1
|
Sozzi M, Inaba K, Schellenberg MA, Matsushima K, Martin MJ. Dangerous passage: the utility and accuracy of modern chest computed tomography in penetrating thoracic injuries with potential transmediastinal trajectory. Eur J Trauma Emerg Surg 2023; 49:2439-2445. [PMID: 37358631 PMCID: PMC10728241 DOI: 10.1007/s00068-023-02315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
AIM The aim of this study is to evaluate utility and reliability of chest CT as a standalone screening modality for stable patients with thoracic GSWs and potential transmediastinal trajectories. METHODS All patients with thoracic GSWs over a 5-year period were identified. Unstable patients requiring immediate surgery were excluded and the remaining underwent chest CT with intravenous contrast. Sensitivity and specificity for clinically significant injuries were tested against an aggregate gold standard of discharge diagnosis including imaging, operative and clinical findings. RESULTS A total of 216 patients met inclusion criteria and underwent chest CT. After imaging, 65 (30.1%) had indication for immediate surgery, of which 10 (4.6%) underwent a thoracic procedure for chest injuries while 151 (69.9%) were selected for nonoperative management (NOM). 11 (5.1%) required a delayed thoracic operation, none due to injuries missed on CT. The remaining 140 (64.8%) underwent successful NOM. Up to 195 (90.3%) patients had successful NOM of thoracic injuries. Only 9.2% required additional imaging, all negative. CT identified a cardiac injury in one case and a vascular injury in two cases, all confirmed by surgery, while one thoracic IVC injury missed on CT was found intraoperatively. 2 patients had CT suspicious for esophageal injury, ruled out by following investigations. There was one death in the total cohort, none in the NOM group. CONCLUSIONS Modern high-quality CT provides highly accurate and reliable screening modality for penetrating chest and mediastinal injuries and can be used as a standalone study in most patients or to guide further tests. Chest CT facilitated successful NOM.
Collapse
Affiliation(s)
- Marco Sozzi
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA.
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Morgan A Schellenberg
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Kazuhide Matsushima
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Matthew J Martin
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| |
Collapse
|
2
|
Sozzi M, Wu Y, Matsushima K, Schellenberg M, Inaba K, Martin M. Impact of Postoperative Imaging Following Emergency Surgery for Penetrating Ballistic Thoracic Trauma. Am Surg 2023; 89:4018-4024. [PMID: 37165630 DOI: 10.1177/00031348231175451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Patients undergoing emergent surgical procedures after penetrating trauma can benefit from postoperative imaging studies to identify potential missed injuries or indications to additional surgery. Aim of this study is to describe postoperative imaging findings in patients who underwent emergent operation for thoracic gunshot wounds (GSWs) and the subsequent need for further surgery, diagnostic evaluations or consults. METHODS Patients who survived to receive imaging evaluation after emergency surgery for penetrating chest trauma in a level I trauma center between 2017 and 2021 were included. Results of postoperative diagnostic evaluation were screened to determine their impact on the subsequent management. RESULTS Overall, 125 patients admitted with a thoracic GSW underwent an emergent surgical procedure and 29 survived to receive postoperative imaging and were included. Postoperative CT-scan was performed in 26 (89.6%) patients, echocardiography in 8 (27.5%). Other tests included esophagoscopy (1) and bronchoscopy (1). Impact on management of abnormal imaging included a new indication to surgery or additional procedures in 7 cases and need for additional imaging or consults in other 8 cases. Bone fractures and lung injuries were more often diagnosed on postoperative CT-scan. In 3 patients, abnormal echocardiographic findings led to a second cardiac operation. CONCLUSION Following emergency surgery for penetrating trauma, completion of injury assessment with CT-scan can lead to identification of missed or additional injuries, while other imaging is indicated according to operative findings. In this study, 24.1% had additional surgical pathology identified by postoperative imaging while others had findings requiring additional studies or specialist consult evaluations.
Collapse
Affiliation(s)
- Marco Sozzi
- LAC+USC Medical Center, Division of Trauma and Acute Care Surgery, Los Angeles, CA, USA
| | - Yutung Wu
- LAC+USC Medical Center, Division of Trauma and Acute Care Surgery, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- LAC+USC Medical Center, Division of Trauma and Acute Care Surgery, Los Angeles, CA, USA
| | - Morgan Schellenberg
- LAC+USC Medical Center, Division of Trauma and Acute Care Surgery, Los Angeles, CA, USA
| | - Kenji Inaba
- LAC+USC Medical Center, Division of Trauma and Acute Care Surgery, Los Angeles, CA, USA
| | - Matthew Martin
- LAC+USC Medical Center, Division of Trauma and Acute Care Surgery, Los Angeles, CA, USA
| |
Collapse
|
3
|
Osman M, Khalil R, Abdalla AH, Katta A, Nashef S, Elameen S. A rare chest X-ray sign in the diagnosis of an intracardiac bullet: case report. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gunshot injuries to the heart are often seen in cardiac surgical practice. Victims are usually investigated with various types of imaging modalities, including simple chest X-ray (CXR) which is a primary imaging modality that can easily locate a bullet and is useful in monitoring before surgical intervention as bullets may migrate.
Case presentation
A 32-year-old man was admitted as an emergency in a primary hospital after being injured by a gunshot to the chest. The bullet entry was over the back of the left shoulder with no exit point seen. The chest X-ray showed left pleural effusion and a retained intrathoracic bullet. A chest drain was inserted and drained 2200 ml of blood. Computed tomography (CT) scan showed an intracardiac bullet associated with left lower lobe contusion and left-sided hemothorax. He was urgently transferred to theater for exploration via left thoracotomy. The bullet could not be found so the inlet point in the left ventricle was sutured. After stabilizing the patient, he was referred to a specialized cardiac center for further management.
The patient arrived at our center 2 days after the injury, fully conscious and hemodynamically stable. On arrival, chest X-rays were obtained to rule out possible migration of the bullet and revealed that the retained bullet was still within the cardiac silhouette. The X-ray appearance of the bullet showed a characteristically double contour, strongly suggesting that the bullet had lodged in the heart muscle and was moving with each heartbeat.
The patient was transferred to the theater for median sternotomy. The aorta, superior vena cava, and inferior vena cava were cannulated, and cardiopulmonary bypass was initiated. The aorta was cross-clamped and the cardioplegia was given. Palpation of the still heart readily identified the bullet within the interventricular septum. The left ventricle was opened 1 cm from the left anterior descending artery just on top of the bullet. The bullet was successfully retrieved. The bullet was transfixing the septum causing a small ventricular septal defect which was closed using a Teflon patch and the ventricle was repaired.
Conclusion
The double contour appearance of the bullet indicates that the bullet is moving and strongly suggests an intramyocardial position.
Collapse
|
4
|
Abstract
Here in Canada, we often think of gun violence as confined to conflict zones, terrorism, and more of a problem for our southern neighbor. However, in recent years, it has also become a Canadian problem with increased gun violence related to criminal activity presenting in daily practice. Radiologists play a critical role in the evaluation of ballistic trauma and must therefore be familiar with both the common and uncommon patterns of ballistic injury. In this article, we review the mechanisms of ballistic trauma as well as their resultant injury patterns in order to guide image interpretation.
Collapse
Affiliation(s)
- Noah G Ditkofsky
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
| | - Hillel Maresky
- Department of Radiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shobhit Mathur
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Darwish B, Mahfouz MZ, Izzat MB. Usefulness of routine computed tomography in the evaluation of penetrating war injuries to the chest. Interact Cardiovasc Thorac Surg 2018; 27:703-707. [PMID: 29722886 DOI: 10.1093/icvts/ivy152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/05/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This review was conducted to compare the contributions of chest X-ray (CXR) and computed tomography (CT) towards detecting intrathoracic damage in patients with penetrating war injuries to the chest and to determine whether identification of additional injuries by chest CT will have an impact on the choice of therapeutic interventions and clinical outcomes. METHODS We reviewed records of 449 patients (374 men, mean age 29.3 ± 14.8 years) who were admitted to our hospital with penetrating war injuries to the chest over a 7-year period. Collected data included mechanisms of injury, associated injuries, results of CXRs and chest CTs, methods of management, in-hospital stays, complications and mortalities. RESULTS Immediate screening CXRs were obtained in all patients not requiring emergent thoracotomies, of which 91.4% showed positive signs of injury. Chest CTs were performed at the discretion of the physicians in 49.4% of patients, and CXR-positive findings were confirmed in all cases, while revealing additional injuries in 11% of patients. Chest CT findings led to additional closed chest drainage in 5.6% of patients but had no impact on treatment strategy in 94.4% of scanned patients. Follow-up CXRs showed new positive findings in 22 patients, leading to additional closed chest drainage in 3 patients and delayed open thoracotomies in 7 other patients. CONCLUSIONS CXRs continue as the primary diagnostic modality in the assessment of patients with penetrating war injuries to the chest. Chest CTs can be omitted in most patients, thus reducing CT imaging case-load substantially, while most clinically significant chest injuries remain sufficiently recognized.
Collapse
Affiliation(s)
- Bassam Darwish
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Z Mahfouz
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | | |
Collapse
|
6
|
Acevedo E, Sjoholm LO, Santora T, Goldberg AJ. A Review of the Role and Utility of Chest Computed Tomography in Penetrating Chest Trauma. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Abstract
Traumatic esophageal injuries occur less than 10% of the time in the setting of blunt or penetrating trauma. The purpose of this literature review is to provide an update on the most recent changes involving the diagnosis and treatment of esophageal injuries. A literature search was conducted using PubMed, to identify articles written in English language with the terms "non- iatrogenic", "esophageal", "trauma", "diagnosis", "management", and "prognosis". Case reports and articles involving non-traumatic esophageal perforations were excluded. Fifty pertinent articles in English language from 1947 to 2015 were selected for review. Based on the review of all articles, we designed a diagnostic and therapeutic algorithm to facilitate the diagnosis and management of the traumatic esophageal injury.
Collapse
|
8
|
Fu HY, Ting M, Wang YC, Yu HY. Intracardiac foreign body resulting from a transmediastinal gunshot mimics an extracardiac foreign body: An image presentation. J Formos Med Assoc 2017; 116:815-818. [PMID: 28709823 DOI: 10.1016/j.jfma.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022] Open
Abstract
A transmediastinal gunshot wound (TMGW) is one of the most severe traumatic injuries, with a high mortality rate. Prompt diagnosis and emergency surgical intervention with or without cardiopulmonary bypass are usually required to save lives. We report a particular case of TMGW in which the computed tomography imaging findings indicated an extracardiac foreign body. However, intraoperative findings revealed an intracardiac foreign body, and urgent cardiopulmonary bypass was performed to remove the foreign body. We suggest that cardiopulmonary bypass should be on standby during an exploratory sternotomy for TMGW, when the trajectory of the bullet hints at a cardiac-penetrating injury according to imaging studies and the location of the bullet remains unaffected by the patient's postural changes.
Collapse
Affiliation(s)
- Hsun-Yi Fu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Mao Ting
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
| |
Collapse
|
9
|
Dreizin D, Boscak AR, Anstadt MJ, Tirada N, Chiu WC, Munera F, Bodanapally UK, Hornick M, Stein DM. Penetrating Colorectal Injuries: Diagnostic Performance of Multidetector CT with Trajectography. Radiology 2016; 281:749-762. [DOI: 10.1148/radiol.2015152335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
10
|
Matsushima K, Inaba K, Dollbaum R, Khor D, Jhaveri V, Jimenez O, Strumwasser A, Demetriades D. The role of computed tomography after emergent trauma operation. J Surg Res 2016; 206:286-291. [DOI: 10.1016/j.jss.2016.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/02/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
|
11
|
Zeidenberg J, Durso AM, Caban K, Munera F. Imaging of Penetrating Torso Trauma. Semin Roentgenol 2016; 51:239-55. [DOI: 10.1053/j.ro.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
12
|
Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries. J Trauma Acute Care Surg 2016; 79:1089-95. [PMID: 26680145 DOI: 10.1097/ta.0000000000000772] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm. We encourage institutions to use this guideline to formulate their own local protocols.The algorithm contains letters at decision points; the corresponding paragraphs in the text elaborate on the thought process and cite pertinent literature. The annotated algorithm is intended to (a) serve as a quick bedside reference for clinicians; (b) foster more detailed patient care protocols that will allow for prospective data collection and analysis to identify best practices; and (c) generate research projects to answer specific questions concerning decision making in the management of adults with esophageal injuries.
Collapse
|
13
|
Navsaria PH, Chowdhury S, Nicol AJ, Edu S, Naidoo N. Penetrating Trauma to the Mediastinal Vessels: a Taxing Injury. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
14
|
Abstract
The use of computed tomography (CT) for hemodynamically stable victims of penetrating torso trauma continues to increase but remains less singular to the work-up than in blunt trauma. Research in this area has focused on the incremental benefits of CT within the context of evolving diagnostic algorithms and in conjunction with techniques such as laparoscopy, endoscopy, and angiographic intervention. This review centers on the current state of multidetector CT as a triage tool for penetrating torso trauma and the primacy of trajectory evaluation in diagnosis, while emphasizing diagnostic challenges that have lingered despite tremendous technological advances since CT was first used in this setting 3 decades ago. As treatment strategies have also changed considerably over the years in parallel with advances in CT, current management implications of organ-specific injuries depicted at multidetector CT are also discussed.
Collapse
Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201 (D.D.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami Fla (F.M.)
| | - Felipe Munera
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201 (D.D.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami Fla (F.M.)
| |
Collapse
|
15
|
Abstract
This article discusses the role of radiology in evaluating patients with penetrating injuries to the chest. Penetrating injuries to the chest encompass ballistic and nonballistic injuries and can involve superficial soft tissues of the chest wall, lungs and pleura, diaphragm, and mediastinum. The mechanism of injury in ballistic and nonballistic trauma and the impact the injury trajectory has on imaging evaluation of penetrating injuries to the chest are discussed. The article presents the broad spectrum of imaging findings a radiologist encounters with penetrating injuries to the chest, with emphasis on injuries to the lungs and pleura, diaphragm, and mediastinum.
Collapse
Affiliation(s)
- Anthony M Durso
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA
| | - Kim Caban
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA
| | - Felipe Munera
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, Radiology Services, University of Miami Hospitals, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA.
| |
Collapse
|
16
|
Zepeda CÁ, Castro PP, Castillo F, Sanhueza B, Ruiz I. Treatment of hemodynamically stable penetrating mediastinal gunshot wounds in chile: Comparison of 3 cases and literature review. J Emerg Trauma Shock 2015; 8:70-1. [PMID: 25709262 PMCID: PMC4335167 DOI: 10.4103/0974-2700.150406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carlos Álvarez Zepeda
- Department of Thoracic Surgery, Hospital Barros Luco-Trudeau, Santiago, Chile ; Department of Surgery, South Campus, University of Chile, Santiago, Chile E-mail:
| | | | - Felipe Castillo
- Emergency Department, Hospital Barros Luco-Trudeau, Santiago, Chile
| | - Belen Sanhueza
- Department of Surgery, South Campus, University of Chile, Santiago, Chile E-mail:
| | - Ivan Ruiz
- Department of Surgery, South Campus, University of Chile, Santiago, Chile E-mail:
| |
Collapse
|
17
|
Gunn ML, Clark RT, Sadro CT, Linnau KF, Sandstrom CK. Current Concepts in Imaging Evaluation of Penetrating Transmediastinal Injury. Radiographics 2014; 34:1824-41. [DOI: 10.1148/rg.347130022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
18
|
Mollberg NM, Wise SR, De Hoyos AL, Lin FJ, Merlotti G, Massad MG. Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram. Ann Thorac Surg 2012; 93:1830-5. [PMID: 22560266 DOI: 10.1016/j.athoracsur.2012.02.095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest computed tomography (CCT) is a method of screening for intrathoracic injuries in hemodynamically stable patients with penetrating thoracic trauma. The objective of this study was to examine the changes in utilization of CCT over time and evaluate its contribution to guiding therapeutic intervention. METHODS A level 1 trauma center registry was queried between 2006 and 2011. Patients undergoing CCT in the emergency department after penetrating thoracic trauma as well as patients undergoing thoracic operations for penetrating thoracic trauma were identified. Patient demographics, operative indications, use of CCT, injuries, and hospital admissions were analyzed. RESULTS In all, 617 patients had CCTs performed, of whom 61.1% (371 of 617) had a normal screening plain chest radiograph (CXR). In 14.0% (51 of 371) of these cases, the CCT revealed findings not detected on screening CXR. The majority of these injuries were occult pneumothoraces or hemothoraces (84.3%; 43 of 51), of which 27 (62.8%) underwent tube thoracostomy. In only 0.5% (2 of 371), did the results of CCT alone lead to an operative indication: exploration for hemopericardium. The use of CCT in our patients significantly increased overall (28.8% to 71.4%) as well as after a normal screening CXR (23.3% to 74.6%) over the study period. CONCLUSIONS The use of CCT for penetrating thoracic trauma increased 3.5-fold during the study period with a concurrent increase in findings of uncertain clinical significance. Patients with a normal screening CXR should be triaged with 3-hour delayed CXR, serial physical examinations, and focused assessment with sonography for trauma; and CCT should only be used selectively as a diagnostic modality.
Collapse
Affiliation(s)
- Nathan M Mollberg
- Department of Surgery, Division of General Surgery, University of Illinois at Mount Sinai Hospital, and Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Ultrasound in Diagnosing Torso Injuries. POLISH JOURNAL OF SURGERY 2009. [DOI: 10.2478/v10035-009-0081-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
|