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

Abstract

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.

Occult pneumomediastinum after blunt chest trauma: worrisome finding yet good clinical outcome

“…It is reported that occult pneumomediastinum resolved in average 3 hours after the initial exam [2]. CT exams are more sensitive to detect free mediastinal air than chest X-ray and the expanding use of CT scan for first assessment plays a role not only in diagnosing mediastinal air but also in the management of trauma patients, in particular, those with blunt chest trauma [3,6]. Another feature expected from CT is the ability to detect possible esophageal injuries with high sensitivity.…”

“…Radiologic evaluation is important for the diagnosis and management at this prospect. In this regard, multidetector computed tomography (MDCT) plays a key role in the setting of thoracic blunt trauma [3]. However, its controversial utility and benefits in trauma patients, oral contrast administration in proper patients can aid in diagnosis by narrowing the differentials in terms of esophageal perforation.…”

Indicators of occult pneumothorax in thoracic trauma: a retrospective descriptive study

“…In addition, the accurate, rapid and reliable diagnosis of pneumothorax, and its occult type is the primary issue for trauma management and writing accurate medicolegal reports, because an extremely small pneumothorax may progress, especially when mechanical ventilation and general anesthesia are used, and may reach life-threatening sizes. 3,14,19,20 Therefore, thoracic CT should be employed for the appropriate diagnosis and treatment of OPTX, to more accurately determine this potentially life threatening condition especially among those who have experienced traumatic chest injuries.…”