Objective: The objective of this study was to review the prevalence and radiological features of rib fractures missed on initial chest CT evaluation, and to examine the diagnostic value of additional coronal images in a large series of trauma patients. Methods: 130 patients who presented to an emergency room for blunt chest trauma underwent multidetector row CT of the thorax within the first hour during their stay, and had follow-up CT or bone scans as diagnostic gold standards. Images were evaluated on two separate occasions: once with axial images and once with both axial and coronal images. The detection rates of missed rib fractures were compared between readings using a non-parametric method of clustered data. In the cases of missed rib fractures, the shapes, locations and associated fractures were evaluated. Results: 58 rib fractures were missed with axial images only and 52 were missed with both axial and coronal images (p50.088). The most common shape of missed rib fractures was buckled (56.9%), and the anterior arc (55.2%) was most commonly involved. 21 (36.2%) missed rib fractures had combined fractures on the same ribs, and 38 (65.5%) were accompanied by fracture on neighbouring ribs. Conclusion: Missed rib fractures are not uncommon, and radiologists should be familiar with buckle fractures, which are frequently missed. Additional coronal imagescan be helpful in the diagnosis of rib fractures that are not seen on axial images.
There were 36 hepatic injuries and 30 splenic injuries in 60 patients combined injuries with liver and splenic injury 2. Types of llljury were 3 subcapsular, 11 intraparenchymal , and 22 transected types in the liver and were 2 intraparenchymal and 28 transected types in the spleen 3. Most common degree of parenchymal injuries was minimal in the li ver and was moderate or severe in the sp leen 4. Amount of hemoperitoneum in transected types was not increased approximately to the degree of parenchymal injury in the liver and was increased approximately to the degree of parenchymal injury in the spleen 5. 62 % of hepatic injuries and 31 % of splenic injuries were recovered by only conservartive treatment 6. 2 cases were failed to conservartive treatment due to delayed development of hemoperitoneum in transected hepatic injuriesIn conclusion , abdominal CT scan is absolutely necessary for the evalu ation of type and degree of injury , the amount and the location of hemoperitoneum , the decision of treatment methood , and the resolving process after conservative treatment in hepatic and splenic injuries
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