22 year old male arrives prone on a stretcher to the ED after being shot in the butt. A CT scan was performed, which shows entry site in the left gluteal cleft, and retained bullet fragment in the left hip subcutaneous tissues. There is a focal hyperdensity along the tract.

On spectral analysis, the focal hyperdensity along the tract is not seen on virtual non-contrast, and shows iodine uptake, and is consistent with active bleeding.

Patient was clinically completely stable, and was discharged after removal of the bullet.

According to Wikipedia, a million-dollar wound "is military slang referring to a type of wound received in combat which is serious enough to get the soldier sent away from the fighting, but is neither fatal nor permanently crippling."

This patient reminded me of Forrest Gump, who got to leave Vietnam and eat tons of ice cream after being shot in the butt; although it is unlikely that this patient acquired this wound in the line of patriotic duty. Also, as far as I know, patient did not get any direct benefit from this wound either.

Conventional CT: Bullet (red arrow) in left hip. Entry (blue arrow) in the left gluteal fold. Notice small hyperdensity along the tract.

Virtual non-contrast: the hyperdensity is not visualized.

Focal iodine uptake (red arrow) on iodine map. This is consistent with active extravasation, this is not a bullet fragment.

40 keV monoE significantly accentuates the active extravasation.

Cases

Million dollar wound