What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma?

Sternal fracture in the age of pan-scan

“…Many studies have demonstrated that cervical spine CT diagnoses many more injuries than plain cervical spine radiographs, and recent literature suggests that chest CT similarly detects many more thoracic injuries, such as rib fractures and pulmonary contusions, than plain CXR. Given that sternal fracture is not readily seen on the single anterior-posterior view radiographs primarily used in trauma patients and the upsurge in chest CT use with much greater sensitivity for injury, it is likely that more sternal fractures -especially minor ones -are now being diagnosed [7][8][9][10][11][12][13]. Traditional teachings regarding diagnosis and management may therefore no longer apply with these minor SF diagnoses.…”

“…Widely available, rapid CT has transformed diagnostic trauma evaluation with many centres adopting routine head-to-pelvis CT (pan-scan) for victims of major trauma [5][6][7][8]. Computed tomography has replaced X-ray as the imaging modality of choice for evaluation of patients with trauma.…”

Blunt chest trauma: is there a place for rib stabilization?

“…Other studies have found similar results (25,26). In contrast, several investigators noted that while CT is more sensitive, the additional information rarely was clinically significant (27,28). Finally, the use of three dimensional reconstruction in the diagnosis of rib fractures has limited utility compared to 2-D approaches, although this may change as technology advances (29).…”

Chest X-rays in detecting injuries caused by blunt trauma

“…On the contrary, others [6,12,13] suggested that TCT should be withheld in the initial management of patients. The low sensitivity of CXR suggests that CXRnegative patients should undergo further investigations if they are highly suspected.…”

“…And the use of TCT has raised three problems in practice: increased cancer World J Emerg Med, Vol 7, No 1, 2016 Agladioglu et al risk caused by exposure to ionizing radiation; increased costs imposed by TCT; and increased length of ED stay due to unnecessary screening with TCT. [6,7] Since the appropriate sequence of different imagings and indications of TCT in evaluation of chest trauma are not clear-cut, the present study is undertaken to define the value of CXR in detecting chest injuries in patients with blunt trauma.…”