Presentation
Nail gun vs right groin
Patient Data
CT Abdomen/Pelvis
Findings:
A linear metallic density object penetrates the right thigh at the level of the lesser trochanter, and is directed supero-medially. It runs through the substance of pectineus, and its tip sits in the proximal femoral triangle, between pectineus and iliopsoas. It appears to run just medial to the right femoral vein, though owing to metallic artefact, injury to the femoral vein cannot be excluded on imaging. Subcutaneous soft tissue stranding at the entry site, but no large thigh hematoma is identified.
Conclusion:
Penetrating injury to right thigh. Nail passes in very close proximity to the right femoral vein and may contact the vein, though metallic artefact obscures fine detail in the region. No large thigh or groin hematoma.
Right Groin Ultrasound
Targeted examination was performed to assess the proximity of the penetrating nail to vascular structures.
The nail is seen to pass immediately medial to the femoral vein without breaching its wall. No hematoma is seen. There is normal phasic flow within the femoral vein proximal and distal to the penetrating nail.
Case Discussion
This lucky chap couldn't have fired the nail any closer to his femoral vein without piercing it. Perhaps he's missed his calling as an interventionalist?
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