Hintergrund: Hemithoraxaufnahmen (HT) sind eine spezielle radiografische Technik zur Darstellung der knöchernen Anteile der Thoraxwand. Die Technik findet häufig Anwendung in der Evaluation von Bagatelltraumen des Thorax, oft in Kombination mit Thoraxübersichtsaufnah-men (THÜ Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4 % men, 38.6 % women, median age: 51 years, range: 13 -92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5 %) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5 %) patients. Considering the 157 patients with fractured ribs, 73 (46.8 %) had a single fracture, 38 (24.4 %) and two fractures and 45 (28.8 %) had more than two fractures. When assessing the 405 CRs, we detected 69 (17 %) fractures while the corresponding RS of the same patients revealed 87 (21.5 %) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1 % received medical therapy, while 64.5 % of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
BackgroundRib series (RS) are a special radiological technique to improve the visualization of the bony parts of the chest.ObjectivesThe aim of this study was to evaluate the diagnostic accuracy of rib series in minor thorax trauma.MethodsRetrospective study of 56 patients who received RS, 39 patients where additionally evaluated by plain chest film (PCF). All patients underwent a computed tomography (CT) of the chest. RS and PCF were re-read independently by three radiologists, the results were compared with the CT as goldstandard. Sensitivity, specificity, negative and positive predictive value were calculated. Significance in the differences of findings was determined by McNemar test, interobserver variability by Cohens kappa test.Results56 patients were evaluated (34 men, 22 women, mean age =61 y.). In 22 patients one or more rib fracture could be identified by CT. In 18 of these cases (82%) the correct diagnosis was made by RS, in 16 cases (73%) the correct number of involved ribs was detected. These differences were significant (p = 0.03). Specificity was 100%, negative and positive predictive value were 85% and 100%. Kappa values for the interobserver agreement was 0.92-0.96. Sensitivity of PCF was 46% and was significantly lower (p = 0.008) compared to CT.ConclusionsRib series does not seem to be an useful examination in evaluating minor thorax trauma. CT seems to be the method of choice to detect rib fractures, but the clinical value of the radiological proof has to be discussed and investigated in larger follow up studies.
A rupture of the right atrium following blunt trauma of the thorax was operated with success. The effectiveness of different diagnostic procedures is discussed.
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