Radiology’s role in treating combat wounds cannot be overlooked, as the care provided can save the patient’s life.
Memorial Day recognizes the U.S. military personnel who have made the ultimate sacrifice for their country. In honor of those who have served, the ACR Veterans Affairs and Military Radiology Committees would like to present an anonymized story highlighting a unique radiologic journey in combat trauma.
The convoy inched its way across the dusty plains of Afghanistan. Inside the Mine Resistant Ambush Protected (MRAP) vehicle, Staff Sergeant (SSG) Mike Reynolds (name changed to protect anonymity) sat strapped in his five-point harness. A Civil Affairs team member, SSG Reynolds was on his way to meet with a group of village elders.
Suddenly, the blast from an improvised explosive device erupted beneath them. A pure vertical force shot upward through boots, pelvis and spine in a textbook under-body blast. For the soldiers inside the MRAP, it was the moment that their lives changed forever.
From the point of injury, SSG Reynolds was evacuated to the Role III forward hospital (in-theater field hospital). Initial radiographs demonstrated shattered calcanei, an unstable pelvis and multiple vertebral fractures. Axial compression had driven force from heel to skull, shattering bone and propelling fragments toward the spinal canal. When the Army radiologist identified a retropulsed fragment, the question was not whether the bones were broken but whether the cord was damaged.
A strategic medevac carried SSG Reynolds to the NATO Role IV medical center (advanced tertiary care medical center outside the combat zone) at Landstuhl, Germany, where dedicated CT and MRI exams detailed a roadmap of the various traumatic findings: a “combat burst fracture” of L3 with posterior wall retropulsion, bilateral superior and inferior pubic rami fractures with sacral impaction, bilateral type IV intra-articular calcaneal fractures and, most significant, focal contusion of the spinal cord with edema. Thankfully the cord was bruised rather than transected, but the hematoma and edema could still be disastrous.
With the burst fragment threatening canal compromise, decompression and stabilization were planned. Intraoperative fluoroscopy and postoperative CT confirmed reduction and hardware placement. Meanwhile, the calcaneal and pelvic injuries had been staged: temporary external fixation in theater gave way to definitive fixation later in the Role V system (medical centers in the DOD or VA system specializing in long-term recovery). Each image — preoperative, intraoperative, postoperative — was a chapter in a story of damage control evolving into reconstruction.
The brain MRI performed at Landstuhl was a quiet counterpoint. While SSG Reynolds had been spared CT-evident acute intracranial findings, there was more subtle evidence of diffuse axonal injury. Microhemorrhage and periventricular signal changes were documented and monitored, a reminder that blast exposure carries cognitive and neuropsychiatric consequences that may not declare themselves immediately.
Several weeks later, critical care air transport flew SSG Reynolds to a Role V medical center in the U.S. There, radiology continued its custodial role: serial radiographs and CTs assessed fracture healing, interval ultrasounds excluded deep venous thrombosis and MRI tracked evolving spinal cord edema and sequelae of traumatic brain injury. Meanwhile, there were small clinical victories: a transferred patient sitting upright for the first time, regained sensation in a dermatome, the slow reclamation of independence. Radiology’s role shifted from acute triage to chronic stewardship, documenting healing and guiding interventions.
Months later, SSG Reynolds was transferred to a regional Veterans Affairs (VA) polytrauma center for long-term rehabilitation. Review of the imaging archive by the VA radiologist with the polytrauma team told the complete story. Radiology had been both witness and guide, to diagnose and quantify injury, guide surgical interventions and monitor recovery.
Under-body blast produces a characteristic constellation of injuries, such as calcaneal crush, pelvic disruption, lumbar burst fracture and potential neural compromise, but each patient’s course is singular. For SSG Reynolds, the images were more than diagnostic tools — they were milestones on a path from the battlefield to home. They were a testament to the true measure of success: the patient’s regained function and return to his life and family. In modern combat medicine, radiology does not merely observe injury — it helps to rewrite the ending.
Disclaimer: The opinions and assertions expressed herein are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of War or the Department of Veterans Affairs.
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