Thursday, January 30, 2014

MYSTERY

A twenty-year old man was found supine on Thompson Creak Trail with a bullet wound. The entrance of the wound was on the left lateral side 1 cm above the third rib. The exit wound was 5 cm above the belly button in the umbilical region. While tracing the bullet path you notice at the entrance the bullet travels in the frontal plane with a 45-degree downward angle. On inspection of the right side of the rib cage by x-ray you observe the 8th rib fractured. Fragments of the bullets are then traced to the final exit wound. What is the leading differential diagnosis(and why ) and what are three plausible alternatives and how would you rule them out.

The bullet could have the fourth, fifth, or sixth rib and fracture those ribs, causing the bone to crack into the 8th rib. The bullet then could have changed direction and exited from around the umbilical region. This would explain the fracture of the eight rib while the third rib was the area hit.

Some other plausible alternatives

The bullet could have splintered after contacting the third rib and would have hit the eight rib, as well as the exit area.

The exit area could have been the entrance and the bullet coudl have split when hitting the third rib again.

The bullet could have gone straight through but the patient fell and fractured his/her eighth rib.

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