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Wu J, Liu N, Li X, Fan Q, Li Z, Shang J, Wang F, Chen B, Shen Y, Cao P, Liu Z, Li M, Qian J, Yang J, Sun Q. Convolutional neural network for detecting rib fractures on chest radiographs: a feasibility study. BMC Med Imaging 2023; 23:18. [PMID: 36717773 PMCID: PMC9885575 DOI: 10.1186/s12880-023-00975-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Chest radiography is the standard investigation for identifying rib fractures. The application of artificial intelligence (AI) for detecting rib fractures on chest radiographs is limited by image quality control and multilesion screening. To our knowledge, few studies have developed and verified the performance of an AI model for detecting rib fractures by using multi-center radiographs. And existing studies using chest radiographs for multiple rib fracture detection have used more complex and slower detection algorithms, so we aimed to create a multiple rib fracture detection model by using a convolutional neural network (CNN), based on multi-center and quality-normalised chest radiographs. METHODS A total of 1080 radiographs with rib fractures were obtained and randomly divided into the training set (918 radiographs, 85%) and the testing set (162 radiographs, 15%). An object detection CNN, You Only Look Once v3 (YOLOv3), was adopted to build the detection model. Receiver operating characteristic (ROC) and free-response ROC (FROC) were used to evaluate the model's performance. A joint testing group of 162 radiographs with rib fractures and 233 radiographs without rib fractures was used as the internal testing set. Furthermore, an additional 201 radiographs, 121 with rib fractures and 80 without rib fractures, were independently validated to compare the CNN model performance with the diagnostic efficiency of radiologists. RESULTS The sensitivity of the model in the training and testing sets was 92.0% and 91.1%, respectively, and the precision was 68.0% and 81.6%, respectively. FROC in the testing set showed that the sensitivity for whole-lesion detection reached 91.3% when the false-positive of each case was 0.56. In the joint testing group, the case-level accuracy, sensitivity, specificity, and area under the curve were 85.1%, 93.2%, 79.4%, and 0.92, respectively. At the fracture level and the case level in the independent validation set, the accuracy and sensitivity of the CNN model were always higher or close to radiologists' readings. CONCLUSIONS The CNN model, based on YOLOv3, was sensitive for detecting rib fractures on chest radiographs and showed great potential in the preliminary screening of rib fractures, which indicated that CNN can help reduce missed diagnoses and relieve radiologists' workload. In this study, we developed and verified the performance of a novel CNN model for rib fracture detection by using radiography.
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Affiliation(s)
- Jiangfen Wu
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710054 China ,InferVision Institute of Research, Beijing, 100025 China ,grid.11135.370000 0001 2256 9319Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100191 China
| | - Nijun Liu
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,Department of Medical Imaging, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, 712000 China
| | - Xianjun Li
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Qianrui Fan
- InferVision Institute of Research, Beijing, 100025 China
| | | | - Jin Shang
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Fei Wang
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Bowei Chen
- grid.412262.10000 0004 1761 5538School of Information Science and Technology, Northwest University, Xi’an, 710127 China
| | - Yuanwang Shen
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,Department of Medical Imaging, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, 712000 China
| | - Pan Cao
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,Department of Radiology, Tuberculosis Hospital of Shannxi Province (The Fifth People’s Hospital of Shaanxi Province), Xi’an, 710100 China
| | - Zhe Liu
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Miaoling Li
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China
| | - Jiayao Qian
- InferVision Institute of Research, Beijing, 100025 China
| | - Jian Yang
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710054 China
| | - Qinli Sun
- grid.452438.c0000 0004 1760 8119Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta West Road No. 277, Xi’an, 710061 China ,grid.43169.390000 0001 0599 1243The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, 710054 China
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Kim JH, Han SG, Cho A, Shin HJ, Baek SE. Effect of deep learning-based assistive technology use on chest radiograph interpretation by emergency department physicians: a prospective interventional simulation-based study. BMC Med Inform Decis Mak 2021; 21:311. [PMID: 34749731 PMCID: PMC8573755 DOI: 10.1186/s12911-021-01679-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Interpretation of chest radiographs (CRs) by emergency department (ED) physicians is inferior to that by radiologists. Recent studies have investigated the effect of deep learning-based assistive technology on CR interpretation (DLCR), although its relevance to ED physicians remains unclear. This study aimed to investigate whether DLCR supports CR interpretation and the clinical decision-making of ED physicians. METHODS We conducted a prospective interventional study using a web-based performance assessment system. Study participants were recruited through the official notice targeting board for certified emergency physicians and residents working at the present ED. Of the eight ED physicians who volunteered to participate in the study, seven ED physicians were included, while one participant declared withdrawal during performance assessment. Seven physicians' CR interpretations and clinical decision-making were assessed based on the clinical data from 388 patients, including detecting the target lesion with DLCR. Participant performance was evaluated by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy analyses; decision-making consistency was measured by kappa statistics. ED physicians with < 24 months of experience were defined as 'inexperienced'. RESULTS Among the 388 simulated cases, 259 (66.8%) had CR abnormality. Their median value of abnormality score measured by DLCR was 59.3 (31.77, 76.25) compared to a score of 3.35 (1.57, 8.89) for cases of normal CR. There was a difference in performance between ED physicians working with and without DLCR (AUROC: 0.801, P < 0.001). The diagnostic sensitivity and accuracy of CR were higher for all ED physicians working with DLCR than for those working without it. The overall kappa value for decision-making consistency was 0.902 (95% confidence interval [CI] 0.884-0.920); concurrently, the kappa value for the experienced group was 0.956 (95% CI 0.934-0.979), and that for the inexperienced group was 0.862 (95% CI 0.835-0.889). CONCLUSIONS This study presents preliminary evidence that ED physicians using DLCR in a clinical setting perform better at CR interpretation than their counterparts who do not use this technology. DLCR use influenced the clinical decision-making of inexperienced physicians more strongly than that of experienced physicians. These findings require prospective validation before DLCR can be recommended for use in routine clinical practice.
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Affiliation(s)
- Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Preventive Medicine , Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Sang Gil Han
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ara Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hye Jung Shin
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Song-Ee Baek
- Department of Radiology, Division of Emergency Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Brown SR, Still SA, Eudailey KW, Beck AW, Gunn AJ. Acute traumatic injury of the aorta: presentation, diagnosis, and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1193. [PMID: 34430634 PMCID: PMC8350653 DOI: 10.21037/atm-20-3172] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
Despite advances in detection and treatment, acute traumatic aortic injury (ATAI) is associated with high rates of morbidity and mortality. Both physical and hemodynamic forces have been postulated as mechanisms of aortic injury during a traumatic event. For patients who survive the initial injury, rapid detection is critical for diagnosis and procedural planning, which requires a thorough knowledge of both its clinical presentation and the available diagnostic imaging modalities. Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can each have a role in the diagnosis of ATAI. After stabilization of the patient, the management of ATAI is guided by the severity of injury. Appropriately selected patients with low grade injuries may be managed non-operatively. When treatment is required, there are both open surgical and endovascular options. In current practice, endovascular approaches with stent-graft placement are preferred due to their high clinical success and low rates of complications. Complications from endograft placement can include: endoleak, endograft collapse, infection, endograft failure, and endograft migration. Open surgical repair is now reserved for patients with unfavorable anatomy for endovascular therapies. This review provides a comprehensive overview of ATAI including its epidemiology and demographics, mechanisms of injury, clinical and radiographic diagnosis, treatment options, and post-therapeutic follow-up.
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Affiliation(s)
- S Rodes Brown
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sasha A Still
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew J Gunn
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Mansour J, Raptis DA, Bhalla S. Multimodality Imaging of Cardiac Trauma. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev 2020; 7:CD013031. [PMID: 32702777 PMCID: PMC7390330 DOI: 10.1002/14651858.cd013031.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chest X-ray (CXR) is a longstanding method for the diagnosis of pneumothorax but chest ultrasonography (CUS) may be a safer, more rapid, and more accurate modality in trauma patients at the bedside that does not expose the patient to ionizing radiation. This may lead to improved and expedited management of traumatic pneumothorax and improved patient safety and clinical outcomes. OBJECTIVES To compare the diagnostic accuracy of chest ultrasonography (CUS) by frontline non-radiologist physicians versus chest X-ray (CXR) for diagnosis of pneumothorax in trauma patients in the emergency department (ED). To investigate the effects of potential sources of heterogeneity such as type of CUS operator (frontline non-radiologist physicians), type of trauma (blunt vs penetrating), and type of US probe on test accuracy. SEARCH METHODS We conducted a comprehensive search of the following electronic databases from database inception to 10 April 2020: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Database of Abstracts of Reviews of Effects, Web of Science Core Collection and Clinicaltrials.gov. We handsearched reference lists of included articles and reviews retrieved via electronic searching; and we carried out forward citation searching of relevant articles in Google Scholar and looked at the "Related articles" on PubMed. SELECTION CRITERIA We included prospective, paired comparative accuracy studies comparing CUS performed by frontline non-radiologist physicians to supine CXR in trauma patients in the emergency department (ED) suspected of having pneumothorax, and with computed tomography (CT) of the chest or tube thoracostomy as the reference standard. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from each included study using a data extraction form. We included studies using patients as the unit of analysis in the main analysis and we included those using lung fields in the secondary analysis. We performed meta-analyses by using a bivariate model to estimate and compare summary sensitivities and specificities. MAIN RESULTS We included 13 studies of which nine (410 traumatic pneumothorax patients out of 1271 patients) used patients as the unit of analysis; we thus included them in the primary analysis. The remaining four studies used lung field as the unit of analysis and we included them in the secondary analysis. We judged all studies to be at high or unclear risk of bias in one or more domains, with most studies (11/13, 85%) being judged at high or unclear risk of bias in the patient selection domain. There was substantial heterogeneity in the sensitivity of supine CXR amongst the included studies. In the primary analysis, the summary sensitivity and specificity of CUS were 0.91 (95% confidence interval (CI) 0.85 to 0.94) and 0.99 (95% CI 0.97 to 1.00); and the summary sensitivity and specificity of supine CXR were 0.47 (95% CI 0.31 to 0.63) and 1.00 (95% CI 0.97 to 1.00). There was a significant difference in the sensitivity of CUS compared to CXR with an absolute difference in sensitivity of 0.44 (95% CI 0.27 to 0.61; P < 0.001). In contrast, CUS and CXR had similar specificities: comparing CUS to CXR, the absolute difference in specificity was -0.007 (95% CI -0.018 to 0.005, P = 0.35). The findings imply that in a hypothetical cohort of 100 patients if 30 patients have traumatic pneumothorax (i.e. prevalence of 30%), CUS would miss 3 (95% CI 2 to 4) cases (false negatives) and overdiagnose 1 (95% CI 0 to 2) of those without pneumothorax (false positives); while CXR would miss 16 (95% CI 11 to 21) cases with 0 (95% CI 0 to 2) overdiagnosis of those who do not have pneumothorax. AUTHORS' CONCLUSIONS The diagnostic accuracy of CUS performed by frontline non-radiologist physicians for the diagnosis of pneumothorax in ED trauma patients is superior to supine CXR, independent of the type of trauma, type of CUS operator, or type of CUS probe used. These findings suggest that CUS for the diagnosis of traumatic pneumothorax should be incorporated into trauma protocols and algorithms in future medical training programmes; and that CUS may beneficially change routine management of trauma.
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Affiliation(s)
- Kenneth K Chan
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Daniel A Joo
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zahra A Premji
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Abel Wakai
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
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Abstract
More than 45% of polytraumatized patients in Germany suffer from severe thoracic trauma. Due to the urgent time factor (e.g. respiratory insufficiency and severe bleeding), a structured procedure in the diagnostics and treatment according to the advanced trauma life support (ATLS) criteria is necessary both prehospital and in the emergency room in order to provide the patient with adequate care. If a patient is stable or can be stabilized there is the option of using extended diagnostics, such as whole body computer tomography (CT) scanning with contrast medium, to select a treatment that is optimally adapted to the injury pattern. This can be performed by open surgery, minimally invasive surgery and interventional radiologically/endoscopically and depends on the injured organ as well as the extent of the injury. This means that only an interdisciplinary approach guarantees optimal care for patients with thoracic trauma.
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Warhadapande S, Dariushnia SR, Kokabi N, O'Connell WG, Newsome JM, Findeiss LK, Majdalany BS. Clinical Approach to and Work-up of Bleeding Patients. Semin Intervent Radiol 2020; 37:24-30. [PMID: 32139967 DOI: 10.1055/s-0039-3402017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A bleeding patient is a common consult for interventional radiologists. Prompt triage, preprocedural evaluation specific to the site of hemorrhage, and knowledge of resuscitative strategies allow for a potentially life-saving procedure to be appropriately and safely performed. Having a firm understanding of the clinical work-up and management of a bleeding patient has never been more important. In this article, a discussion of the clinical approach and work-up of a bleeding patient for whom interventional radiology is consulted is followed by a discussion of etiology-specific preprocedural work-up.
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Affiliation(s)
- Shantanu Warhadapande
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sean R Dariushnia
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - William G O'Connell
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Janice M Newsome
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Laura K Findeiss
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
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Gavelli F, Patrucco F, Daverio M, De Vita N, Bellan M, Rena O, Balbo PE, Avanzi GC, Castello LM. Sequelae of traumatic rib fractures: management in the Emergency Department. ACTA ACUST UNITED AC 2020. [DOI: 10.23736/s0026-4954.19.01863-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hwang EJ, Nam JG, Lim WH, Park SJ, Jeong YS, Kang JH, Hong EK, Kim TM, Goo JM, Park S, Kim KH, Park CM. Deep Learning for Chest Radiograph Diagnosis in the Emergency Department. Radiology 2019; 293:573-580. [DOI: 10.1148/radiol.2019191225] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Eui Jin Hwang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ju Gang Nam
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Woo Hyeon Lim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Sae Jin Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Yun Soo Jeong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ji Hee Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Eun Kyoung Hong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Taek Min Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Sunggyun Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ki Hwan Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
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Marro A, Chan V, Haas B, Ditkofsky N. Blunt chest trauma: classification and management. Emerg Radiol 2019; 26:557-566. [DOI: 10.1007/s10140-019-01705-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
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Kani KK, Mulcahy H, Porrino JA, Chew FS. Thoracic cage injuries. Eur J Radiol 2019; 110:225-232. [DOI: 10.1016/j.ejrad.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023]
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Abstract
Aortic injury remains a major contributor to morbidity and mortality from acute thoracic trauma. While such injuries were once nearly uniformly fatal, the advent of cross-sectional imaging in recent years has facilitated rapid diagnosis and triage, greatly improving outcomes. In fact, cross-sectional imaging is now the diagnostic test of choice for traumatic aortic injury (TAI), specifically computed tomography angiography (CTA) in the acute setting and CTA or magnetic resonance angiography (MRA) in follow-up. In this review, we present an up-to-date discussion of acute traumatic thoracic aortic injury with a focus on optimal and emerging CT/MR techniques, imaging findings of TAI, and potential pitfalls.
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Affiliation(s)
- Lewis D Hahn
- 1 Department of Radiology, Stanford University School of Medicine, Stanford, USA
| | - Anand M Prabhakar
- 2 Divisions of Cardiovascular and Emergency Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Evan J Zucker
- 1 Department of Radiology, Stanford University School of Medicine, Stanford, USA
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¿Está indicado realizar una tomografía computarizada torácica urgente en el traumatismo leve-moderado? RADIOLOGIA 2018; 60:347-350. [DOI: 10.1016/j.rx.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
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Tomas X, Facenda C, Vaz N, Castañeda EA, Del Amo M, Garcia-Diez AI, Pomes J. Thoracic wall trauma-misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:384-397. [PMID: 28932697 DOI: 10.21037/qims.2017.08.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Blunt injuries to the chest wall are an important chapter on emergency room (ER) departments, being the third most common injuries in trauma patients which ominous complications could appear. This article describes different types of traumatic events affecting the chest wall, which maybe misdiagnosed with conventional X-ray. Special emphasis has been done in computed tomography (CT) and multidetector CT (MDCT) imaging. This technique is considered the "gold-standard" for those traumatic patients, due to its fast acquisition covering the whole area of interest in axial plane, reconstructing multiplanar (2D, 3D) volume-rendered images with a superb quality and angiographic CT capabilities for evaluating vascular damage. Complementary techniques such as ultrasonography (US) and magnetic resonance imaging (MRI) may improve the diagnostic accuracy due to its great capacity in visualising soft-tissue trauma (muscle-tendinous tears) and subtle fractures. All these imaging methods have an important role in quantifying the severity of chest wall trauma. The findings of this study have been exposed with cases of our archives in a didactic way.
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Affiliation(s)
- Xavier Tomas
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Catherine Facenda
- Department of Radiology, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida 25198, Spain
| | - Nuno Vaz
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Edgar Augusto Castañeda
- Department of Radiology, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Pedro i Pons, 1, Sant Cugat del Vallés Barcelona 08190, Spain
| | - Montserrat Del Amo
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Ana Isabel Garcia-Diez
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Jaime Pomes
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
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Talbot BS, Gange CP, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics 2017; 37:628-651. [DOI: 10.1148/rg.2017160100] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Brett S. Talbot
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Christopher P. Gange
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Apeksha Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Nina Klionsky
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Susan K. Hobbs
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Abhishek Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
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Lee TL, Hsuan CF, Shih CH, Liang HW, Tsai HS, Tseng WK, Hsu KL. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report. BMC Cardiovasc Disord 2017; 17:56. [PMID: 28183285 PMCID: PMC5301382 DOI: 10.1186/s12872-017-0496-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Case presentation Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Conclusion Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.
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Affiliation(s)
- Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Chen-Hsiang Shih
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Huai-Wen Liang
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Hsing-Shan Tsai
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Wei-Kung Tseng
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan.
| | - Kwan-Lih Hsu
- Department of Internal Medicine, E-Da cancer hospital / I-Shou University, Kaohsiung, Taiwan
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Kim SJ, Bista AB, Min YG, Kim EY, Park KJ, Kang DK, Sun JS. Usefulness of low dose chest CT for initial evaluation of blunt chest trauma. Medicine (Baltimore) 2017; 96:e5888. [PMID: 28079832 PMCID: PMC5266194 DOI: 10.1097/md.0000000000005888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/26/2022] Open
Abstract
We aimed to compare the diagnostic performance and inter-observer consistency between low dose chest CT (LDCT) and standard dose chest CT (SDCT) in the patients with blunt chest trauma.A total of 69 patients who met criteria indicative of blunt chest trauma (77% of male; age range, 16-85) were enrolled. All patients underwent LDCT without intravenous (IV) contrast and SDCT with IV contrast using parameters as following: LDCT, 40 mAs with automatic tube current modulation (ATCM) and 100 kVp (BMI <25, n = 51) or 120 kVp (BMI>25, n = 18); SDCT, 180 mAs with ATCM and 120 kVp. Transverse, coronal, sagittal images were reconstructed with 3-mm slice thickness without gap and provided for evaluation of 3 observers. Reference standard images (transverse, coronal, sagittal) were reconstructed using SDCT data with 1-mm slice thickness without gap. Reference standard was established by 2 experienced thoracic radiologists by consensus. Three observers independently evaluated each data set of LDCT and SDCT.Multiple-reader receiver operating characteristic analysis for comparing areas under the ROC curves demonstrated that there was no significant difference of diagnostic performance between LDCT and SDCT for the diagnosis of pulmonary injury, skeletal trauma, mediastinal injury, and chest wall injury (P > 0.05). The intraclass correlation coefficient was measured for inter-observer consistency and revealed that there was good inter-observer consistency in each examination of LDCT and SDCT for evaluation of blunt chest injury (0.8601-1.000). Aortic and upper abdominal injury could not be appropriately compared as LDCT was performed without using contrast materials and this was limitation of this study.The effective radiation dose of LDCT (average DLP = 1.52 mSv⋅mGy cm) was significantly lower than those of SDCT (7.21 mSv mGy cm).There is a great potential benefit to use of LDCT for initial evaluation of blunt chest trauma because LDCT could maintain diagnostic image quality as SDCT and provide significant radiation dose reduction. A further study of LDCT with IV contrast for evaluation of aortic and upper abdominal injury is needed.
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Affiliation(s)
- Sung Jung Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | | | - Young Gi Min
- Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea
| | - Eun Young Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Doo Kyoung Kang
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University Hospital, Suwon, Korea
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Imaging Techniques in Emergency Surgeries. Int Anesthesiol Clin 2016; 54:22-38. [PMID: 26655507 DOI: 10.1097/aia.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Imaging of blunt chest trauma]. Radiologe 2015; 54:886-92. [PMID: 25116049 DOI: 10.1007/s00117-013-2637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. STANDARD RADIOLOGICAL METHODS Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. METHODOLOGICAL INNOVATIONS Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. PRACTICAL RECOMMENDATIONS In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients.
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Parker MW, Shah SS, Hall M, Fieldston ES, Coley BD, Morse RB. Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children. Pediatrics 2015; 136:e573-81. [PMID: 26304828 DOI: 10.1542/peds.2015-0995] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many studies have demonstrated a rise in computed tomography (CT) utilization in abstract children's hospitals. However, CT utilization may be declining, perhaps due to awareness of potential hazards of pediatric ionizing radiation, such as increased risk of malignancy. Th e objective is to assess the trend in CT utilization in hospitalized children at freestanding children's hospitals from 2004 to 2012 and we hypothesize decreases are associated with shifts to alternate imaging modalities. METHODS Multicenter cross-sectional study of children admitted to 33 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between January 1, 2004, and December 31, 2012. The rates of CT, ultrasound, and MRI for the top 10 All-Patient Refined Diagnosis Related Groups (APR-DRGs) for which CT was performed in 2004 were determined by billing data. Rates of each imaging modality for those top 10 APR-DRGs were followed through the study period. Odds ratios of imaging were adjusted for demographics and illness severity. RESULTS For all included APR-DRGs except ventricular shunt procedures and nonbacterial gastroenteritis, the number of children imaged with any modality increased. CT utilization decreased for all APR-DRGs (P values , .001). For each of the APR-DRGs except seizure and infections of upper respiratory tract, the decrease in CT was associated with a significant rise in an alternative imaging modality (P values # .005). CONCLUSIONS For the 10 most common APR-DRGs for which children received CT in 2004,a decrease in CT utilization was found in 2012. Alternative imaging modalities for 8 of the diagnoses were used.
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Affiliation(s)
| | | | - Matthew Hall
- Children’s Hospital Association, Overland Park, Kansas
| | - Evan S. Fieldston
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Brian D. Coley
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rustin B. Morse
- Department of Pediatrics, Children’s Medical Center, Dallas, Texas
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Berrington de Gonzalez A, Kleinerman RA. CT Scanning: Is the Contrast Material Enhancing the Radiation Dose and Cancer Risk as Well as the Image? Radiology 2015; 275:627-9. [PMID: 25997129 DOI: 10.1148/radiol.2015150605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amy Berrington de Gonzalez
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, 6120 Executive Blvd, Bethesda, MD 20892
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Itakura KS, Pillsbury MM, Rodriguez RM. Interruptions of Trauma Resuscitations for Radiographic Procedures. J Emerg Med 2015; 49:231-5. [PMID: 26004852 DOI: 10.1016/j.jemermed.2015.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although x-ray studies provide important diagnostic information during trauma resuscitations, they may also lead to significant interruptions in care. OBJECTIVES We sought to determine the frequency and duration of interruptions for chest x-ray studies (CXR) and pelvic x-ray studies (PXR) and the frequency of lead apron use among providers who exited trauma rooms during resuscitation. METHODS Using a convenience sampling method, we conducted a prospective, observational study from August 2013 to March 2014, enrolling adult trauma patients at a Level I trauma center who received CXR and PXR in the first 30 min of evaluation. An observer stood outside resuscitation rooms and recorded the time elapsed from the first provider exiting the room to the last provider returning. We recorded how many exiting providers wore lead aprons and whether unused aprons were available. RESULTS Of the 156 trauma cases observed, 67.3% were of male patients with a mean age of 52 years (interquartile range [IQR] 34-67 years); 97.4% (184/189) of radiographs resulted in interruptions of trauma evaluation. Mean and median interruption times were 67 s and 50 s, respectively (IQR 25-95) for CXR; 37 s and 27 s, respectively (IQR 16-43) for PXR; and 160 s and 180 s, respectively (IQR 120-180) for combined CXR/PXR. A mean of 3.5 providers (IQR 3-5) left the immediate bedside and exited the room during x-ray studies. Most (91%) providers leaving the room were not wearing lead aprons, and extra aprons were available in the room 91% (167/184) of the time. CONCLUSIONS Radiographic procedures often result in interruptions of trauma resuscitations despite the availability of lead aprons.
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Affiliation(s)
- Kaoru S Itakura
- University of California San Francisco School of Medicine, San Francisco, California
| | | | - Robert M Rodriguez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
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Abstract
OBJECTIVE. Falls are a common cause of emergency department (ED) visits in the United States. We evaluated trends in CT utilization for adult fall patients in the United States from 2001 to 2010. MATERIALS AND METHODS. Using the National Hospital Ambulatory Medical Care Survey, we identified all visits from 2001 to 2010 of adult patients presenting to EDs after falls. This database surveys approximately 500 EDs annually for 4 weeks, providing national estimates on ED resource utilization and outcomes. We studied trends in CT utilization and proportion of visits with life-threatening conditions (intracranial hemorrhage, organ laceration, axial skeletal fractures) after falls. We also studied the association between CT utilization rates and demographic characteristics and admission status. RESULTS. A total of 22,166 unweighted observations representing 73,241,368 visits were identified. The proportion of adult fall patient visits during which CT was performed increased from 11.4% in 2001 to 28.0% in 2010 (p < 0.0001), whereas the proportion of adult fall visits with life-threatening conditions increased from 5.7% to 8.2% (p < 0.0001). On adjusted analysis (adjusting for life-threatening condition and demographic variables), each successive year was independently associated with CT utilization (odds ratio, 1.21 [95% CI, 1.21-1.21]). The odds of CT utilization in 2010 compared with 2001 were 2.62 (95% CI, 2.61-2.62). CONCLUSION. There was a 2.5-fold increase in CT utilization among adult fall patient visits from 2001 to 2010. When demographic and clinical variables were controlled for, increasing year was independently associated with CT utilization. These findings suggest that CT may be overutilized among adult fall patients.
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Emet M, Saritemur M, Altuntas B, Karaca L, Sari FM, Bilgin Y, Kantarci M, Aslan S. Dual-source computed tomography may define cardiac contusion in patients with blunt chest trauma in ED. Am J Emerg Med 2015; 33:865.e1-3. [PMID: 25618764 DOI: 10.1016/j.ajem.2014.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 12/26/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022] Open
Abstract
We report a 20-year-old woman with blunt chest trauma because of a motor vehicle injury who has traumatic asphyxia and hypotension. The diagnosis of blunt cardiac injury was put by using dual-energy computed tomography in the emergency department because other laboratory and imaging modalities were useless. After hospitalization in intensive care unit, she was treated with supportive and antiedema therapy. The patient was extubated on the fifth day and discharged on the ninth day without any sequel. Coexistence of traumatic asphyxia with blunt cardiac injury is rare. Several imaging techniques such as transthoracic and transesophageal echocardiography, contrast-enhanced multislice thorax computed tomography or initial electrocardiogram, and troponin I levels are used to detect the myocardial damage, but diagnostic capability is low. Dual-energy computed tomography is a promising new technology with the ability of defining blunt cardiac injuries and may have an indication in the emergency setting in patients with hemodynamic instability to rule in traumatic cardiac complications especially when electrocardiogram and transthoracic echocardiography are useless in the emergency department.
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Affiliation(s)
- Mucahit Emet
- Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Murat Saritemur
- Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Bayram Altuntas
- Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Leyla Karaca
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fatih Mehmet Sari
- Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Yasin Bilgin
- Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Sahin Aslan
- Department of Emergency Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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