Imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV)

Abstract

Purpose: To recognize the imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV).

Materials and methods: A retrospective radiological review of 688 patients self-reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 30 patients with 89 thoracic injuries. Imaging and demographic data were collected.

Results: Thirty survivors with 89 injuries to the thorax were identified with a median age of 43.5 years (21-65 years). IPV was reported or disclosed as the direct cause of injury in 50% (15/30) of survivors, including all nine patients who sustained penetrating injuries. The most common injury type was fracture (72%, 64/89) with 52 rib, 3 sternal, 2 clavicular, and 7 vertebral fractures. There were 3 acromioclavicular dislocations. Among rib fractures, right lower anterior rib fractures (9-12 ribs) were the most common(30%, 16/52). There were 10 superficial soft tissue injuries. There were 12 deep tissue injuries which included 2 lung contusions, 2 pneumomediastinum, 7 pneumothoraces, 1 hemothorax. One third of patients had concomitant injuries of other organ systems, most commonly to the head and face, followed by extremities and one third of patients had metachronous injuries.

Conclusion: Acute rib fractures with concomitant injuries to the head, neck, face, and extremities with an unclear mechanism of injury should prompt the radiologist to discuss the possibility of IPV with the ordering physician.

Advances in knowledge: Recognizing common injuries to the thorax will prompt the radiologists to suspect IPV and discuss it with the clinicians.

Keywords: Chest injuries; Domestic abuse; Domestic violence; Fractures; Intimate partner violence; Thoracic injuries.

Fig. 1

Graph depicting distribution of fractures in thorax of survivors of intimate partner violence based on the bones involved

Fig. 2

Axial chest CT images in a 45-year-old woman with IPV with acute on chronic rib fractures. A Mildly displaced fracture of the right anterior seventh rib (white arrow). B Old fracture of the right anterior fourth rib (thin arrow). C Old fracture of the left anterior fifth rib (thin arrow)

Fig. 3

Axial chest images in a 38-year-old woman with IPV with multiple penetrating injuries. A Linear air track in the left anterior chest wall consistent with a penetrating stab injury (black arrow). Also seen in a left apical pneumothorax (thin black arrow). B Emphysema in the left axillary region (black arrow). Also seen is left apical pneumothorax (thin arrow). Focal consolidation in the left lung apex adjacent to the pneumothorax is consistent with lung contusion (white arrow). C Pneumoperitoneum in the abdomen (black arrows)

Fig. 4

Axial chest images in a 43-year-old woman with IPV with multiple penetrating injuries. A Subcutaneous emphysema in the left neck consistent with penetrating injury (black arrow). B, C Right pneumothorax (black arrow). D Focal hemothorax in the right upper anterior pleura (white arrow). Also note active extravasation of contrast