CHEST.
Plate 110.
Shrapnel—Plate 110.
CHEST.
Gunshot Wound of the Chest,
with Lodgment of the Missile in the Lung.
The posterior chest wall is next to the plate, as the posterior rib shadows are much more distinct and much smaller than the shadows of the anterior ribs.
The shadow of the ball is blurred, which shows that it moved with respiration and is, therefore, probably in the lung. The shadow is only slightly enlarged and is fairly dense, which indicates it to be not far from the ribs and, therefore, in the posterior portion of the lung.
The treatment of such cases is conservative; infection is not common; hæmothorax pleurisy, empyema, pneumonia, and pulmonary abscess are most frequent complications, named in the order of frequency. Pulmonary abscess is very rare. Pneumonia was seen in a personal case.
Plate 111.
Shrapnel—Plate 111.
CHEST.
Gunshot Wound of Chest, with
Lodgment of the Missile Superficially.
While the missile is not a shrapnel ball, it presents similar conditions and does not need to be separately classified.
The vertebral border of the scapula is distinctly shown in light shadow, indicating its position near the plate.
The outline of the missile is so distinct and the shadow so dense that it must lie near the plate, and is located superficially in the infraspinatus fossa.
Plate 112.
Shrapnel—Plate 112.
CHEST.
Gunshot Wound of the Chest, with Fractured Rib
and Lodgment of the Missile in the Axilla.
The back of the patient lay on the plate, as is indicated by the normal size of the ribs behind and the exaggerated outline in front.
The ball struck the sixth rib behind and caused a fracture at the angle. It then continued its course to the axilla. The normal size of the shadow of the ball indicates that it lies superficially behind the head of the humerus.
The wound of the rib was infected superficially, and the secretion of the wound carried away the most of the metal particles which the ball in striking deposited on impact.
Plate 113.
Shrapnel—Plate 113.
CHEST.
Gunshot Wound of the Chest, with
Lodgment of the Missile in the Axilla.
There is no wound of the bone.
The ball lies in the axilla, behind, not close to, the plate, because the density of the shadow is not very great and the size is slightly enlarged. The distance from the plate is probably that of the mid-axillary line.
The wound is not infected. Pain and impaired movement of the arm suggested localization of the missile and indicate removal in the subsequent course of treatment.
Plate 114.
Shrapnel—Plate 114.
CHEST.
Gunshot Wound of the Chest, with the
Lodgment of the Missile in the Axilla.
The posterior chest wall lay next to the plate.
The almost normal size of the shadow of the ball indicates that it lies near the plate, and the blurred outline shows that it has moved with the chest in respiration. The ball lies, therefore, in the posterior axilla near the middle of the outer border of the scapula, imbedded in the thoracic muscles.
The treatment is expectant. Such wounds are rarely infected. Pain or impairment of function only would indicate removal of the missile from a clean wound.