Contemporary radiological analysis of an historical non-fatal gunshot wound: Importance of the deltopectoral triangle in determining severity of injury

• Contemporary CT techniques can be used to analyze the trajectory of penetrating trauma.
• Plain x-rays may be used with CT data to determine the trajectory of penetrating objects.
• The deltopectoral triangle is a relative “safe haven” in the region of the upper chest.

A family member made an approach to our institution with an oral history of his grandfather’s self-inflicted, non-fatal gunshot wound and 2 clinical x-rays from 1928 asking if the injury could be further investigated. Generic CT data from an individual of similar age and gender was used to reconstruct the bullet path based on the radiographic findings of a marked skin entry site and fracture of the left scapula. Trajectory assessment suggested that the bullet passed through the deltopectoral triangle from superior to inferior missing most vital structures including the axillary artery and vein, emphasizing the importance of the triangle as a relatively “safe haven” for penetrating injury. This case highlights the potential value of CT trajectory analysis even without contemporary CT data. Findings based on this analysis support the attending doctor’s statement at the time that the “bullet was only 1 cm (sic) either way from death”.