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CT imaging of blunt chest trauma

Oikonomou A, Prassopoulos P - Insights Imaging (2011)

Bottom Line: METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations).The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted.CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.

Affiliation: Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Thrace Greece.

ABSTRACT

BACKGROUND: Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects. METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted. RESULTS: The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care. CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.

Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)
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Fig22: Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)

Mentions: Rib fractures are the most common injury in blunt chest trauma, occurring in 50% of cases. A single rib fracture is usually not clinically significant, whereas multiple rib fractures indicate severe injury. Fractures of the first three ribs imply high-energy trauma that may be associated with injury of the brachial plexus or subclavian vessels. Fractures of the fourth up to the eighth ribs are the most common, while fractures of the last four ribs are usually associated with intra-abdominal injury. Reconstructed MIP and volume-rendered CT images depict with great detail the number and sites of rib fractures (Fig. 22). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig. 23). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [9].Fig. 22

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CT imaging of blunt chest trauma

Oikonomou A, Prassopoulos P - Insights Imaging (2011)

Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)
© Copyright Policy
Fig22: Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)
Mentions: Rib fractures are the most common injury in blunt chest trauma, occurring in 50% of cases. A single rib fracture is usually not clinically significant, whereas multiple rib fractures indicate severe injury. Fractures of the first three ribs imply high-energy trauma that may be associated with injury of the brachial plexus or subclavian vessels. Fractures of the fourth up to the eighth ribs are the most common, while fractures of the last four ribs are usually associated with intra-abdominal injury. Reconstructed MIP and volume-rendered CT images depict with great detail the number and sites of rib fractures (Fig. 22). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig. 23). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [9].Fig. 22

Bottom Line: METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations).The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted.CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.

Affiliation: Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Thrace Greece.

ABSTRACT

Background: BACKGROUND: Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects. METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted. RESULTS: The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care. CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3259405&rFormat=json&query=null&req=5