The nearly normal size of the shadow of the projectile shows it to be much nearer the posterior than the anterior chest wall. The blurred outline shows it to have moved with respiration. Such conditions locate its position within the thoracic cavity.
The emergency treatment is antiseptic dressing and rest.
The subsequent treatment depends upon pleural involvement or the extremely rare infection of the lung.
These cases are nearly all aseptic, and if the great vessels and nerves of the chest escape injury results are generally favorable.
Gunshot Wound of the Pelvis, with Lodgment of the Missile in the Abdomen.
The course of the bullet was from behind forward, striking the crest of the ilium, on which it was deflected, and spattering off some lead fragments. The slight penetration indicates a velocity of extremely long range and a striking energy lessened by ricochet.
The irregular outline of the shadow of the projectile shows its deformity, and the blurred outline indicates intra-abdominal movement with respiration.
While the missile, as revealed by its shadow, is not a shrapnel ball, the distribution of lead particles is more suggestive of a shrapnel than of a rifle projectile, and the ballistic conditions are more characteristic of the former than of the latter.
There was no abdominal reaction; the invasion of the abdomen was revealed by the radiograph.
The treatment in such cases is noninterference unless subsequent developments furnish definite indications.
Gunshot Wound of the Gluteal Region, with Lodgment of the Bullet Near the Ischium.
Wound of entrance, over gluteal prominence on a transverse line through the great trochanter.
There was no bone injury in this case. The bullet, to have lodged in the soft parts after relatively slight penetration, must have struck the body at extreme range when its energy was almost spent in flight, for its normal outline indicates that it was not retarded by ricochet. The long axis is almost perpendicular to the plate. As the posterior pelvis was next to the plate, the fairly dense shadow shows the projectile was not far from the plate and behind the ischium.
The treatment is conservative; infection in such cases is extremely rare; and only pain or impaired function after many months of convalescence justifies operation for removal of the missile.