Urology

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Pain and swelling re-occurs at gunshot wound site
JAAPA, 08/10/09

Spivey JL et al. – The patient is a 17–year–old male who sustained an accidental, small–caliber gunshot wound to his left hand 6 weeks ago. Sudden onset 2 days ago of pain, swelling, and warmth in the palm of the injured hand prompted this visit. The patient said his hand felt “tight and warm” but was only mildly painful. He denied any re–injury to the hand and did not have fever, chills, nausea, vomiting, or malaise. He also denied numbness, motor deficit, or coldness in his fingers. The patient was otherwise healthy and was not taking any medications...The correct diagnosis is a ruptured aneurysm of the ulnar artery. The aneurysm was most likely formed by cavitation and/or blast forces from the gunshot wound. The patient recalled striking the palm of his left hand on a car door the day the swelling began. This blunt force presumably caused the aneurysm to burst, resulting in bleeding into the palmar area with the clot forming a natural tamponade. A wrist block and incision and drainage were performed in the treatment room.

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