MR IMAGING OF THORACIC TRAUMA

Evaluation of the multi-slice computed tomography outcomes in diaphragmatic injuries related to penetrating and blunt trauma

PURPOSE

Traumatic diaphragmatic rupture is a diagnostic challenge for both surgeons and radiologists and generally occurs secondary to blunt and penetrating trauma of thoracoabdominal region.

MATERIAL AND METHODS

56 patients who underwent surgical procedure due to blunt or penetrating trauma were included to the study.

RESULTS

There were 37 diaphragmatic ruptures in the left side and 19 patients in the right side. The most common radiological finding was "the direct monitoring of defect" (54,3%).

CONCLUSION

Findings suggestive of diaphragmatic rupture must be carefully evaluated in patients with blunt or penetrating thoracoabdominal trauma.

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients with blunt thoracoabdominal injury (16.23%) were studied. Age range was 8-60 years (mean 34 years). Male-female ratio was 18:1. Various features seen on CT scan were diaphragmatic discontinuity in 13 (68.42%), thickened diaphragm in 10 (52.63%), "collar sign" in 8 (42.10%), visceral herniation in 12 (63.15%), dependent viscera sign in 8 (42.10%), and segmental nonrecognition of the diaphragm in 1 patient (5.88%). Two patients presented with delayed rupture. In the rest mean duration between time of injury and performance of CT scan was 44.35 h (range 3-288 h). Fourteen patients underwent operative management. Sensitivity, specificity, and accuracy of MDCT scan were 100, 93, and 95%, respectively. Three patients (15.78%) expired. MDCT is a highly accurate modality for detecting traumatic diaphragmatic hernia.

Delayed pericardial tamponade after penetrating chest trauma

Delayed pericardial tamponade (PT) after penetrating heart trauma is now a rare condition as a result of advances in medical and surgical management. We report the case of a 32-year-old man with delayed PT after a stab wound from a knife. The initial evaluation was consistent with a traumatic apical myocardial infarction. After an uneventful initial course, the patient developed acute PT, which required emergency surgery. A thrombus was discovered over a laceration in the mid-segment of the left anterior descending artery and a simple suture was performed.

Magnetic resonance imaging of thoracic aortic aneurysm and dissection

MRI is an extremely useful technique for the evaluation of the thoracic aorta. It provides a comprehensive evaluation of all the important structures within the chest and allows for high-resolution imaging of both the aortic lumen and the wall itself. As such, it is a sensitive method for delineating the extent of disease, branch-vessel involvement, and superimposed complications. Technical advances, such as stepped-table MRA and bolus-timing strategies, continue to improve overall image quality. In addition, the recent development of blood-pool contrast agents may further impact the diagnostic yield. Given these facts, MRI is likely to remain a mainstay in this patient population for years to come.