, or kidney [7]. Throughout this manuscript, CT angiography (CTA) will presuppose at least 2 postcontrast phases of imaging in addition to the angiography phase.
Penetrating Torso Trauma.  Introduction/Background Penetrating torso trauma occurs when a foreign body disrupts the skin and enters the patient. The anatomical boundaries of the torso begin cranially at the thoracic inlet and caudally at the inferior margins of the greater trochanters, excluding the appendicular skeletal structures. Penetrating trauma most commonly occurs from gunshots and stabbings, although any object can impale the patient. High rates of mortality and morbidity are associated with gunshot wounds, with approximately 42,222 deaths in 2020 or 13.7 deaths per 100,000 people [1]. Stab wounds are much more common, estimated at 434,259 injuries annually; however, these wounds rarely result in death. According to the Centers for Disease Control and Prevention, between 2003 and 2019, a total number of 6,015 deaths were reported in the United States from stab injuries [1]. Special Imaging Considerations Imaging, in particular multidetector CT, plays a central role in guiding management in patients with penetrating trauma. Contrast-enhanced CT with multiplanar reformations is the standard imaging tool in the evaluation of patients with penetrating trauma due to its fast acquisition and excellent resolution [2,3]. Single versus multiphasic protocols vary depending upon both institutional protocols and clinical presentation. Multiphasic protocols that include an arterial phase may improve the identification and characterization of vascular injuries, whereas the assessment of solid organs in the abdomen and pelvis is best performed during the portal venous phase [6]. Furthermore, the American Association for the Surgery of Trauma recommends dual-phase CT (arterial and venous phases) for accurate diagnosis of vascular injuries of the solid organs including the spleen, liver, or kidney [7]. Throughout this manuscript, CT angiography (CTA) will presuppose at least 2 postcontrast phases of imaging in addition to the angiography phase.