Patterns of thoracic injury in bomb blast victims: A retrospective radiological review

Introduction: Bombings, accounting for approximately 50% of global terrorist incidents, frequently cause high-morbidity thoracic trauma, including blast lung injury. This retrospective radiological review characterizes injury patterns in bomb blast victims to guide mass casualty response and improve patient outcomes. Methods: This retrospective observational review, conducted at Aga Khan University Hospital (January 2004–October 2024), included 130 patients with bomb blast injuries. Demographics, injury mechanisms, and imaging findings were categorized by blast type and summarized using frequencies, percentages, medians, and interquartile ranges. Results: Among 130 victims (94.6% males; median (interquartile range) age, 32 (26.0–43.5) years), initial chest X-ray was performed in 85.4% of cases, detecting foreign bodies (22.8%), emphysema (10.4%), and atelectasis (10.4%). Computed tomography was performed in 28.5% of the patients on the second imaging assessment; however, foreign bodies and atelectasis persisted at 14.4%–15.9% on follow-up. Primary blast injuries predominated (68.4%–78.8%), followed by secondary (15.0%–23.3%), tertiary (0%–4.7%), and quaternary (1.8%–4.4%) injuries; additionally, 48.5% of patients did not undergo a third study. Conclusions: Primary blast injuries predominate, with frequent foreign bodies, emphysema, and atelectasis. Initial chest X-ray facilitates rapid assessment, while computed tomography is reserved for complex cases. Tailored imaging protocols may enhance timely care and outcomes in resource-limited settings.