Multidetector-row computed tomography of thoracic trauma

Abstract

Summary Imaging in trauma patients has dramatically evolved since the advent of computed tomography (CT), particularly multidetector CT (MDCT) technology. Axial MDCT images of the body can be acquired in seconds and shown any plane, allowing immediate viewing and interpreting. These factors make CT an invaluable means to detect many injuries not previously visible by any other noninvasive imaging techniques. Potentially subtle, but significant, thoracic injuries such as pneumothorax, haemothorax, aortic injury, sternal and spinal fractures can be detected on MDCT easily. In this article, the author will discuss the use of MDCT in the diagnosis of various thoracic injuries.

Penetrating Thoracic Injury

“…The presence of a presternal or retrosternal hematoma should prompt a search for a sternal fracture. 33 Hemorrhage may occur in the extrapleural space. Extrapleural hematomas typically remain contained, do not migrate, or change in configuration.…”

“…In these patients chest tube thoracotomy is performed despite the size of a pneumothorax. 33 A tension pneumothorax occurs when the air trapped in the pleural space is under pressure resulting in mass effect on the mediastinal structures and contralateral lung (Fig. 21).…”

“…If they go untreated, patients are at risk for developing infection, adhesions, and calcifications. 33 CXRs are unreliable in determining the amount of residual clot in the thoracic cavity; therefore, CT is preferred to evaluate their evolution. 31 …”

“…However, in patients with ARDS or on positive pressure ventilation, they make take months to resolve. 33 Positive airway pressure ventilation can result in their expansion and subsequent mass effect on the surrounding lung leading to respiratory compromise. Lacerations also serve as a nidus for infection and abscess formation.…”

“…A contused lung can result in respiratory compromise and serve as a nidus for development of infection. 33 Presumed contusions that persist should be further assessed for superimposed processes, such as acute respiratory distress syndrome (ARDS) and pneumonia.…”