Radiographic evaluation can also help identify retained foreign bodies and suggest trajectory, which may direct initial surgical exploration. Variant 2: Adult. Ballistic penetrating torso trauma, unknown trajectory, normotensive. Initial imaging. FAST can help triage patients and direct initial bedside and surgical procedures. Hemopericardium, pneumothorax, and free intraperitoneal fluid discovered at FAST have significant implications on next steps in management of the patient. Some trauma systems also use prehospital FAST to expedite management upon arrival to the hospital [14,16]. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There is no relevant literature regarding the use of CT chest, abdomen, and pelvis without and with IV contrast for initial evaluation of penetrating torso trauma. The addition of a noncontrast phase may delay definitive diagnosis and typically does not provide additional information pertinent to penetrating trauma [31]. CT Chest, Abdomen, and Pelvis Without IV Contrast There is no relevant literature regarding the use of CT chest, abdomen, and pelvis without IV contrast for initial evaluation of penetrating torso trauma. Although noncontrast CT may be helpful in determining trajectory, demonstration of internal injuries, specifically solid organs, is much more apparent with IV contrast. During the global shortage of contrast in 2022, unenhanced CT scans were used for acute and posttraumatic patients in emergency departments at some institutions [32]. CTA Chest, Abdomen, and Pelvis IV Contrast In the hemodynamically stable patient population, multiphasic imaging can provide additional useful information regarding the source of active bleeding. Additionally, it is important to remember that imaging can be performed after damage control surgery to identify injuries that may need definitive treatment [29,33].
Penetrating Torso Trauma. Radiographic evaluation can also help identify retained foreign bodies and suggest trajectory, which may direct initial surgical exploration. Variant 2: Adult. Ballistic penetrating torso trauma, unknown trajectory, normotensive. Initial imaging. FAST can help triage patients and direct initial bedside and surgical procedures. Hemopericardium, pneumothorax, and free intraperitoneal fluid discovered at FAST have significant implications on next steps in management of the patient. Some trauma systems also use prehospital FAST to expedite management upon arrival to the hospital [14,16]. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There is no relevant literature regarding the use of CT chest, abdomen, and pelvis without and with IV contrast for initial evaluation of penetrating torso trauma. The addition of a noncontrast phase may delay definitive diagnosis and typically does not provide additional information pertinent to penetrating trauma [31]. CT Chest, Abdomen, and Pelvis Without IV Contrast There is no relevant literature regarding the use of CT chest, abdomen, and pelvis without IV contrast for initial evaluation of penetrating torso trauma. Although noncontrast CT may be helpful in determining trajectory, demonstration of internal injuries, specifically solid organs, is much more apparent with IV contrast. During the global shortage of contrast in 2022, unenhanced CT scans were used for acute and posttraumatic patients in emergency departments at some institutions [32]. CTA Chest, Abdomen, and Pelvis IV Contrast In the hemodynamically stable patient population, multiphasic imaging can provide additional useful information regarding the source of active bleeding. Additionally, it is important to remember that imaging can be performed after damage control surgery to identify injuries that may need definitive treatment [29,33].