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Article |

Ultrasonographic Examination of Wound Tracts

William R. Fry, MD; R. Stephen Smith, MD; James J. Schneider, MD; Claude H. Organ Jr, MD
Arch Surg. 1995;130(6):605-608. doi:10.1001/archsurg.1995.01430060043008.
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Objective:  To determine if ultrasonography is useful in evaluating penetrating injuries of the trunk to assess whether violation of the peritoneum or pleura has occurred.

Methods:  The study group was 29 patients who suffered gunshot (n=17), stab (n=10), or shotgun (n=2) wounds. The abdomen was at risk in 21 injuries, the thorax in eight. The results of physical examination and plain x-rays suggested the pleura and or peritoneum might be intact in all patients. Using a 7-MHZ transducer, wound tract(s) were imaged, looking for the presence of soft-tissue air and/or echolucent areas consistent with soft-tissue blood. Injuries were deemed extraperitoneal or extrapleural if (1) the entire tract was visualized; (2) it appeared superficial to the deepest fascial structure in that area; and (3) in shotgun injuries, all visible pellets on x-ray films were identified by ultrasound in the abdominal wall.

Results:  Evidence of penetration occurred in four abdominal wounds and one thoracic wound. These were confirmed by operation in the abdominal cases and by subsequent chest x-ray examination in the one thoracic wound. The diagnosis of nonpenetration was confirmed in all the remainder by serial benign abdominal examination (n=15), chest x-ray examination (n=8), and laparoscopy (n=1). Positive and negative predictive accuracy were thus 100% in this pilot series.

Conclusions:  Ultrasonographic exploration of penetrating truncal injuries is feasible and accurate. Ultrasonographic wound exploration may serve as a noninvasive and safe replacement for diagnostic laparoscopy, conventional local wound exploration, peritoneal lavage, and 6-hour chest x-rays (repeated chest x-rays taken 6 hours after initial chest x-ray examination). If used as part of the initial physical examination, cost-effectiveness can also be realized.(Arch Surg. 1995;130:605-608)


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