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Itagaki Y, Sato N, Ohmine R, Ikushima T, Kaneko T, Shirosaki T, Tanaka H, Morimoto H, Fukuda N, Iimura Y, Hirano S. Transabdominal impalement injury by an iron pipe - A case report. Trauma Case Rep 2024; 51:101010. [PMID: 38600911 PMCID: PMC11004714 DOI: 10.1016/j.tcr.2024.101010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Impalement injuries are rare and complex problems, often involving multiple organ injuries. An 18-year-old male was admitted to our emergency department after a car accident. Positioned in the right-side recumbent position, he had a 4.5 cm diameter pipe penetrating from his left abdomen to his back. Given the pipe's length exceeding the CT gantry's capacity, further imaging tests were not feasible. Consequently, the patient proceeded directly to the operating room without preoperative imaging. Before laparotomy, a left thoracotomy was conducted for aortic cross-clamping, anticipating uncontrollable bleeding during pipe removal. The subsequent laparotomy, with the patient in the right-side recumbent position, revealed the pipe impaling through the mesentery of the descending colon without evident major vessel injury. The pipe was cautiously extracted. The patient was subsequently discharged on day 26. The absence of imaging feasibility emphasized that current hemodynamic stability does not rule out the potential for significant vessel injury. Therefore, the sequential approach of left thoracotomy for aortic cross-clamping followed by laparotomy emerges as a potentially beneficial strategy in cases of transabdominal impalement. The impalement injury requires our preparedness and flexibility, which should be tailored to the individual case.
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Affiliation(s)
- Yuki Itagaki
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido 0608638, Japan
| | - Nagato Sato
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
| | - Ritsu Ohmine
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
| | - Takuya Ikushima
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
| | - Tsukasa Kaneko
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido 0608638, Japan
| | - Tomohide Shirosaki
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido 0608638, Japan
| | - Hironori Tanaka
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido 0608638, Japan
| | - Hirofumi Morimoto
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido 0608638, Japan
| | - Naoya Fukuda
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
| | - Yasuaki Iimura
- Department of Surgery, Kushiro City General Hospital, 1-12, Shunko-dai, Kushiro, Hokkaido 085-0822, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido 0608638, Japan
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Philip AJ, Sneha DV, Theckumparampil N, Jagdish S. Successful management of a thoracoabdominal impalement injury. S AFR J SURG 2023; 61:232-233. [PMID: 38450698 DOI: 10.36303/sajs.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
A 63-year-old female presented to the hospital with a history of alleged accidental fall onto a rusted iron rod. She was hypotensive but stable. Cooling of the rod while cutting the protruding part was performed as per basic trauma life support (BTLS) access. Following resuscitation, she was re-evaluated clinically and radiologically, and prepared for surgery. The iron rod trajectory was shown on computed tomography (CT) scan to be entering through the left popliteal fossa, then traversing the abdominal cavity with injury to the descending colon and the left dome of the diaphragm. At laparotomy the iron rod was removed under vision. The laceration to the left dome of the diaphragm was repaired. The perforation of the descending colon was identified and repaired. Colostomy was deferred as there was no peritoneal contamination. The penetrating thigh wound was debrided. Her recovery was uneventful. She was discharged on postoperative day 15. She came for follow-up as out-patient after 3 weeks and the thigh wound had healed. Impalement injuries are rare and often severe. Most impalement injuries require a multidisciplinary approach. Adequate early resuscitation, proper evaluation and early surgical management is ideal. Immediate stabilisation of the foreign body from the time of encounter is essential. Removal under anaesthesia is mandatory.
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Affiliation(s)
- A J Philip
- Department of General Surgery, Pondicherry Institute of Medical Sciences, India
| | - D V Sneha
- Department of General Surgery, Pondicherry Institute of Medical Sciences, India
| | - N Theckumparampil
- Department of Radiology, Pondicherry Institute of Medical Sciences, India
| | - S Jagdish
- Department of General Surgery, Pondicherry Institute of Medical Sciences, India
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Hunduma G, Vilar Alvarez ME, Kukreja R, Veres L, Tamburrini A. An impressive case of isolated thoracic impalement. Trauma Case Rep 2023; 46:100868. [PMID: 37347006 PMCID: PMC10279911 DOI: 10.1016/j.tcr.2023.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
Case A 61-year-old male construction worker was admitted to our Emergency Department due to being impaled in the chest after fall onto the long pole of his cement mixer. He was promptly scanned through the CT then transferred to theatre where unique technique for intubation was utilised prior to performing a Video Assisted Thoracoscopic Surgery exploration and extraction of the foreign object. Discussion Impalement injuries are classified into Types I or II depending on the direction of movement of the human body in relation to the foreign object. There currently is no consensus on the best management of chest wall injuries involving impalements. Our case utilised Video Assisted Thoracoscopic Surgery as the dominant method of intervention together with highly skilled anaesthetic preparation. Conclusion The combined expert anaesthetic and surgical approach utilised collectively had a role in ensuring the best possible outcome for the patient.
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Affiliation(s)
- Gabriel Hunduma
- Wessex Cardiothoracic Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Maria Elena Vilar Alvarez
- Wessex Cardiothoracic Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Roy Kukreja
- Anaesthetic Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lukacs Veres
- Wessex Cardiothoracic Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alessandro Tamburrini
- Wessex Cardiothoracic Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Muacevic A, Adler JR, Azar F, Hus N. A Non-Fatal Impalement Injury to the Right Thorax: A Case Report. Cureus 2023; 15:e33517. [PMID: 36779161 PMCID: PMC9904860 DOI: 10.7759/cureus.33517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
Impalement injuries secondary to motor vehicle collisions are rare. Reviewing the systematic approach to treating these injuries can benefit the surgical community. This case report discusses the presentation and management of a 32-year-old male who was involved in a high-speed, roll-over motor vehicle collision. The car struck a chain-link fence, and the unrestrained passenger sustained a fence post impalement injury to his right thorax. He was alert and oriented when emergency services arrived. He was extricated rapidly and transported to our level-one trauma center, where he received definitive operative management. The patient survived the injury and was discharged home. This case highlights key points in the systematic approach to impalement injuries, including minimal handling of the impaled object, expedient transfer to the local trauma center, emergent operative intervention, vascular control prior to removal of the foreign object, and aggressive irrigation and debridement of the wound.
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Kerketta AH, Kumar R, Sahu S, Laik JK, Rajak MK. Wooden foreign body impalement through the right shoulder region – an unusual penetrating injury: A case report. World J Orthop 2022; 13:1064-1068. [PMID: 36567864 PMCID: PMC9782543 DOI: 10.5312/wjo.v13.i12.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/17/2022] [Accepted: 11/04/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impalement of the body is a rare injury and comes with varied presentation. There is no set classification or defined protocols for managing this injury. This case report aims to create awareness among trauma surgeons about unusual presentation and management of such case.
CASE SUMMARY A 45-year-old man presented to the emergency department with a sharp penetrating wooden plank at right clavicular region between the neck and shoulder following a road traffic accident. The vehicle had crashed into a roadside wooden hut, thus causing an impalement injury. He was meticulously worked up and taken to emergency theatre. The wooden plank was removed and the wound healed uneventfully. Postoperatively, he had fairly good shoulder function and was able to return back to work successfully.
CONCLUSION Each impalement injury brings in challenges in management as no two cases are the same. The varied presentation and risks involved should be known to medical professionals handling the emergency. Coordinated multidisciplinary team approach is needed for successful outcome.
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Affiliation(s)
- Abhay Harsh Kerketta
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| | - Ritesh Kumar
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Jayanta Kumar Laik
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| | - Manoj Kumar Rajak
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
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LN M, Sreekar B, Balachandran G, Varghese B. Thoracoabdominal Impalement Injuries—Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Negash S, Mammo TN. Two lucky survivors of thoracic impalement in childhood: case report and literature review. BMC Surg 2020; 20:134. [PMID: 32539857 PMCID: PMC7296619 DOI: 10.1186/s12893-020-00790-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Penetrating thoracic injuries are uncommon in childhood. Massive penetrating injury due to impalement is even more rare and has scarcely been reported. It has a dramatic clinical presentation and is often fatal, depending on the organs injured. CASE PRESENTATION Two boys presented with an unusual mechanism of injury. They fell from a height to be impaled by a large stick. Appropriate emergency medical service was not available and surgery was delayed by more than 24 h after the accident. Both children were labelled "lucky" as they survived the injury without any significant sequelae. CONCLUSION We discuss two new cases of pediatric thoracic impalement and perform the first literature review on the subject. Emphasis should be given to the initial care which comprises avoiding premature removal, rapid transport, resuscitation, anti-tetanus and antibiotics. All reported cases had a favorable outcome, even those managed within the constraints of low-income countries.
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Affiliation(s)
- Samuel Negash
- Division of pediatric surgery, Department of surgery, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Tihitena Negussie Mammo
- Division of pediatric surgery, Department of surgery, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
A man in his 50s suffered an impalement on a crowbar after falling from the roof of a domestic shed. A helicopter-based prehospital emergency medical service team was called to assist in the patient's care. The crowbar had entered from the left-upper quadrant and was tenting the skin of the right iliac fossa. Analgesia and prehospital sedation were provided to facilitate extrication. A series of improvisations were carried out to support the logistics of transferring the patient using an air ambulance to the regional major trauma centre with the crowbar in situ. The patient was taken to the operating theatre without any imaging and a section of perforated bowel was removed. He made a full recovery and was discharged home 9 days postincident.
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Affiliation(s)
- Saad Jawaid
- Emergency Department, University Hospital of Leicester, Leicester, UK.,Pre-hospital Emergency Medicine, Magpas Air Ambulance, Huntingdon, UK
| | - Dan Cody
- Pre-hospital Emergency Medicine, Magpas Air Ambulance, Huntingdon, UK
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Muhammad Afzal R, Armughan M, Javed MW, Rizvi UA, Naseem S. Thoracic impalement injury: A survivor with large metallic object in-situ. Chin J Traumatol 2018; 21:369-372. [PMID: 30348473 PMCID: PMC6354130 DOI: 10.1016/j.cjtee.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/12/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023] Open
Abstract
Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene. Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae. Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists. Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.
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Affiliation(s)
- Randhawa Muhammad Afzal
- Department of Surgery, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, Pakistan.
| | - Muhammad Armughan
- Department of Surgery, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
| | - Muhammad Waqas Javed
- Department of Surgery, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
| | - Usman Ali Rizvi
- Department of Surgery, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
| | - Sajida Naseem
- Department of Surgery, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
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Abstract
Impalement injuries transfix a victim in an inescapable or helpless position. A study was undertaken at Forensic Science SA from 2002 to 2016 of all impalement deaths. There were six vehicle accidents (M:F=5:1; age 14-67 years, average age 38.5 years) involving impalements with a tree branch ( n=2; groin and chest), a metal pipe ( n=2; leg and head), a metal bridge railing (groin) and a metal fence post (chest). Two cases (both males, aged 47 and 18 years) had slipped on fences/gates, with impalements of the ankle and groin. A case of suicide (male, aged 80 years) was impaled through the head on a bolt fixed to the floor. A homicide case (male, aged 27 years) involved impalement through the chest by a spear from a spear gun. In certain cases (e.g. with anogenital injuries), differentiating accidental from inflicted impalement injuries may be difficult. In equivocal cases, adequate scene evaluations with photographic documentation are required prior to autopsy, ideally with the object available for examination.
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Affiliation(s)
- Roger W Byard
- 1 Forensic Science SA, Australia
- 2 School of Medicine, The University of Adelaide, Australia
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Alani M, Mahmood S, El-Menyar A, Atique S, Al-Thani H, Peralta R. An unusual case of transpelvic impalement injury: A case-report. Int J Surg Case Rep 2017; 41:26-29. [PMID: 29031173 PMCID: PMC5645491 DOI: 10.1016/j.ijscr.2017.08.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Impalement injury is a rare type of mechanical injury following forceful insertion of projecting object into the body. Careful planning for removal of the impaling object is essential to decrease the blood loss and preserve the function of the injured organ. PRESENTATION OF CASE A 27 year-old male fell from 4m height over a U shaped projecting up metallic bar. The bar penetrated the left side of the pelvis and traversed through the left iliac bone causing a comminuted fracture in the supra-acetabular region extending to the left psoas muscle, injuring the viscera and causing fracture of the right femur. Exploratory laparotomy was performed and the metallic bar was pulled out from the sigmoid colon through the inlet of the injury. Intramedullary nailing was performed for femur fracture. The patient developed infection (Methicillin-sensitive Staphylococcus aureus and Escherichia coli) during the post-operative course that was successfully managed with antibiotic therapy. Finally the patient was sent home after a week in a good health condition. DISCUSSION Two surgical teams worked in sequence to fix the injuries starting with the trauma team followed by the orthopedic surgeons. CONCLUSION Impalement injury is a serious injury that needs a multidisciplinary team with a coordinated approach to achieve a favorable outcome.
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Affiliation(s)
- Mushrek Alani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Saeed Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma Section, Hamad General Hospital, Doha, Qatar.
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Fadl SA, Ehlers AP, Wallace G, Gross JA. Core curriculum illustration: abdominal wood impalement injury from motor vehicle collision. Emerg Radiol 2017; 27:111-113. [PMID: 28660527 DOI: 10.1007/s10140-017-1532-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
This is the 42nd installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.erad.org/page/CCIP_TOC.
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Affiliation(s)
| | - Annie P Ehlers
- Department of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Gabriel Wallace
- Department of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, 325, 9th Avenue, Seattle, WA, 98104, USA
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