Penetrating chest trauma predominantly occurs after gunshot or stab wounds and the extent of injury can range from mild and local tissue damage to life-threatening bleeding, hemo/pneumothorax, and respiratory failure. Dyspnea, hemoptysis, and shock are some of the most common symptoms. A properly conducted physical examination is sufficient to make the initial diagnosis that is further supported by imaging studies such as ultrasonography and computed tomography (CT).
Chest trauma is more commonly described in clinical practice after blunt force injuries (motor vehicle accidents, falls, sport-related contact, etc.), but in approximately 10% of cases, penetrating chest trauma may be encountered . Gunshot (mainly high-velocity) and stab wounds are the two main causes of such trauma, while impalement and other forms have been observed in some cases   . This type of injury is seen across all ages and males seem to be more frequently affected  . One of the worrisome aspects of penetrating chest trauma is the potential damage to the vascular structures (major blood vessels and the heart), which is why mortality rates are higher compared to blunt chest trauma   . Furthermore, skeletal fractures (of the ribs, and the sternum), direct lung injury (causing pneumothorax, hemothorax, contusion, or damage of the parenchyma), as well as diaphragmatic and esophageal injury can accompany penetrating chest trauma   . The clinical presentation may not always reflect the severity of trauma , and respiratory-related complaints are reported - dyspnea, hypoxemia, and hemoptysis . As both cardiac output and respiratory function might decline rapidly (particularly if the heart is damaged), hemorrhage and cardiorespiratory insufficiency can cause life-threatening shock   . Sepsis is a late, but very important complication .
As early initiation of proper therapy could be life-saving, the importance of a prompt diagnostic workup is of critical importance. Physicians should be able to make the diagnosis after a detailed inspection of the chest, suggesting the pivotal role of a physical examination. The presence of bowel sounds in the thorax and abnormal breathing sounds are important abnormal findings . A thorough patient history must cover the mode of injury, when it occurred, and assess the course and progression of symptoms. Imaging studies, however, are necessary to determine the extent of injury and the status of the surrounding organs and tissues. Plain radiography is described as a good initial method to start the diagnostic workup , but thoracic ultrasonography, because of the ability to use it in the field and more easily in the emergency setting, has emerged as an equally effective, if not superior procedure for the evaluation of penetrating chest trauma  . Digital radiography seems to be highly useful for the assessment of skeletal injuries , but the introduction of computed tomography (CT) has greatly improved the overall quality of diagnostics . Multidetector CT (MDCT) is the gold-standard for identifying the exact status of the organs situated in the thorax and should be employed whenever possible  .