Michael U. Antonucci, MD
Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0210.
Computed tomography images from 3 victims of gun violence.
Left. A young patient shot in the right temple. Noncontrast computed tomography shows minimal skin swelling near the entry site (A; arrow) with extensive ballistic and skull fragments in the underlying right temporal lobe. No exit wound was seen on examination, and the bullet stopped along the contralateral inner table (B; arrowhead), with resultant parenchymal hematoma as well as subarachnoid and large left subdural hemorrhages (B; arrow). Three-dimensional reconstruction shows a small hole near the skull entry site (C; arrow), and 3-dimensional oblique reconstruction (D) highlights the trajectory across both cerebral hemispheres. Center. A young patient fatally shot in the right parietal region. There are extensive metal and bone fragments in the right cerebral hemisphere with surrounding hemorrhage (E; arrow), midline shift, and a partially visualized right subdural hematoma (E; arrowhead). Three-dimensional reconstruction shows an extensively comminuted skull fracture with a small residual bullet fragment demarcating the calvarial entry site (F; arrow). Right. A young patient with extensive ballistic injury to the bilateral frontal lobes with bone and metal fragments, hemorrhage, and edema (G; arrow). The force of the gunshot also produced a large and severely comminuted bilateral frontal skull fracture with sinus involvement visible on 3-dimensional reconstruction (H; arrow).
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Antonucci MU. Firearm Injury Prevention. Ann Intern Med. 2019;171:304–305. doi: https://doi.org/10.7326/L19-0210
Download citation file:
Published: Ann Intern Med. 2019;171(4):304-305.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use