Beyond E-FAST: Using POCUS to Suggest the Bullet’s Injury Path of a Thoracoabdominal Gunshot – Case Report

Transmediastinal traumatic injuries challenge trauma surgeons due to their potential to involve thoracic and abdominal cavities, requiring rapid assessment for timely interventions. This case report describes a 27-year-old male with a thoracoabdominal gunshot wound, emphasizing the potential role of ultrasound in emergency settings. The patient presented with diminished left-sided breath sounds and stable hemodynamics. Physical examination revealed an entry wound at the sixth intercostal space. With portable X-ray unavailable, ultrasound detected left hemothorax, pneumothorax, and pneumopericardium. The sonographic findings suggested the bullet’s trajectory and helped further management. CT confirmed findings, with esophagoscopy and thoracoscopy identifying minor esophageal and pericardial injuries. Discharged three days post-injury, the patient highlights ultrasound’s utility in resource-limited settings despite lower sensitivity compared to CT.