This pictorial review discusses multi-detector computed tomography (MDCT) cases of non-vascular traumatic chest injuries, with a brief clinical and epidemiological background of each of the pathology. The purpose of this review is to familiarize the reader with common and rare imaging patterns of chest trauma and substantiate the advantages of MDCT as a screening and comprehensive technique for the evaluation of these patients. Images from a level 1 trauma center were reviewed to illustrate these pathologies. Pulmonary laceration, pulmonary hernia, and their different degrees of severity are illustrated as examples of parenchymal traumatic lesions. Pleural space abnormalities (pneumothorax and hemothorax) and associated complications are shown. Diaphragmatic rupture, fracture of the sternum, sternoclavicular dislocation, fracture of the scapula, rib fracture, and flail chest are shown as manifestations of blunt trauma to the chest wall. Finally, direct and indirect imaging findings of intrathoracic airway rupture and post-traumatic foreign bodies are depicted. The advantage of high quality reconstructions, volume rendered images, and maximal intensity projection for the detection of severe complex traumatic injuries is stressed. The limitations of the initial chest radiography and the benefits of MDCT authenticate this imaging technique as the best modality in the diagnosis of chest trauma.

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The objective of this study is to assess the trends in imaging utilization in adults with diagnosis of appendicitis and the role that imaging plays in the escalating appendicitis hospital charges. Data on demographics, imaging utilization, and charges of all patients discharged after a diagnosis of appendicitis during 6 years (1999-2004) were obtained from the integrated database of a large hospital. The number of discharges from 1999 to 2004 in the institution steadily decreased. An average of 2.34 imaging studies per patient were obtained, increasing from 1.85 in 1999 to 3.07 in 2004 (p = 0.001). Computed tomography (CT) studies represented 65.9% of the total of studies obtained, while plain films and ultrasound represented 19 and 14%, respectively. The percentage of patients who underwent CT increased from 51.4 to 75.7%, with relative decreases of 12 and 54% for plain abdominal films and ultrasound, respectively. Patients older than 65 years had higher rates of imaging utilization, averaging 4.3 compared with 1.86 studies in their younger counterparts (p = 0.001). Imaging utilization rates did not significantly differ among races (p > 0.5), genders (p > 0.8), discharge services (p > 0.1), or payer groups (p > 0.5). Average hospital charges for appendicitis increased by 16.3%, while imaging charges increased as a fraction of hospital charges from 7.89 to 10.87%. Imaging utilization has increased rapidly, but trends show a slowdown that might correspond with achievement of standardization. This suggests that long-term continuous rising is unlikely. Imaging charges correlate with increased hospital charges but cannot explain or accurately predict them.

The objectives of the study were to review the clinical entities that can cause ankylosis of the spine and to illustrate the spectrum of traumatic injury patterns. Ankylosing spondylitis, diffuse idiopathic systemic hyperostosis, degenerative spondyloarthropathy, and spinal canal stenosis can render the spine susceptible to trivial trauma. Multidetector computed tomography and magnetic resonance imaging can accurately diagnose vertebral and soft tissue traumatic injury patterns in this patient population.

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