Penetrating Chest Trauma

Anatomy

The simplest anatomic classification is based on the likelihood of specific organ injury. Classically, penetrating injuries between the nipple lines anteriorly or the scapula posteriorly have the potential for cardiac or great vessel injury. The ‘‘danger zone’’ has been described as the region between the epigastrium to the sternal notch and laterally within 3 cm of the sternum.^9,15 Injuries below the level of the tip of the scapula posteriorly or the inframammary crease/nipple anteriorly have the potential to traverse the diaphragm, particularly left lower thoracic injuries.¹ As many as 20% of patients with penetrating injuries will have associated abdominal injuries.¹⁴ Unfortunately, particularly with gunshot wounds, any region of the chest may be affected, and these anatomic relationships should only be considered as generalizations.