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Special Feature
March 2013

Image of the Month—Quiz Case

Author Affiliations


Author Affiliations: Department of Surgical Oncology, John Wayne Cancer Institute at St John's Health Center, Santa Monica, California (Dr Leung); and Division of Trauma Surgery and Critical Care, Virginia Commonwealth University, Richmond (Drs Goldberg and Ivatury).

JAMA Surg. 2013;148(3):295. doi:10.1001/jamasurg.2013.318a

A 21-year-old man presented to the emergency department after gunshot wound to the right shoulder. His only concern was chest pain. He denied any dyspnea. On examination, the patient appeared to have no airway compromise and was hemodynamically stable. Physical examination was remarkable for 2 penetrating wounds, one on his right shoulder and one on his left shoulder. After administration of intravenous contrast, computed tomography (CT) scan of the chest was performed (Figure 1).

Image not available

Figure 1. Computed tomography scan of the chest.

What Is the Diagnosis?

A.  Tracheal injury

B.  Esophageal injury

C.  Aortic injury

D.  Subclavian artery injury