Gunshot Wounds: Ballistics and Imaging Findings

Ballistic traumas are defined by a projectile entering the body. Such projectiles include bullets, birdshot, and metal fragments from the covering or the contents of an explosive device. They frequently cause severe wounds characterized by a range of clinical pictures and a large spectrum of concomitant wounds. The major aims of imaging are to define the path of the projectile or projectiles, to evaluate which tissues have been injured, to estimate the severity of injury, and to determine what additional studies are needed. A routine radiograph is performed in patients with gunshot wounds. The diagnostic approach has been changed by the use of multidetector row computed tomography (MDCT) due to its technical developments particularly faster data acquisition and advanced image reconstructions. In the evaluation of patients with gunshot injuries, MDCT is considered the method of choice to identify hemorrhage, bullet, bone fragments, air, hemothorax, nerve lesions, musculoskeletal lesions, and vessel injuries. Moreover, MDCT technology and multiplanar reformation postprocessing allow meticulous trajectory analysis that potentially benefits the clinical outcomes of patients aiding time-saving triage and correct image-based diagnosis of organ and vessel damage. Familiarity of ballistics and forensic sciences will therefore help the radiologist in assessment and localization of the damage caused by projectiles.