High-velocity missile injuries of the thorax

Nine patients who sustained high-velocity missile injuries to the thorax are reported. Two types of injury were seen: a 'through-and-through' injury (6 patients), and a 'tangential' injury (3 patients). Six patients underwent thoracotomy: 3 had pulmonary resections and 2 had closure of bronchopleural fistulas, while 1 had repair of the diaphragm and liver, which were lacerated, and a pleural toilet. A further patient had a rib resection for empyema at a later stage. All patients had intercostal drains inserted as initial treatment. There were no deaths, and those patients who underwent pulmonary resection recovered fully and rapidly after operation. Extensive pulmonary damage and lobar infarction occurred with 'tangential' high-velocity missile injuries to the thorax.