Computed tomography in the diagnosis of blunt thoracic injury

Marts, Boyd C.; Durham, Rodney M.; Shapiro, Marc J.; Mazuski, John E.; Zuckerman, Darryl A.; Sundaram, Murali; Luchtefeld, William B.

doi:10.1016/s0002-9610(05)80146-1

Cited by 94 publications

(52 citation statements)

References 20 publications

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“…Some studies suggest that the use of thorax CT may lead to a change in therapy of patients and improved outcomes [3,13]. This change ranges from 8 to 70% of the cases in the literature [14,3]. We change the management in 30% of our cases.…”

Section: Discussionmentioning

confidence: 87%

Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

Ergin¹

2011

Ann Clin Anal Med

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Özet AmaçBu çalışmanın amacı künt travmalı stabil hastalarda bilgisayarlı toraks tomografisinin klinik ve adli önemini araştırmaktı. Gereç ve YöntemlerTravma sonrası 24 saat içinde akciğer grafisi ve bilgisayarlı toraks tomografisi çekilen künt toraks travmalı 50 hasta retrospektif olarak incelendi. Hastaların dağılımı, torasik lezyonlar, tedavi yöntemleri ve adli sorunları incelendi. Bulgular Çalışmamızda, en sık tespit edilen lezyon kot fraktürü idi. Bilgisayarlı göğüs tomografisi torasik lezyonların tespitinde düz akciğer grafisine göre üstün bulundu. Altmışsekiz (%33) okült lezyon saptandı. Bu lezyonların 46 (%18)'sı düz akciğer grafileri ile saptanamayan hayatı tehdit edici lezyonlardı. Yandaş yaralanma 33 (66%) hastada vardı. Pelvis ve ekstremite kırıkları en sık olanlardı.Göğüs bilgisayarlı tomografisi pnömotoraks, hemotoraks ve akciğer kontüzyo-nunun tespitinde akciğer grafisine üstün bulundu. Seksenbir hayatı tehdit edici lezyon saptandı ve bu lezyonların 50'si (%61: pnömotoraks 13, hemotoraks 24, akciğer kontüzyonu 9 ve pnömomediastinum 4) düz akciğer grafileri ile tespit edilememişti. Klinik tedavi uygulaması 15 (%30) hastada ve adli yaklaşım 14 (%28) hastada değişti. Sonuç Göğüs bilgisayarlı tomografilerinin torasik travmalarda tedavi ve adli konularda titiz bir inceleme imkanı sağladığını düşünmekteyiz. Anahtar KelimelerTravma, Yaralanma, Göğüs, Bilgisayarlı Tomografi, Göğüs Radyolojisi, Adli. Abstract AimThe aim of this study was to investigate the medical and forensic importance of thorax computed tomography in stable patients with blunt chest trauma. Material and MethodsFifty patients with blunt chest injury were retrospectively evaluated with chest radiography and thorax computed tomography in the first 24 hours after trauma. Patient demographics, thoracic lesions, management options, and forensic assessment were rewieved. ResultsThe most common lesion of the study was rib fracture. Thorax computed tomography was significantly superior to chest radiography in detecting thoracic lesions. Sixty eight (33%) occult lesions were detected. Forty six (18%) of these were life threatening that not detected with plain chest radiography. Associated injuries were present in 33 (66%) patients. Pelvic and extremity fractures were the most common injury. Thorax computed tomography was significantly superior to chest radiography in detecting pneumothorax , hemothorax and lung contusion. Eightyone life threatening lesions were detected and 50 (61%; pneumothorax 13, hemothorax 24, lung contusion 9, and pneumomediastinum 4) of these lesions could not be detected with plain chest radiography. The clinical management [in 15 patients (30%)], and the forensic assesment was changed [in 14 (28%)] patients were changed. ConclusionWe concluded that using Computed Tomography of the thorax in thoracic travmas prive meticulous assesment in management of patients and forensic issues.

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Section: Discussionmentioning

confidence: 87%

Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

Ergin¹

2011

Ann Clin Anal Med

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“…On the contrary, others [6,12,13] suggested that TCT should be withheld in the initial management of patients. The low sensitivity of CXR suggests that CXRnegative patients should undergo further investigations if they are highly suspected.…”

Section: Discussionmentioning

confidence: 99%

Chest X-rays in detecting injuries caused by blunt trauma

Ağladıoğlu¹,

Serinken²,

Dal³

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarifi ed at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. RESULTS:Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures ] but the lowest in pneuomediastinum ]. The specifi city of CXR was close to 100% in detecting a wide array of entities.CONCLUSION: CXR remains to be the fi rst choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if signifi cant injury has not been ruled out.

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“…Na literatura o acidente automobilísti-co é a causa mais comum de trauma torá-cico, variando entre 70% e 85% do total de casos (6,9) . Na nossa casuística as lesões por arma de fogo predominaram com quatro casos, representando cerca de 36,4%, seguidas pelo atropelamento, presente em três casos (27,2%).…”

Section: Discussionunclassified

Lesões traumáticas do mediastino: aspectos na tomografia computadorizada

2003

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As lesões traumáticas mediastinais constituem achados pouco freqüentes no trauma torácico, mas são de extrema importância, por representarem mau prognóstico, dada a sua gravidade e lesões associadas. O trauma mediastinal é cada vez mais diagnosticado pela tomografia computadorizada, em especial pelo rápido tempo de aquisição decorrente da técnica helicoidal, que permite a avaliação de pacientes em estado grave, possibilitando a adoção de conduta terapêutica eficiente. Os autores estudaram 11 pacientes com trauma torácico submetidos a tomografia computadorizada, os quais apresentaram lesões mediastinais. A hemorragia mediastinal representou a lesão mais comum nesta casuística, manifestando-se sob a forma de infiltração da gordura mediastinal, com a presença de material denso permeando os espaços mediastinais, ou sob a forma de hematoma. O hemopericárdio representou a segunda lesão mais comum, caracterizado por material denso ou líquido no interior do pericárdio. As lesões aórticas foram observadas em três casos, caracterizadas por irregularidade parietal no contorno aórtico ou por pseudo-aneurisma. Neste trabalho o trauma torácico fechado foi observado em seis casos, enquanto o trauma aberto ocorreu em cinco pacientes. As causas de trauma fechado foram atropelamento, colisão automobilística e queda de altura. A forma penetrante de traumatismo torácico decorreu de dois modos de agressão: lesão por arma de fogo e lesão por arma branca Unitermos: Hemorragia mediastinal; Lesão da aorta; Tomografia computadorizada. Traumatic mediastinal lesions: computed tomography findings.Traumatic mediastinal lesions are unusual findings in patients with thoracic trauma but may represent poor prognosis and be associated with severe lesions. Mediastinal trauma is increasingly being diagnosed by computed tomography due to the fast acquisition times of helical techniques, allowing the evaluation of critically ill patients and the adoption of efficient therapeutic measures. The authors studied 11 patients with mediastinal lesions who were submitted to computed tomography due to thoracic trauma. The most frequent finding was mediastinal bleeding characterized by infiltration of mediastinal fat, dense material within the mediastinal spaces or hematoma. Hemopericardium was the second most common lesion in this series, appearing as dense or liquid material in the pericardium. Aortic lesions such as wall irregularities or pseudoaneurisms were less commonly seen (three patients). In this study blunt thoracic traumas were observed in six cases whereas penetrating trauma occurred in five cases. The causes of blunt trauma were pedestrians struck by car, motor vehicle accidents and falls. Penetrating trauma was due to lesions produced by bullets or knifes.

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Computed tomography in the diagnosis of blunt thoracic injury

Cited by 94 publications

References 20 publications

Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

Chest X-rays in detecting injuries caused by blunt trauma

Lesões traumáticas do mediastino: aspectos na tomografia computadorizada

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