Diagnostic Imaging in pediatric thoracic trauma

Abstract

Thoracic trauma accounts for approximately 14% of blunt force traumatic deaths, second only to head injuries. Chest trauma can be blunt (90% of cases) or penetrating. In young patients, between 60 and 80% of chest injuries result from blunt trauma, with over half as a consequence of impact with motor vehicles, whereas in adolescents and adults, penetrating trauma has a statistically more prominent role. Pulmonary contusions and rib fractures are the most frequent injuries occurring. Chest X-ray is the first imaging modality of choice to identify patients presenting with life-threatening conditions (i.e., tension pneumothorax, huge hemothorax, and mediastinal hematoma) and those who require a CT examination. Multi-Slice Computed Tomography is the gold standard to evaluate chest injuries. In fact, the high spatial resolution, along with multiplanar reformation and three-dimensional (3D) reconstructions, makes MDCT the ideal imaging method to recognize several chest injuries such as rib fractures, pneumothorax, hemothorax, lung contusions and lacerations, diaphragmatic rupture, and aortic injuries. Nevertheless, when imaging a young patient, one should always keep into account the ALARA concept, to balance an appropriate and low-dose technique with imaging quality and to reduce the amount of ionizing radiation exposure. According to this concept, in the recent years, the current trends in pediatric imaging support the rising use of alternative imaging modalities, such as US and MRI, to decrease radiation exposure and to answer specific clinical questions and during the observation period also. As an example, ultrasound is the first technique of choice for the diagnosis and treatment of pleural and pericardial effusion; its emerging indications include the evaluation of pneumothoraces, costocondral and rib fractures, and even pulmonary contusions.

Possible Role of Thoracic Ultrasound in the Diagnostic Pathway of Infant Abuse in the Pediatric Emergency Department

“…Other studies have reported that ultrasound is more sensitive than radiography to detect rib fractures 16–18 . Similar results were also found with the use of ultrasound in pediatric traumatic injuries, 19–22 although no cases of abuse were considered in those studies.…”

The role of Lung Ultrasound in the diagnosis of SARS-COV-2 disease in pregnant women

“…In line with our findings, we strongly recommend the use of LUS in pregnant women affected by SARS-COV-2 disease, in order to carry out a therapeutic and patient-tailored approach, as well as overall management, based on LUS. Moreover, it can also be performed in the follow-up of the treatment response in symptomatic patients( 27 , 28 ).…”

Recommendations for Operation, Measurement, Reporting and Application of Pediatric Lung Ultrasound: Chinese Experts Consensus

“…Pediatric lung injury is most commonly from blunt trauma, which usually resulting in hemothorax, pneumothorax, lung contusion, lung laceration, pericardial effusion, and rupture of the heart [42]. Lung contusion can lead to potential ARDS.…”