PENETRATING TRAUMA

CHEATSHEET
This is a list of all the structures passing by different anatomical lines and
Injuries to structures of heart. These tables can be used to answer common
penetrating trauma or chest tube placement questions on your exam.

NOTE:
• Blunt injuries are diffuse and can injure various structures around the point of
trauma.

• Penetrating trauma can be at different angles and hence injuring different

structures like in cases of gunshot wounds, an entry wound in almost any part of
the body can result in a penetrating abdominal injury, depending on the path the
bullet may have taken through the body. This list is however assuming the injury
is straight through the line.

• As a general rule, any wound located anteriorly between the nipple line (T4) and
the groin creases, and posteriorly between T4 and the curves of the iliac crests
is considered a potential penetrating abdominal injury!

INJURIES TO THE HEART

• The right ventricle forms most of the anterior wall of the heart and extends from
approximately the right border of the sternum to approximately 2 inches to the
left of the sternum at the level of the fourth intercostal space.

• The left atrium forms the posterior wall of the heart. The only portion of the left
atrium seen on the anterior surface of the heart is the left auricular appendage,
which is at the level of the second intercostal space on the left.

• The left ventricle forms most of the left border of the heart and the
diaphragmatic surface of the heart. It forms the anterior wall of the heart in a
region from approximately 2-3 inches from the left border of the sternum from
the third to the fifth intercostal space.

• The right atrium forms the right border of the heart. Its anterior surface is on the
right side of the sternum from approximately the third rib to the sixth rib.

• The left lung is displaced away from the sternum on the left side by the
presence of the heart.

 BY MID CLAVICULAR LINE

RIGHT TRAUMA LEVEL LEFT
Upper lobe of Right lung 1st RIB - 4th RIB
Middle lobe of Right Upper lobe of Left lung
4th RIB - 6th RIB
lung
Lower lobe of Left lung
Lower lobe of Right lung 6th Intercostal space
+ Fundus of stomach
Diaphragm + Liver Diaphragm + Spleen
through parietal pleura 6th RIB - 8th RIB through parietal pleura
of lung of lung
Diaphragm + Splenic
flexure of descending
Diaphragm + Liver 8th RIB - 10th RIB
colon through parietal
pleura of lung.

BY PARAVERTEBRAL LINE
RIGHT TRAUMA LEVEL LEFT
Upper lobe of Right lung 1st RIB - 3rd RIB Upper lobe of Left lung
3rd RIB - 9th RIB Lower lobe of Left lung
Lower lobe of Right lung Lower lobe of Left lung
9th Intercostal space
+ Spleen
Diaphragma + Spleen
Diaphragm through
10th Intercostal space through parietal pleura
parietal pleura of lung
of lung
Diaphragm + Upper Diaphragm + Upper
portion of Right Kidney portion of Left Kidney
11th Intercostal space
through parietal pleura through parietal pleura
of lung of lung
Vertebral level T11 (12th
Right Kidney Left Kidney
ICS) - L3
 BY MID AXILLARY LINE
RIGHT TRAUMA LEVEL LEFT
Lower lobe of Right lung 1st RIB - 3rd RIB Lower lobe of Left lung
Diaphragm + Spleen
Diaphragm through
3rd RIB - 9th RIB through parietal pleura
parietal pleura of lung
of lung

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