THORACO-

ABDOMINAL
INUJURIES
INJURIES TO
CHEST
Forensic Anatomy:
1. Spleen, most of liver & stomach lie
beneath
costal margin, so vulnerable to both
stabbing &
blunt injuries.
2. Penetrating injuries can involve
peritoneal cavity
as well as pleural cavity by perforating
diaphragm.
3. Heart is vulnerable to stabs.
4. Heart lies flat than vertical.
Injuries to Chest Wall :
- Rigid chest wall necessary for respiration.
- Fracture of ribs can affect respiration if,
1. Multiple rib fractures
2. Broken ends penetrating pleura & lungs
- Flail Chest: Multiple fractures of ribs associated

with sternum fracture.

- Paradoxical respiration: Flail part is sucked
in
during inspiration.
- Common in RTA
- Ribs are commonly fractured along anterior and
posterior axillary lines.
- Attempts at resuscitation Can
cause rib
fractures.
- Child abuse: Rib fractures are very
much
common, important diagnostic
sign.
Hemorrhage and Infection
in the Chest:
- Blunt as well as penetrating injuries can
cause rupture of large vessels as well as
intercostal & mammary vessels in chest.
- Several liters of blood accumulate in
chest without external hemorrhage.
- Gunshot injuries also cause
hemothorax.
Pneumothorax: 3 types
1. Simple: Leak in pleura air enters in
pleural cavity Communication closes.

2. Valve like: Air can enter in pleural cavity

with each inspiration, but can not

escape
Tension pneumothorax.

3. Direct communication with exterior.

Injuries to Lungs:
A) Contusion:
- Can be coup or contrecoup.
- Decceleration Injuries RTA or fall.
- Along posterolateral surfaces.
- Outline of ribs may be imprinted.
- Pincer Contusions: Lower margins
of lungs
trapped in narrow costo-phrenic
angles.
Injuries to Lungs:
B) Laceration:
- Occur in blunt injuries.
- Lobes or parts of lobes may be
detached.
- Hilum may tear.
C) Penetrating: Stabbing by Knife.
D) Blast Injury:
Injuries to the Heart:
- Vulnerable to both penetrating & blunt injuries.
A) Penetrating Injuries: Most of the stab
wounds
enter through intercostal space or ribs, rarely
through diaphragm.
- Shallow stab Only myocardium is injured or
superficial cut is there.
- Most common part injured is right ventricle.
- Right ventricle injuries are dangerous than left
ventricle injuries.
- Leakage from heart leads to cardiac
tamponade.
Injuries to the Heart:
B) Blunt Injuries: traffic accidents,
fall from height.
- Most commonly front portion of
heart is
injured, but posterior bruising can
occur if
the heart is compressed against
the thoracic
spine.
Hemopericardum & Cardiac
Tamponade:
Hemopericardium:
Source: Heart or great vessels.

- If blood escapes to exterior or

pleural
cavities, death may occur due to
blood loss.

-But if blood accumulates, it can

lead to
Cardiac Tamponade:
- Blood accumulates faster than it
can escape pressure in pericardial
sac increases
prevent passive filling of atria
during
diastole.

- 400-500 ml of blood is sufficient to

cause death.
Injuries to great vessels:
- Most common is aorta.
- Deceleration trauma Pendulum effect
Transection of
aorta.
- Common site is 1.5cm distal to the
attachment of
ligamentum arteriosum.
- Ladder tears- multiple intimal tears
near the main
transection.
- Pulmonary artery is less vulnerable.
ABDOMINAL
INJURIES
Important Points:
1. Intestines occupy large frontal area
commonly
perforated.
2. Due to overlapping nature, injuries to
intestine
are multiple.
3. Stomach as partially protected by rib
cage, not
commonly injured.
4. Liver & spleen are common causes of
hemoperitoneum.
5. Abdominal wall is commonly injured.
Intestine:
- Crushed against prominent lumbar
vertebrae.
- Duodenum & jejunum are
particularly
vulnerable.
- Mesentry- Damage to local arteries

infarction of the
bowel.
- Colon is rarely injured.
Spleen:
- Rupture of spleen is common
especially
enlarged due to malaria, glandular
fever etc.

- Can be injured either from impact

on its surface or from traction from
pedicle.
Liver:
- Common injury in road traffic
accidents.
- Also injured in external cardiac
massage.
Kidney:
- Being deeply situated at the back
of the
abdomen, rarely injured.
- Kicking injury, when victim is lying
on the
ground can cause kidney injury.
Injuries to pelvic organs:
- RTA runover accidents.
- Side impact injure superior
ramus &
dislocate sacroiliac
joint.
- Fall from height dislocate hips.
- Bladder: Injured commonly, if full.
- Penis & Scrotum Commonly injure
in
fights.