MedPix Medical Image Database COW - Case of the Week Case Contributor: James G. Smirniotopoulos, M.D. Affiliation: Uniformed Services University

MedPix No: 14423 - History Pt Demographics: Age = 34 y.o. Gender = man A combat gunshot wound in the distal left thigh injuring the distal femoral artery and vein. Hemorrhage control was obtained at the point of injury using a CAT tourniquet and topical hemostatic agents. Downloaded by (-1)

MedPix No: 14423 - EXAM & LABS Active bleeding open wound, distal left thigh near knee.

Penetrating GSW, Admission to Triage This patient had active bleeding on the scene, both arterial and venous, from a penetrating injur. Tourniquets are in place. Downloaded by (-1)

Vascular Trauma - Gunshot Wound - superficial femoral artery and vein. Javid shunts were placed in both injured vessels at a forward Level II echelon facility and secured by silk ties before evacuation to the Air Force Theater Hospital. Both the arterial and venous shunts were patent upon arrival. Downloaded by (-1)

Vascular Trauma - Gunshot Wound - superficial femoral artery and vein. Javid shunts were placed in both injured vessels at a forward Level II echelon facility and secured by silk ties before evacuation to the Air Force Theater Hospital. Both the arterial and venous shunts were patent upon arrival. Downloaded by (-1)

Vascular Trauma - Gunshot Wound Exposure of penetrating GSW vascular injury. The temporary Javid shunts are shown in place. You can see the floor of the surgical suite (green) just below the vessels. This was a perforating injury. Downloaded by (-1)

FINDINGS Serial images demonstrate:1) admission (tourniquets) and dressing2) exploration of wound3) temporary plastic shunts in place for transfer to next level of care

DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Penetrating vascular injury, arterial and venous

Diagnosis: Gunshot wound, Traumatic Vascular Injury Dx Confirmed by: Surgery

DISCUSSION