Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings

Sangster, Guillermo; Gonzalez-Beicos, Aldo; Carbó, Alberto; Heldmann, Maureen; Ibrahim, Hassan; Carrascosa, Patrícia; Nazar, Miguel; D'Agostino, H B

doi:10.1007/s10140-007-0651-8

Cited by 109 publications

(95 citation statements)

References 30 publications

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“…As the omentum is flexible and mobile abdominal structure, it might initiate a herniation into the thorax [34]. It has been reported that the diagnosis of TDI may be missed in 30% of cases on initial CT scanning [35]. Affected patients are typically showed severe multi-organ injures that may dominate and mask the presentation of TDI.…”

Section: Discussionmentioning

confidence: 99%

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Al-Thani

Jabbour

El‐Menyar

et al. 2018

BEAT

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Objective: To investigate the presentation, management and outcomes of left and right-sided traumatic diaphragmatic injury (TDI) in a single level I trauma center. Methods: This cross-sectional study was conducted during a 7-year period from 2008 to 2015 in a level I trauma center in Qatar. We included all the patients who presented with TDIs during the study period. Data included demographics, mechanism of injury, associated injuries, initial vitals, emergency department disposition, length of ICU and hospital stay, ventilator days, management, and outcomes. The variables were analyzed and compared for patients with left (LTDI) and right (RTDI). Results: A total of 52 TDI cases (79% LTDI and 21% RTDI) were identified with a mean age of 31±11. LTDI patients were more likely to have higher Injury severity scores (p=0.50) and greater AAST organ injury scoring (p=0.661 for all) than RTDI patients. Surgical repair was performed for 85% LTDI vs. 73% RTDI (p= 0.342). Recurrent DIs was reported only in LTDI (5.1% vs. 0.0%; p=0.911). Twelve patients died (9 LTDI and 3 RTDI), of them 5 had associated head injury. Conclusion: This single-institution study confirms that LTDI are more commonly diagnosed than RTDI. Exploratory laparotomy is the most frequent procedure considered for the management of diaphragmatic injuries in the emergency settings. To improve outcomes in patients presenting with TDI, large prospective multicenter studies are needed to standardize the TDI management protocols including the diagnostic workup, timing of surgical intervention, and the most appropriate approach of treatment.

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Section: Discussionmentioning

confidence: 99%

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Al-Thani

Jabbour

El‐Menyar

et al. 2018

BEAT

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“…These fractures are rarely life threatening by themselves, but can be an external indicator of more severe visceral injury inside the abdomen and chest [2,4,5,15]. The most common mechanism of injury for rib fractures in the elderly is a fall from a height or standing.…”

Section: Discussionmentioning

confidence: 99%

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

Cho¹,

Sung²,

Kim³

2012

BJR

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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.

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“…From the comparison of virtopsy and autopsy, we noticed that the presence of fluid in the paranasal sinuses was not noticed during the autopsy. The only patient without fluid in the paranasal sinuses, and who had died in 2005 after the air crash, had cerebral oedema with subarachnoid and intraventricular haemorrhage, cerebral venous congestion, multiple bone fractures in the head (fracture of the orbital floor with orbital emphysema and herniation of the inferior rectus muscle), in the chest (multiple rib fractures) and in the pelvis (fracture of the sacrum and of the acetabular edge with haemarthrosis); moreover, this patient showed haemothorax seen as the ''haematocrit sign'' [13], pneumomediastinum and air in the heart chambers, aorta, pulmonary artery and its lobar branches, descending thoracic aorta and in the arterial and venous splanchnic vessels.…”

Section: Resultsmentioning

confidence: 92%

Role of virtopsy in the post-mortem diagnosis of drowning

Vernuccio

Galfano

et al. 2014

Radiol med

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Purpose Due to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning. Materials and methods We retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy. Results All the cadavers showed fluid in the airways and patchy ground-glass opacities in the lung. Only one patient had no fluid in the digestive tract; this patient had a left parietal bone fracture with a large gap and other multiple bone fractures (nose, clavicle, first rib and patella). One of the three patients who had fluid in the digestive tract had no fluid in the paranasal sinuses. This latter patient showed cerebral oedema with subarachnoid and intraventricular haemorrhage, multiple bone fractures (orbital floor, ribs, sacrum and acetabular edge) and air in the heart, in the aorta and in bowel loops. ConclusionTo date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in that it allows us to understand if the victim was alive or dead when he entered the water and if the cause of death was drowning.

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Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings

Cited by 109 publications

References 30 publications

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

Role of virtopsy in the post-mortem diagnosis of drowning

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