Radiologic features of injuries from the Boston Marathon bombing at three hospitals

The aim of this study is to describe the radiologic imaging findings of primary, secondary, tertiary, and quaternary blast injuries in patients injured in the Boston Marathon bombing on April 15, 2013.

A total of 43 patients presenting to three acute care hospitals and undergoing radiologic investigation within 7 hours of the time of the bombing on April 15, 2013, were included in this study. The radiographic and CT features of these patients were evaluated for imaging findings consistent with primary, secondary, tertiary, and quaternary blast injury.

There were no pulmonary or gastrointestinal manifestations of the primary blast wave on imaging. Secondary blast injuries identified on imaging included a total of 189 shrapnel fragments identified in 32 of the 43 patients. The shrapnel was identified most often in the soft tissues of the leg (36.5%), thigh (31.2%), and pelvis (13.2%). Imaging identified 125 ball bearings, 10 nails, one screw, 44 metal fragments, and nine other (gravel, glass, etc.) foreign bodies.

Injuries from the Boston Marathon bombing were predominantly from the secondary blast wave and resulted in traumatic injuries predominantly of the lower extremities. The most common shrapnel found on radiologic evaluation was the ball bearing.