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Neuroradiology Case of the Week

Case 277

Ashwani K. Sharma, MD, and P-L Westesson, MD, PhD, DDS

Clinical Presentation: A 18-year-old male presented with accidental bird shots injury.

Imaging Findings: Multiple small radiopaque shadows. Findings on plain radiographs are especially striking when compared to CT. MRI is contraindicated. Especially important in imaging is detection of hematoma and vascular injury.

Diagnosis: Bird shots injury

Discussion: Air guns are weapons that masquerade as toys. A report from the US Consumer Product Safety Commission in 1985 stated that children sustained 70,000 air gun injuries from 1981 to 1984 [1]. More recent figures are lacking, prompting the Centers for Disease Control and Prevention and the US Consumer Products Safety Commission to collect contemporary data on pellet gun injuries from 91 representative sentinel emergency departments [2]. Air gun injuries were described in 1975 by Reilly et al. [3] as a "talk and die" injury because many people, both in the general public and in the health care setting, thought that nobody ever dies or is seriously disabled from a BB gun wound.
     Modern air rifles are very powerful and potentially dangerous, yet they are sold without a license because they are considered toys. A  case series reported on 16 patients who were shot with air rifles [4]. The BB (ball bearing) penetrated the aorta of two patients, one of whom died. Particularly alarming to us is the fact that nine patients had been shot intentionally after minor arguments with other children. The assailants were neighborhood children in seven cases, a friend in five, and a sibling in two.

References:

1. Beale S. Non-powder guns - projectiles. US Government Memorandum US Consumer Safety Product Commission, Washington, DC (May 9, 1985).
2. Friedman D, Hammond J, Cardone J, Sutyak J. The air gun: toy or weapon? South Med J. 1996 May;89(5):475-8. [Medline]
3. Reilly PL, Graham DI, Adams JH, Jennett B. Patients with head injury who talk and die. Lancet. 1975 Aug 30;2(7931):375-7. [Medline]
4. Radhakrishnan J, Fernandez L, Geissler G. Air rifles--lethal weapons. J Pediatr Surg. 1996 Oct;31(10):1407-8. [Medline]