Evaluation of vertebral artery injury from ballistic trauma to the neck

• Published in: Emergency radiology 1997-11, Vol.4 (6), p.346-348
• Main Authors: Bear, Howard M., Zoarski, Gregg H., Rothman, Michael I.
• Format: Article
• Language: English
• Subjects: Medical imaging; Spine; Trauma; Veins & arteries
• ISSN: 1070-3004; 1438-1435
• DOI: 10.1007/BF01451069

This study was conducted to assess the likelihood of vertebral artery injury after gunshot wounds to the neck in patients without and with fracture of the cervical spine. All patients presenting to the emergency department with cervical gunshot wounds were evaluated with cervical spine radiographs; if a fracture was suspected, a computed tomographic scan was obtained. All patients with cervical gunshot wounds underwent selective angiography of the cervical vessels. The images were retrospectively reviewed by three American Board of Radiology boardcertified radiologists, assessing for the presence of fracture and vascular injury. Of the 50 patients presenting with ballistic trauma to the neck, 21 patients had sustained a cervical spine fracture; of these, 9 patients had a vertebral artery injury. Only 1 of the 29 patients without a cervical spine fracture had vascular damage. In that patient, however, the bullet was lodged between the transverse processes of the cervical vertebrae at the level of vascular injury. In the absence of a cervical spine fracture or evidence that the missilés trajectory has crossed the vertebral artery, injury to the vertebral artery is unlikely after a gunshot wound to the neck. A computed tomographic scan of the neck may help in tailoring the angiogram performed after ballistic injury.[PUBLICATION ABSTRACT]