Fig. 14

a Axial non-contrast CT face image in a 19-year-old male victim of a shotgun injury to the orbito-facial region. Multiple shotgun pellets are identified in the malar soft tissues, nasal fossae, maxillary sinuses, nasopharynx and masticator space, particularly on the right at this axial level. Fracture fragmentation of the right maxillary sinus, malar and retroantral haematoma and antral haemorrhagic fluid are present. The involvement of the nasal, nasopharyngeal and oral (the latter not shown) airway raises potential for distal migration of pellets (as well as of in-driven tissue fragments) through the upper aerodigestive tract into the lower respiratory tract and gastrointestinal tract. b Plain chest radiograph in the same patient as in 13a performed during trauma survey on admission demonstrates distal migration of a shotgun pellet (blue arrow) into the mid-oesophagus (confirmed on CT chest assessment [not shown]). The patient is intubated. c Axial image of a contrast-enhanced CT thorax of the same patient as in a and b, performed 12 h later also confirms aspiration of a shotgun pellet (blue arrow) associated with distal subsegmental left lower lobe atelectasis (blue arrowhead). There had also been further distal intra-oesophageal migration of the mid-oesophageal shotgun pellet (image not shown)