Images in Clinical Medicine
Backscatter from Lead
N Engl J Med 2004; 351:e17November 4, 2004
- Article
A 65-year-old man underwent routine chest radiography before undergoing cardiac catheterization. The images (Panels A and B) revealed the presence of many little spheres in the posterior thoracic wall. On inquiry, the patient reported that he had been shot accidentally by a colleague while hunting 20 years earlier. At that time, he had been admitted to the hospital for a few days and had recovered uneventfully. The patient had normal liver and kidney function; the serum concentration of free lead was within the normal range (16 μg per deciliter [0.8 μmol per liter]). The hemoglobin level was 14.8 g per deciliter (9.2 mmol per liter), and the mean corpuscular volume was 86 μm3.
The damage caused by a gunshot depends on the location of the wound. If the projectiles do not penetrate internal organs or cause either infection or lead intoxication, they can be left in situ.
Rutger J. Hassink, M.D., Ph.D.
Pieter A. Doevendans, M.D., Ph.D.
University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands
