Multidetector CT of Blunt Thoracic Trauma

Published Online:https://doi.org/10.1148/rg.286085510

Thoracic injuries are significant causes of morbidity and mortality in trauma patients. These injuries account for approximately 25% of trauma-related deaths in the United States, second only to head injuries. Radiologic imaging plays an important role in the diagnosis and management of blunt chest trauma. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician.

© RSNA, 2008

References

  • 1 The American College of Surgeons Committee on Trauma Leadership. In: Clark DE, Fantus RJ, eds. National Trauma Data Bank (NTDB) Annual Report 2007. Chicago, Ill: American College of Surgeons, 2007; 1–64. Google Scholar
  • 2 GaillardM, Hervé C, Mandin L, Raynaud P. Mortality prognostic factors in chest injury. J Trauma1990; 30: 93–96. Crossref, MedlineGoogle Scholar
  • 3 Report on injuries in America: all unintentional injuries, 2005. Available at: http://www.nsc.org/library/report_table_1.htm. Accessed December 9, 2007. Google Scholar
  • 4 ExadaktylosAK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal” chest radiograph? J Trauma2001; 51: 1173–1176. Crossref, MedlineGoogle Scholar
  • 5 OmertL, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg2001; 67: 660–664. MedlineGoogle Scholar
  • 6 LivingstonDH, Haurer CJ. Trauma to the chest wall and lung. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004; 507–537. Google Scholar
  • 7 DowningSW, Sperling J, Mirvis SE, et al. Experience with spiral CT scanning as the sole diagnostic method for traumatic aortic rupture. Ann Thorac Surg2001; 72: 495–501. Crossref, MedlineGoogle Scholar
  • 8 MayberryJC. Imaging in thoracic trauma: the trauma surgeon’s perspective. J Thorac Imaging2000; 15: 76–86. Crossref, MedlineGoogle Scholar
  • 9 MillerLA. Chest wall, lung, and pleural space trauma. Radiol Clin North Am2006; 44: 213–224. Crossref, MedlineGoogle Scholar
  • 10 De MoyaMA, Seaver C, Spaniolas K, et al. Occult pneumothorax in trauma patients: development of an objective scoring system. J Trauma2007; 63: 13–17. Crossref, MedlineGoogle Scholar
  • 11 WagnerRB, Crawford WO Jr, Schimpf PP. Classification of parenchymal injuries of the lung. Radiology1988; 167: 77–82. LinkGoogle Scholar
  • 12 CohnSM. Pulmonary contusion: review of the clinical entity. J Trauma1997; 42: 973–979. Crossref, MedlineGoogle Scholar
  • 13 WanekS, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin2004; 20: 71–81. Crossref, MedlineGoogle Scholar
  • 14 RileyRD, Miller PR, Meredith JW. Injury to the esophagus, trachea and bronchus. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004; 539–552. Google Scholar
  • 15 EuathrongchitJ, Thoongsuwan N, Stern EJ. Non-vascular mediastinal trauma. Radiol Clin North Am2006; 44: 251–258. Crossref, MedlineGoogle Scholar
  • 16 ChenJD, Shanmuganathan K, Mirvis SE, Killeen KL, Dutton RP. Using CT to diagnose tracheal rupture. AJR Am J Roentgenol2001; 176: 1273–1280. Crossref, MedlineGoogle Scholar
  • 17 ScaglioneM, Romano S, Pinto A, Sparano A, Scialpi M, Rotondo A. Acute tracheobronchial injuries: impact of imaging on diagnosis and management implications. Eur J Radiol2006; 59: 336–343. Crossref, MedlineGoogle Scholar
  • 18 MacklinCC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications. Arch Intern Med1939; 64: 913–926. CrossrefGoogle Scholar
  • 19 WintermarkM, Schnyder P. The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest2001; 120: 543–547. Crossref, MedlineGoogle Scholar
  • 20 StraussDC, Tandon R, Mason RC. Distal thoracic oesophageal perforation secondary to blunt trauma: case report. World J Emerg Surg2007; 2: 8. Crossref, MedlineGoogle Scholar
  • 21 MartelG, Al-Sabti H, Mulder DS, Sirois C, Evans DC. Acute tracheoesophageal burst injury after blunt chest trauma: case report and review of the literature. J Trauma2007; 62: 236–242. Crossref, MedlineGoogle Scholar
  • 22 PasqualeM, Timothy F. Practice management guidelines for trauma from the Eastern Association for the Surgery of Trauma. J Trauma1998; 44: 941– 956. Crossref, MedlineGoogle Scholar
  • 23 FuldaG, Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley RA. Blunt traumatic rupture of the heart and pericardium: a ten-year experience (1979–1989). J Trauma1991; 31: 167–173. Crossref, MedlineGoogle Scholar
  • 24 ParmleyLF, Manion WC, Mattingly TW. Nonpenetrating traumatic injury of the heart. Circulation1958; 18: 371–396. Crossref, MedlineGoogle Scholar
  • 25 ParmleyLF, Mattingly TW, Manion WC, Jahnke EJ Jr. Nonpenetrating traumatic injury of the aorta. Circulation1958; 17: 1086–1101. Crossref, MedlineGoogle Scholar
  • 26 PretreR, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med1997; 336: 626–632. Crossref, MedlineGoogle Scholar
  • 27 BurkhartHM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal blunt aortic injuries: a review of 242 autopsy cases. J Trauma2001; 50: 113–115. Crossref, MedlineGoogle Scholar
  • 28 MirvisSE, Shanmuganathan K. Diagnosis of blunt traumatic aortic injury 2007: still a nemesis. Eur J Radiol2007; 64: 27–40. Crossref, MedlineGoogle Scholar
  • 29 BraatzT, Mirvis SE, Killeen K, Lightman NI. CT diagnosis of internal mammary artery injury caused by blunt trauma. Clin Radiol2001; 56: 120–123. Crossref, MedlineGoogle Scholar
  • 30 MottoxKL, Wall MJ Jr, LeMaire SA. Injury to the thoracic great vessels. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004; 571–591. Google Scholar
  • 31 SlikerCW. Imaging of diaphragmatic injuries. Radiol Clin North Am2006; 44: 199–211. Crossref, MedlineGoogle Scholar
  • 32 MirvisSE, Shanmuganathan K. Imaging hemidiaphragmatic injury. Eur Radiol2007; 17: 1411–1421. Crossref, MedlineGoogle Scholar
  • 33 AsensioJA, Petrone P, Demetriades D. Injury to the diaphragm. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004; 613–635. Google Scholar
  • 34 BerginD, Ennis R, Keogh C, Fenlon HM, Murray JG. The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol2001; 177: 1137–1140. Crossref, MedlineGoogle Scholar
  • 35 LariciAR, Gotway MB, Litt HI, et al. Helical CT with sagittal and coronal reconstructions: accuracy for detection of diaphragmatic injury. AJR Am J Roentgenol2002; 179: 451–457. Crossref, MedlineGoogle Scholar
  • 36 ZieglerDW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma1994; 37: 975–976. Crossref, MedlineGoogle Scholar
  • 37 BarneaY, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg2002; 45: 43–46. MedlineGoogle Scholar
  • 38 AthanassiadiK, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome. Eur J Cardiothorac Surg2004; 26: 373–376. Crossref, MedlineGoogle Scholar
  • 39 CirauloDL, Elliott D, Mitchell KA, Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg1994; 178: 466–470. MedlineGoogle Scholar
  • 40 ButtersKP. Fractures of the scapula. In: Bucholz RW, Heckman JD, Court-Brown C, eds. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2006; 1257–1284. Google Scholar
  • 41 WeeningB, Walton C, Cole PA, Alanezi K, Hanson BP, Bhandari M. Lower mortality in patients with scapular fractures. J Trauma2005; 59: 1477–1481. Crossref, MedlineGoogle Scholar
  • 42 LunsjoK, Tadros A, Czechowski J, Abu-Zidan FM. Scapular fractures and associated injuries in blunt trauma: a prospective study [abstr]. J Bone J Surg Br2006; 88(suppl): 141-b. Google Scholar
  • 43 ZlowodzkiM, Bhandari M, Zelle B, Kregor PJ, Cole PA. Treatment of scapular fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma2006; 20: 230–233. Crossref, MedlineGoogle Scholar
  • 44 WeddeTB, Quinlan JF, Khan A, Khan HJ, Cunningham FO, McGrath JP. Fractures of the sternum: the influence of non-invasive cardiac monitoring on management. Arch Orthop Trauma Surg2007; 127: 121–123. Crossref, MedlineGoogle Scholar
  • 45 KnoblochK, Wagner S, Haasper C, et al. Sternal fractures are frequent among polytraumatised patients following high deceleration velocities in a severe vehicle crash. Injury2008; 39: 36–43. Crossref, MedlineGoogle Scholar
  • 46 De WaeleJJ, Calle PA, Blondeel L, Vermassen FE. Blunt cardiac injury in patients with isolated sternal fractures: the importance of fracture grading. Eur J Trauma2002; 28: 178–182. CrossrefGoogle Scholar
  • 47 von GarrelT, Ince A, Junge A, Schnabel M, Bahrs C. The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. J Trauma2004; 57: 837–844. Crossref, MedlineGoogle Scholar
  • 48 CopeR. Dislocations of the sternoclavicular joint. Skeletal Radiol1993; 22: 233–238. MedlineGoogle Scholar
  • 49 BuckleyBJ, Hayden SR. Posterior sternoclavicular dislocation. J Emerg Med2008; 34: 331–332. Crossref, MedlineGoogle Scholar
  • 50 KälickeT, Andereya S, Westhoff J, Gekle C, Müller EJ, Muhr G. Anterior sternoclavicular dislocation caused by indirect compression trauma. Eur J Trauma2003; 29: 327–330. CrossrefGoogle Scholar

Article History

Published in print: Oct 2008