Broken Ribs Research Articles

Investigation on energy, economic, and environmental aspects of double-pass solar air heater.

Numerous research studies have found that a double-pass solar air heater (DPSAH) performs better than a single-pass solar air heater (SAH). This suggested study aims to evaluate the performance of a DPSAH setup in Southern Tamil Nadu, India. Several artificial roughness features have been incorporated into the solar black-coated absorber plate for this examination. Broken ribs with semi-circular and semi-polygonal shapes are used and explicitly tested on the absorber plate. Next, the efficiency of these rib designs is contrasted with a typical flat plate DPSAH. These studies also employ three different mass flow rates (0.01kg/s, 0.02kg/s, and 0.03kg/s), enabling a thorough assessment of the DPSAH system's performance at each rate. These studies' findings demonstrate that adding artificial roughness to the solar collector plate has a beneficial effect on the turbulence of fluid flows. As a result, this innovation increases the double-pass solar air heater's (DPSAH) heat transfer rate. It is noteworthy that compared to the DPSAH with flat plates, both rib designs perform better. It is important to remember that the semi-polygonal ribs function better than the semi-circular ones. The average efficiency values for the semi-polygonal rib structure are 17.1%, 18.7%, and 19.1% greater than those seen for flat plates. These efficiency values are additionally 4.4%, 7.4%, and 8.7% higher than those attained with the semi-circular rib topologies at flow rates of 0.01kg/s, 0.02kg/s, and 0.03kg/s, respectively. The study goes into considerable detail on how particular rib patterns can be advantageous economically and environmentally.

Diagnosis of Rib Fracture and Related Complications in Patients with Blunt Chest Wall Trauma Using Point-of-Care Ultrasound vs. Computed Tomography Scan

Background: One of the most common reasons for the referrals of patients to the trauma center is blunt chest injury. Objectives: To determine and compare the diagnostic value of point-of-care ultrasound (POCUS) and computed tomography (CT) scans in detecting rib fractures and their complications in patients with blunt chest wall trauma. Methods: The current cross-sectional study (October 2017-March 2018) was conducted in Shahid Rajaei Hospital, Shiraz, southern Iran. Convenient non-random sampling was employed. Patients with stable vital signs underwent ultra-sonography and later were evaluated by CT scan for fractures and related complications. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and accuracy were calculated and compared between the two procedures. Results: A total of 113 patients with a mean ± standard deviation (SD) age of 44.07 ± 20.07 years were enrolled, of whom 75 (66.3%) and 62 (54.9%) patients had at least one broken rib based on CT scan and sonography, respectively. The frequency of double fractures was higher than other conditions in both CT scans and ultrasound (35.53% and 37.10%). The overall sensitivity of ultrasound was calculated to be 81.58%, and with an increasing number of broken ribs, the sensitivity of ultrasound also increased (73.08% for identifying patients with one damaged rib versus 100% for detecting patients with five or more broken ribs). None of the 13 definite cases of pneumothorax were detected on ultrasound, while the sensitivity of ultrasound was appropriate for hemothorax and subperiosteal hematoma (85.71% and 80.23%, respectively). Conclusions: Ultrasound offers high sensitivity, specificity, and diagnostic power in diagnosing fractures and their complications, but considering the setting of our study, care should be taken when generalizing the findings of this study.

Condition of surplus dairy calves during marketing: A cross-sectional study

In North America, surplus dairy calves are sold soon after birth and often marketed through a third party (e.g., live auction, livestock dealer) before entering veal or dairy beef production. Previous work has demonstrated that a percentage of calves have failed transfer of passive immunity (FTPI) and clinical signs of disease on arrival at calf-raising facilities, but little is known regarding calf condition during marketing. The objectives of this cross-sectional study were to (1) estimate the prevalence of FTPI and poor health outcomes in surplus calves on arrival at livestock dealers, and (2) investigate the association between calf-level variables (body weight, sex, source) and health outcomes. Two livestock dealers in Ohio were visited 2 to 3 times per week, with approximately 28 calves enrolled in the study per visit for a total of 1,119 calves. One blood sample per calf was obtained to evaluate FTPI by measuring serum total protein concentrations (using a cutoff <5.1 g/dL). Calves were clinically evaluated for signs of arthritis, broken ribs or tail, dehydration, depression, diarrhea, fever, navel inflammation, and respiratory disease by 2 observers; health outcomes were dichotomized using clinically relevant cut points. Descriptive statistics were used to estimate the prevalence of calves with poor health outcomes. Multivariable logistic regression models were built to investigate the effect of body weight, sex, and source on health outcomes. Nineteen percent (206/1,091) of calves had FTPI.

The power of person‐centred clinical education

The power of person‐centred clinical education

Esophageal rupture through extreme sadomasochistic practice

We report the case of a woman in her thirties who suffered an esophageal rupture while participating in extreme sadomasochistic practices. After herself seeking help in a hospital for complaints alleged to be from a fall, she was initially diagnosed with several broken ribs and a pneumothorax. The cause of the pneumothorax was later discovered to be an esophageal rupture. When confronted with this atypical injury for a fall, the woman admitted to have accidentally swallowed an inflatable gag, which her partner had afterwards inflated. In addition to the esophageal rupture, the patient also had numerous other externally visible injuries of various ages, reportedly also from sadomasochistic acts. Although an in-depth police investigation was conducted and a “slave contract” was found, the woman’s consent to the extreme sexual practices performed by her life partner could not be substantiated conclusively. The man was convicted for intentional infliction of serious as well as dangerous bodily injury and sentenced to a long term in prison.

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center

BackgroundThe development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for surgical rib fracture fixation (SRFF) after chest trauma.MethodsWe performed a retrospective observational cohort study describing the patients’ characteristics and analyzing the determinants of postoperative complications.ResultsFrom November 2013 to December 2016, 42 patients were referred to our center for SRFF: 12 patients (29%) had acute respiratory failure, 6 of whom received invasive mechanical ventilation. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9–12], with 7 [5–9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the Thoracic Trauma Severity Score (TTSS) (OR = 1.89; CI 95% 1.12–3.17; p = 0.016) and the Simplified Acute Physiology Score II without age (OR = 1.17; CI 95% 1.02–1.34; p = 0.024) were independently associated with the occurrence of a postoperative complication.ConclusionThe TTSS score appears to be accurate for determining thoracic trauma severity. Short and long-term benefit of Surgical Rib Fracture Fixation should be assessed, particularly in non-mechanically ventilated patients.

DETERMINING THE EFFECTIVENESS OF CARDIOPULMONARY RESUSCITATION USING A MANIKIN

Objectives: Many studies have shown that people applying cardiopulmonary resuscitation (CPR) cannot make sustained and effective CPR due to fatigue, sweaty hands, broken ribs, inability to determine the correct area etc. Thus, this study aimed to determine the effectiveness and sustainability of CPR quality using a CPR manikin by following the 2015 CPR guidelines.Material and Method: This study was carried out with 153 student volunteers from seven different health sciences programmes at Izmir University of Economics. All students were trained in first aid and basic life support in the previous school academic year. The time and effectiveness of CPR applied on a CPR manikin (Ambu® Manikin) were measured. The students’ body positioning, blowing capacities, depth of pressures and effective pressure durations were evaluated and numerical data were analysed by t-test. P-value &amp;lt;0.05 was accepted as statistically significant. Data were analysed using SPSS version 21.Results: Of the 153 student volunteers, 60.1% were female and 39.9% were male. The average student age was 20.32 ± 03 years, the average height was 169.20 ± 26 cm and the average weight was 65.12 ± 42 kg. The average effective CPR duration was 2.95 ± 0.86 min, the average pressure depth was 4.33 cm and the average depth of pressures and effective pressure was 0.6 liters. The position of the arms was correct in 83% of the students. In 81% of the cases, the application site was correctly determined. Moreover, 68.6% of the students were able to sustain the pumping activity of the heart. In all parameters other than the arms position, male students had better results than female students. CPR is a very important live-saving method to increase the chance of survival. However, this practice is ineffective unless applied correctly and timely.Conclusion: This study showed that manual chest compression on the manikin became ineffective in both speed and effectiveness just within minutes. This shows that there is a very important deficiency in this area where human life depends on minutes. Thus, developing and commissioning auxiliary external chest compression device that can perform CPR, especially in pre-hospital setting, ambulance and emergency departments, is important.

"If I Become a Vegetable, Then no": A Thematic Analysis of How Patients and Physicians Refer to Prognosis When Discussing Cardiopulmonary Resuscitation.

Background: Documenting decisions about the relevance cardiopulmonary resuscitation (CPR) is a standard practice at hospital admission yet a complex task. Objective: Our aim was to explore how physicians approach and discuss CPR prognosis with older patients recently admitted to a post-acute care unit. Method: We recorded 43 conversations between physicians and patients about the relevancy of CPR that took place at admission at the geriatric rehabilitation service of a Swiss university hospital. Thematic analysis determined (i) who initiated the talk about CPR prognosis, (ii) at what point in the conversation, and (iii) how prognosis was referred to. Results: Prognosis was mentioned in 65% of the conversations. We categorized the content of references to CPR prognosis in five themes: factors determining the prognosis (general health, age, duration of maneuvers); life (association of CPR with life, survival); proximal adverse outcomes (broken ribs, intensive care); long-term adverse outcomes (loss of autonomy, suffering a stroke, pain, generic, uncertainty); and being a burden. Discussion and conclusion: Discussing CPR is important to all patients, including those for whom it is not recommended. Information about CPR prognosis is essential to empower and support patients in expressing their expectations from life-prolonging interventions and attain shared decision-making.

Andrzej Bobkowski and Józef Czapski

Andrzej Bobkowski and Józef Czapski

Rib abnormalities and their association with focal dark spots in Atlantic salmon fillets

Focal dark spots (DS) represent the most common quality problem in farmed Atlantic salmon (Salmo salar L.). DS are predominantly located in the cranio-ventral region of the fillet, that is characterized by the presence of ribs. The current study explores the possible association between abnormal rib morphology and DS types and the frequency of rib abnormalities in the rib cage by X-ray imaging. The fish used were salmon from a common smolt group that were sampled in freshwater (smolt farm) and subsequently two, five, eight and 14 months after sea transfer to small-scale land-based tanks or commercial sea-cages. Large size wild salmon were used as additive. Rib abnormalities were found in most fish, with a consistent number of four abnormalities per rib cage side of smolts, land-based and wild salmon. After transfer from freshwater to sea-cages, there was an abrupt increase from four to 10 abnormal ribs per rib cage side, mainly explained by low-density and shorter ribs. The number of abnormal ribs stabilized in further samplings at around eight abnormalities per rib cage side. In contrast to wild salmon, abnormalities in farmed salmon were symmetrically concentrated in the center of the rib cage in mid and distal parts of ribs, where also most DS were concentrated. No typical black DS were observed in smolts, salmon farmed in land-based tanks or wild salmon. Two months after transfer to sea-cages, 15% of the salmon had fillet-red DS, while fillet-black DS were observed five months after sea transfer (30%). The prevalence of fillet-red DS oscillated between 15 and 3% during the seawater phase, while fillet-black DS increased until the eighth month after seawater transfer, stabilizing in further samplings at 43–45%. The prevalence of rib abnormalities was 1.6 times higher in fillet-black DS than in control tissue, and 2 times higher for peritoneum DS, principally because of various forms of bent-, and broken ribs. There was an association between rib abnormalities and DS, although additional factors influenced the final DS phenotype. Preventing damaging incidents in the late smolt phase and sea-cage operations can likely reduce the prevalence of abnormal ribs and DS.

Single-Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract.

Background Until recently, a large right ventricle outflow tract interfered with the feasibility of standard transcatheter pulmonary valve replacement (PVR). We are describing our experience using a hybrid approach for PVR using a left anterior thoracotomy approach to allow for plication of the main pulmonary artery followed by a transcatheter PVR using a Sapien S3 valve. Methods and Results This is a single-center, retrospective review of patients who were evaluated to be appropriate for a hybrid PVR approach. The patients' demographics, procedure details, and follow-up data were collected. Between May 2018 and April 2021, a total of 11 patients presented for hybrid transcatheter PVR. The median age and weight were 24 years (interquartile range, 19-43 years) and 81.8 kg (interquartile range, 69-91 kg), respectively. Nine out of 11 patients received a transcatheter PVR after main pulmonary artery plication. There were no procedurally related deaths. One major complication was encountered in which the valve was malpositioned requiring successful surgical PVR. Minor complications included acute kidney injury (n=1) and a broken rib (n=1). The median length of stay was 4 days (interquartile range, 2-4 days), with median follow-up of 7 months (interquartile range, 3-18 months). A well-functioning pulmonary valve was observed in all patients at the last follow-up. Conclusions A hybrid approach using left anterior thoracotomy with pulmonary artery plication followed by transcatheter Sapien S3 PVR provides a less-invasive option for patients with an enlarged right ventricular outflow tract. Preliminary results demonstrated this to be a safe option with good short-term outcomes.

Long term outcomes following rib fracture fixation in patients with major chest trauma

Severe chest injuries are associated with significant morbidity and mortality. Surgical rib fixation has become a more commonplace procedure to improve chest wall mechanics, pain, and function. The aim of this study was to characterise the epidemiology and long-term functional outcomes of chest trauma patients who underwent rib fixation in a major trauma centre (MTC). This was a retrospective review (2014-19) of all adult patients with significant chest injury who had rib fixation surgery following blunt trauma to the chest. The primary outcome was functional recovery after hospital discharge, and secondary outcomes included length of intensive care unit (ICU) and hospital stay, maximum organ support, tracheostomy insertion, ventilator days. 60 patients underwent rib fixation. Patients were mainly male (82%) with median age 52 (range 24-83) years, injury severity score (ISS) of 29 (21-38), 10 (4-19) broken ribs, and flail segment in 90% of patients. Forty-six patients (77%) had a good outcome (GOSE grade 6-8). Patients in the poor outcome group (23%; GOSE 1-5) tended to be older [55 (39-83) years vs. 51 (24-78); p=0.05] and had longer length of hospital stay [42 (19-82) days vs. 24 (7-90); p<0.01]. Injury severity, rate of mechanical ventilation or organ dysfunction did not affect long term outcome. Nineteen patients (32%) were not mechanically ventilated. Rib fixation was associated with good long-term outcomes in severely injured patients. Age was the only predictor of long-term outcome. The results suggest that rib fixation be considered in patients with severe chest injuries and may also benefit those who are not mechanically ventilated but are at risk of deterioration.

Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury

PurposeTo evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures.MethodsRetrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Study cohort includes 243 patients that were treated conservatively and 34 patients that underwent SSRF. Demographic patient data, trauma mechanism, injury pattern, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) and hospital course were analyzed. Two matched pair analyses stratified for ISS (32 pairs) and GCS (25 pairs) were performed.ResultsThe majority of patients was male (74%) and aged 55 ± 20 years. Serial rib fractures were associated with more than 6 broken ribs in average (6.3 ± 3.7). Other thoracic bone injury included sternum (18%), scapula (16%) and clavicula (13%). Visceral injury consisted of pneumothorax (51%), lung contusion (33%) and diaphragmatic rupture (2%). Average ISS was 22 ± 7.3. Overall hospital stay was 15.9 and ICU stay 7.4 days. In hospital, mortality was 13%. SSRF did not improve hospital course or postoperative complications in the complete study cohort. However, patients with a significantly reduced GCS (7.6 ± 5.3 vs 11.22 ± 4.8; p = 0.006) benefitted from SSRF. Matched pair analysis stratified for GCS showed shorter ICU stays (9 vs 15 days; p = 0.005) including shorter respirator time (143 vs 305 h; p = 0.003).ConclusionPatients with serial rib fractures and simultaneous moderate or severe traumatic brain injury benefit from surgical stabilization of rib fractures.

Experimental and Numerical Investigation of Flow and Heat Transfer in Stationary Two-Pass Rectangular Duct (AR = 1:2) With Continuous and Broken V-Shaped Ribs

Abstract The combined experimental and large eddy simulations (LES) were performed in the stationary two-pass duct of aspect ratio (AR) 1:2. The experiments were conducted with three different rib arrangements, namely, 60 deg V, 60 deg V–IV, and broken 60 deg V–IV ribs, and the analysis was carried out with Reynolds numbers of 45,000, 60,000, and 75,000. The infrared thermography (IRT) technique is employed to obtain the local temperature distribution on heated smooth and ribbed surfaces. In all ribbed cases, the copper ribs are glued to the heated surface with a fixed rib height-to-hydraulic diameter (e/Dh) ratio of 0.125 and the rib pitch-to-height ratio (P/e) of 10 and 5 for continuous and broken ribs, respectively. In addition, the LES turbulence model was adopted for carrying out a simulation to understand the flow and heat transfer behavior in ducts populated with all three V-shaped ribs. The comparison of the time-averaged thermal fields generated using computations has been made with experimentally measured Nusselt numbers, friction factors, thermal performance factor (TPF), and Reynolds analogy performance parameter (RAPP) for all cases. The overall thermal performance factor was found to be quantitatively within 8.0–10.66% between experimental and numerical results. Among all the cases, the 60 deg V–IV ribbed duct provides the best TPF and RAPP than the other two ribbed ducts, whereas the smooth duct shows poor TPF.

Can One and the Same Instance of Grief Be Both Normal and Disordered?

Can One and the Same Instance of Grief Be Both Normal and Disordered? Jerome C. Wakefield (bio) Miriam solomon resuscitates a famous proposal of George Engel's (1961) to classify normal grief as a medical disorder. She has two main arguments justifying such a reclassification, one based on Engel's "wound analogy" and another a "Humpty Dumpty"-type argument that 'disorder' is a technical term that we can redefine any way we please. I consider them in turn. The Wound-Analogy Argument Solomon says: "I suggest that we allow a concept of "psychological injury" that is analogous to the concept of physical injury." Of course, we already have a whole chapter of the Diagnostic and Statistical Manual of Mental Disorders (DSM) devoted to psychological injuries in the form of "trauma- and stressor-related disorders" (this is where the new "prolonged grief disorder" category will go). Normal grief has never been among these disorders because it is considered a normal-range emotional response to loss rather than something going wrong with mental functioning. Solomon nevertheless wants to place normal grief under "disorder" to make treatment more accessible. Solomon's first strategy for migrating normal grief into the disorder category is to argue that grief is analogous to the healing of a physical injury, and the healing of a physical injury can be both normal and a disorder. She uses the example of an injured accident victim to argue her case: I would like to suggest that a condition can be both normal and disordered. In this context, "normal" is not the opposite of "disordered." To see how this is possible, consider a case of physical injury, such as a motor vehicle accident that leaves a driver, previously in good health, with several broken ribs. The driver needs medical treatment for both fractures and pain and has a disease/disorder that can easily be stated on health insurance forms. Yet the driver's response to the accident—pain and disability—is entirely normal, given their injury. … [I]t is normal to suffer broken bones in this accident. So, in the context of physical injury, "normal" includes the response of a healthy body to injury. I think there are three ways to interpret Solomon's wound-analogy argument that "a condition can be both normal and disordered." I will argue that all three are fallacious when considered in the medical context. [End Page 341] The first interpretation pivots on the premise that "it is normal to suffer broken bones in this accident" and "the driver's response to the accident—pain and disability—is entirely normal, given their injury." In this interpretation, the fractures that result from the accident and the disability that results from the fractures are clear disorders but are also normal. Given a sufficient amount of force on a bone, it will certainly fracture, and given certain fractures, the individual will certainly be disabled, ergo there are disorders that are normal. This argument is invalid in the medical context because it turns on an equivocation of the term 'normal' between the statistical frequencies given certain preconditions (e.g., "given their injuries") versus functional normality representing the range of outcomes consistent with biological design that are medically normal. Failure of a bone to be capable of performing its biologically designed function after being fractured is not medically normal, even if it is a statistically normal outcome under the circumstances. The equivocation here is a common confusion. For example, in influential articles defending changing the label "dependence" that was used in DSM-IV to refer to addiction (Hasin et al., 2013; O'Brien, Volkow, & Li, 2006), it was argued that it is "normal" when taking certain prescribed drugs to develop physiological dependence. Of course, it is indeed expectable for our brains to adjust in this way, but it is not functionally normal for an individual to require the drugs in question in order to function adequately (Wakefield, 2015b). Normality in the statistical sense is not the same as functional normality, and the functional sense is the one relevant to evaluating disorder versus nondisorder (Wakefield, 1992, 1999a, 1999b). The second interpretation is that "a condition can be both...

Discovery of lung cancer after an injury on holiday

Discovery of lung cancer after an injury on holiday

Skeletal pathologies track body plan evolution in ichthyosaurs

Changing predator-prey interactions during the Mesozoic Marine Revolution (MMR) profoundly altered the trajectory of marine tetrapod evolution. Here, we assess potential signatures of this landmark transition through the fossil record of skeletal pathologies in ichthyosaurs — iconic marine reptiles that developed increasingly ‘fish-like’ body plans over time. We surveyed a stratigraphically constrained sample of 200 Middle Triassic ichthyosaur specimens and compared the type, distribution and prevalence of pathologies with an approximately equivalent assemblage of Early Jurassic age. Overall, skeletal pathologies were equally prevalent in these groups, and most often manifested in species >4 m long. However, pathological bones were found to be concentrated in the hind limbs and tail of Triassic ichthyosaurs, whereas the jaws, forelimbs, and ribcage were preferentially affected in Jurassic taxa. We posit that the occurrence of ankylosed zygapophyses in the caudal peak of Triassic ichthyosaurs could represent a functional by-product of their primitive ‘eel-like’ swimming. Conversely, increased instances of broken ribs in Jurassic ichthyosaurs may infer ramming or tail strike behaviours that characterise morphologically ‘fish-like’ marine tetrapods, such as modern toothed whales. Different categories of skeletal pathologies thus evidently reflect structural modifications in the ichthyosaur body plan, and indirectly coincide with ecological turnover during the MMR.

Heat Transfer in a Rotating, Blade-Shaped Serpentine Cooling Passage With Discrete Ribbed Walls at High Reynolds Numbers

Abstract This paper experimentally investigates the effect of rotation on heat transfer in a typical turbine blade, three-pass, serpentine coolant channel with discrete ribbed walls at high Reynolds numbers. To achieve the high Reynolds number (Re → 190,000) and low rotation number conditions, pressurized Freon R-134a vapor is utilized as the working fluid. Cooling flow in the first passage is radial outward; after the 180 deg tip turn, the flow is radial inward through the second passage; and after the 180 deg hub turn, the flow is radial outward in the third passage. The effects of rotation on the heat transfer coefficients were investigated at rotation numbers as low as 0.07 and Reynolds numbers from 85,000 to 187,000 (based on the first passage geometry and flow conditions). Heat transfer coefficients were measured using thermocouples embedded in copper plates to provide regionally averaged heat transfer coefficients. Heat transfer enhancement due to rotation is observed on the first passage, pressure-side with radially outward flow and the second passage, suction-side with radially inward flow, but a reduction in heat transfer is observed on the third passage pressure-side with radially outward flow. In addition, results from the discrete, broken ribs are compared with those from the same serpentine coolant passage with conventional, angled ribbed walls. A significant increase in the heat transfer due to the discrete ribs is observed in the first passage. These results can be useful for understanding real rotor blade coolant passage heat transfer under high Reynolds number and low rotation number conditions.

Chronic Alcoholism Is Bad for Broken Ribs: A Nationwide Analysis of 20,120 Patients with Rib Fractures

Chronic Alcoholism Is Bad for Broken Ribs: A Nationwide Analysis of 20,120 Patients with Rib Fractures

Three-dimensional reconstruction of computed tomography images showing a bullet and its trajectory in lung parenchyma and broken ribs.

Three-dimensional reconstruction of computed tomography images showing a bullet and its trajectory in lung parenchyma and broken ribs.