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Morgan B, Prakash K, Mayberry JC, Brickley MB. Thoracic trauma: Clinical and paleopathological perspectives. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:50-63. [PMID: 36219928 DOI: 10.1016/j.ijpp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research. MATERIALS AND METHODS Trends in paleopathological thoracic trauma literature were assessed by evaluating publications from Bioarchaeology International, International Journal of Osteoarchaeology, International Journal of Paleopathology, and American Journal of Biological Anthropology. Clinical publications on thoracic trauma throughout time were also assessed through a PubMed search, and modern prevalence data was found through trauma databases such as the National Trauma Databank. RESULTS Consideration of thoracic trauma involving concomitant injuries is a recent trend in clinical literature and patient care, but paleopathological research on thoracic trauma has been limited. Since thoracic fractures tend to occur in conjunction with other injuries, assessing them together is critical to the interpretation of trauma in the past. CONCLUSIONS Clinical research into thoracic fractures and concomitant injuries provides valuable data for paleopathological research. Evaluating the likelihood and consequences of concomitant injury in skeletal remains provides a more robust understanding of trauma in the past and its impact on past lifeways. SIGNIFICANCE This paper provides a review of current clinical and paleopathological literature on thoracic trauma and demonstrates the importance of moving beyond the analysis of fractures or trauma of single anatomical elements. LIMITATIONS Thoracic bones are often taphonomically altered and differentially preserved leading to difficulty in identifying and interpreting fractures. SUGGESTIONS FOR FURTHER RESEARCH Practical application of the data presented here to archaeological samples will help to advance paleopathological understandings of thoracic trauma.
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Affiliation(s)
- Brianne Morgan
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
| | - Karanvir Prakash
- Virginia Commonwealth University, Department of Orthopedic Surgery, Richmond, VA, USA.
| | - John C Mayberry
- University of Washington, Department of Surgery, Seattle, WA 98195, USA.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
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Age differences in blunt chest trauma: a cross-sectional study. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:123-126. [PMID: 33014086 PMCID: PMC7526491 DOI: 10.5114/kitp.2020.99074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/15/2020] [Indexed: 01/22/2023]
Abstract
Introduction Trauma is the most common cause of presentation to hospital emergency services. After extremity and cranial injuries, blunt thoracic trauma is the third most common injury. Aim In this study, we aimed to present and assess blunt chest trauma in adults aged below 65 and elderly (age ≥ 65). Material and methods In this study, 130 patients (86 young (age 18-64) and 44 elderly (age ≥ 65)) who applied to the emergency department with blunt thoracic trauma between October 2017 and October 2019 were evaluated retrospectively. Results Of the patients, 99 (76.1%) were male, and 31 (23.9%) were female. The mean age was 54.41 ±20.13 years, and the patients were between 18 and 95 years of age. The most common cause of blunt thoracic trauma in the elderly group was a fall (n = 27; 61.3%), while in-vehicle traffic accident was most common in the young group (n = 43; 50%). "Flail chest," which is observed as a complication after multiple rib fractures, was present in 1 patient in the young group and in 10 patients in the elderly group; the difference was statistically significant (p > 0.05). Seven (5.3%) patients died. The mean hospital stay was 5.1 (1-60) days, which was borderline-significantly higher in the elderly group (p = 0.056). Conclusions Due to its life-threatening properties, the detection of blunt thorax trauma is a priority among multiple-trauma patients. For this reason, an aggressive diagnosis and treatment approach is essential in the whole patient group, especially among the elderly.
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Mauf S, Held U, Gascho D, Baumeister R, Flach P, Nguyen-Kim TDL, Thali MJ, Jentzsch T. Flat chest projection in the detection and visualization of rib fractures: A cross-sectional study comparing curved and multiplanar reformation of computed tomography images in different reader groups. Forensic Sci Int 2019; 303:109942. [DOI: 10.1016/j.forsciint.2019.109942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
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Contralateral Traumatic Hemopneumothorax. Case Rep Emerg Med 2018; 2018:4328704. [PMID: 30729046 PMCID: PMC6313992 DOI: 10.1155/2018/4328704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. The following is the case report of a 37-year-old man who was admitted with a sharp wound to the right paravertebral region who developed a left haemopneumothorax due to a tangential course of the injuring agent. Adequate clinical judgment was followed, and several imaging studies were carried out, leading to the diagnosis of traumatic pneumothorax that was contralateral to the described injury.
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Abstract
Introduction Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT) has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3%) and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05). Conclusion MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by radiologists dealing with trauma.
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Affiliation(s)
| | - Serdar Onat
- Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir
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Halat G, Negrin LL, Chrysou K, Hoksch B, Schmid RA, Kocher GJ. Treatment of air leak in polytrauma patients with blunt chest injury. Injury 2017; 48:1895-1899. [PMID: 28495203 DOI: 10.1016/j.injury.2017.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern. PATIENTS AND METHODS Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak. An evaluation of injury pattern, chest wall injuries in particular, duration of air leak, reason for drainage maintenance in place, hospital length of stay, ICU stay, ventilator duration, type of treatment, and the delay to surgical intervention was performed. RESULTS Whereas 4 patients showed severe air leak and were subsequently scheduled for timely surgical intervention, the remaining 50 patients only showed minor air leak. Only 7 patients with minor air leak suffered from prolonged air leak (>5days), which spontaneously resolved in all of them after a mean duration of 7.7days (range 6-12days). Absence of a prolonged air leak resulted in a shorter length of stay and a shorter duration of mechanical ventilation, although no statistical significance was observed. CONCLUSIONS Early spontaneous cessation of most minor air leaks as well as early surgical intervention for severe air leak lead to very satisfactory patient outcomes with a relatively short hospital stay in our patients. We therefore advocate early surgery for lacerations of the pulmonary parenchyma resulting in severe air leak, whereas minor air leaks can usually be treated conservatively.
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Affiliation(s)
- Gabriel Halat
- Department of Trauma Surgery, Medical University Vienna, Vienna General Hospital, Austria.
| | - Lukas L Negrin
- Department of Trauma Surgery, Medical University Vienna, Vienna General Hospital, Austria
| | - Konstantina Chrysou
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
| | - Beatrix Hoksch
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
| | - Ralph A Schmid
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland.
| | - Gregor J Kocher
- Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland
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Piccolo CL, Ianniello S, Trinci M, Galluzzo M, Tonerini M, Zeccolini M, Guglielmi G, Miele V. Diagnostic Imaging in pediatric thoracic trauma. Radiol Med 2017; 122:850-865. [PMID: 28674910 DOI: 10.1007/s11547-017-0783-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/16/2017] [Indexed: 12/17/2022]
Abstract
Thoracic trauma accounts for approximately 14% of blunt force traumatic deaths, second only to head injuries. Chest trauma can be blunt (90% of cases) or penetrating. In young patients, between 60 and 80% of chest injuries result from blunt trauma, with over half as a consequence of impact with motor vehicles, whereas in adolescents and adults, penetrating trauma has a statistically more prominent role. Pulmonary contusions and rib fractures are the most frequent injuries occurring. Chest X-ray is the first imaging modality of choice to identify patients presenting with life-threatening conditions (i.e., tension pneumothorax, huge hemothorax, and mediastinal hematoma) and those who require a CT examination. Multi-Slice Computed Tomography is the gold standard to evaluate chest injuries. In fact, the high spatial resolution, along with multiplanar reformation and three-dimensional (3D) reconstructions, makes MDCT the ideal imaging method to recognize several chest injuries such as rib fractures, pneumothorax, hemothorax, lung contusions and lacerations, diaphragmatic rupture, and aortic injuries. Nevertheless, when imaging a young patient, one should always keep into account the ALARA concept, to balance an appropriate and low-dose technique with imaging quality and to reduce the amount of ionizing radiation exposure. According to this concept, in the recent years, the current trends in pediatric imaging support the rising use of alternative imaging modalities, such as US and MRI, to decrease radiation exposure and to answer specific clinical questions and during the observation period also. As an example, ultrasound is the first technique of choice for the diagnosis and treatment of pleural and pericardial effusion; its emerging indications include the evaluation of pneumothoraces, costocondral and rib fractures, and even pulmonary contusions.
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Affiliation(s)
| | | | | | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Pisa, Italy
| | - Massimo Zeccolini
- Department of Radiology, Santobono Pediatric Hospital, Naples, Italy
| | | | - Vittorio Miele
- Department of Radiology, University Hospital Careggi, L.go Giovanni Alessandro Brambilla, 3, 50134, Florence, Italy.
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Limiting chest computed tomography in the evaluation of pediatric thoracic trauma. J Trauma Acute Care Surg 2016; 81:271-7. [DOI: 10.1097/ta.0000000000001110] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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]
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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.
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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.
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Langdorf MI, Medak AJ, Hendey GW, Nishijima DK, Mower WR, Raja AS, Baumann BM, Anglin DR, Anderson CL, Lotfipour S, Reed KE, Zuabi N, Khan NA, Bithell CA, Rowther AA, Villar J, Rodriguez RM. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study. Ann Emerg Med 2015; 66:589-600. [PMID: 26169926 DOI: 10.1016/j.annemergmed.2015.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/23/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. METHODS Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. RESULTS Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two patients with occult injury (of 1,454, 13.9%) had major interventions, 343 of 1,454 (23.6%) had minor interventions, and 909 (62.5%) had no intervention. Patients with occult injury included 514 with pulmonary contusions (of 682 total, 75.4% occult), 405 with pneumothorax (of 597 total, 67.8% occult), 184 with hemothorax (of 230 total, 80.0% occult), those with greater than 2 rib fractures (n=672/1,120, 60.0% occult) or sternal fracture (n=269/281, 95.7% occult), 12 with great vessel injury (of 18 total, 66.7% occult), 5 with diaphragm injury (of 6, 83.3% occult), and 537 with multiple occult injuries. Interventions for patients with occult injury included mechanical ventilation for 31 of 514 patients with pulmonary contusion (6.0%), chest tube for 118 of 405 patients with pneumothorax (29.1%), and 75 of 184 patients with hemothorax (40.8%). Inpatient pain control or observation greater than 24 hours was conducted for 183 of 672 patients with rib fractures (27.2%) and 79 of 269 with sternal fractures (29.4%). Three of 12 (25%) patients with occult great vessel injuries had surgery. Repeated imaging was conducted for 50.6% of patients with occult injury (88.1% chest radiography, 11.9% chest CT, 7.5% both). For patients with occult injury, 90.9% (1,321/1,454) were admitted, with 9.1% observed in the ED for median 6.9 hours. Forty-four percent of observed patients were then admitted (4.0% of patients with occult injury). CONCLUSION In a more seriously injured subset of patients with blunt trauma who had both chest radiography and chest CT, occult injuries were found by chest CT in 71% of those with thoracic injuries and one fourth of all those with blunt chest trauma. More than one third of occult injury had intervention (37.5%). Chest tubes composed 76.2% of occult injury major interventions, with observation or inpatient pain control greater than 24 hours in 32.4% of occult fractures. Only 1 in 20 patients with occult injury was discharged home from the ED. For these patients with blunt trauma, chest CT is useful to identify otherwise occult injuries.
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Affiliation(s)
- Mark I Langdorf
- Department of Emergency Medicine, University of California-Irvine, Orange, CA.
| | - Anthony J Medak
- Department of Emergency Medicine, University of California-San Diego, La Jolla, CA
| | - Gregory W Hendey
- Department of Emergency Medicine, University of California-San Francisco, Fresno, Fresno, CA
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California-Davis, Davis, CA
| | - William R Mower
- Department of Emergency Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Brigitte M Baumann
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Deirdre R Anglin
- Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Craig L Anderson
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Shahram Lotfipour
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Karin E Reed
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Nadia Zuabi
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Nooreen A Khan
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Chelsey A Bithell
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Armaan A Rowther
- Department of Emergency Medicine, University of California-Irvine, Orange, CA
| | - Julian Villar
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA
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Altoos R, Carr R, Chung J, Stern E, Nevrekar D. Selective Common and Uncommon Imaging Manifestations of Blunt Nonaortic Chest Trauma: When Time is of the Essence. Curr Probl Diagn Radiol 2015; 44:155-66. [DOI: 10.1067/j.cpradiol.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/22/2022]
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Plasma levels of high mobility group box 1 increase in patients with posttraumatic stress disorder after severe blunt chest trauma: a prospective cohort study. J Surg Res 2014; 193:308-15. [PMID: 25016440 DOI: 10.1016/j.jss.2014.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/03/2014] [Accepted: 06/09/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-mobility group box 1 (HMGB1), a key late mediator of systemic inflammation, is a potentially useful biomarker for predicting outcome in patients with severe blunt chest trauma. The purpose of this study was to define the relationship between plasma levels of HMGB1 and posttraumatic stress disorder (PTSD) in patients with severe blunt chest trauma. METHODS All patients with severe blunt chest trauma (abbreviated injury score ≥3) who were admitted to traumatic surgery department and ultimately survived to follow-up at 6 mo were eligible for the study. HMGB1 was sampled every other day from day 1-day 7 after admission, and plasma concentrations of HMGB1 were measured by a quantitative enzyme-linked immunosorbent assay test. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis. RESULTS PTSD was identified in 43 patients including acute PTSD (n = 21), chronic PTSD (n = 18), and delayed-onset PTSD (n = 4) after 6-mo follow-up, in whom significant higher plasma levels of HMGB1 on days three, five, and seven after blunt chest trauma were noted compared with those seen in patients without PTSD (n = 10). Multivariate logistic analysis showed that transfusion, injury severity score, and HMGB1 levels at day 7 were the valuable risk factors for PTSD. CONCLUSIONS In blunt chest trauma, plasma HMGB1 levels were significantly higher in patients with PTSD compared with patients with non-PTSD. Our data indicate that patients with high plasma levels of HMGB1 may be more prone to develop PTSD including acute and chronic PTSD.
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Cummings KW, Javidan-Nejad C, Bhalla S. Multidetector computed tomography of nonosseous thoracic trauma. Semin Roentgenol 2014; 49:134-42. [PMID: 24836489 DOI: 10.1053/j.ro.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kristopher W Cummings
- Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Cylen Javidan-Nejad
- Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Sanjeev Bhalla
- Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.
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Abstract
Blunt thoracic trauma manifests in various ways, depending on the structures injured and type of injury. Commonly manifested as parenchymal contusion, at times, pseudacavitation may also been seen on the chest X ray. They are to be differentiated from other causes of pulmonary cavitations which are often done based on history. The so called pulmonary pseudo cysts usually have a benign course and needs only observation.
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Affiliation(s)
- Neeraj Gupta
- Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
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Bertolaccini L, Rizzardi G, Filice MJ, Spada E, Terzi A. The "ending neglect" of roentgenograms in penetrating chest trauma. J Thorac Dis 2012; 2:197-8. [PMID: 22263046 DOI: 10.3978/j.issn.2072-1439.2010.02.04.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 10/04/2010] [Indexed: 11/14/2022]
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Abstract
OBJECTIVES To develop a system of quantification of shoulder girdle injuries that stratifies their severity and to assess the association between shoulder girdle injuries and associated nonbony injuries to the head, thorax, and great vessels. DESIGN Retrospective review. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Trauma registry data from all patients who required admission to the hospital from October 1995 through January 2008, specifically patients with shoulder girdle injuries. Excluded were patients with isolated burns and late effects of injuries. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The patterns of shoulder girdle injury and their association with severe, nonorthopaedic injuries (head, thoracic, and great vessel). Also, the severity of all combinations of shoulder girdle injuries were observed using two systems (relative risk totals and injury severity score). RESULTS Of 52,924 patients recorded, 2971 had 3811 shoulder girdle injuries. High-energy mechanisms prevailed, causing over 91% of all shoulder girdle injuries. The rates of head, great vessel, and thoracic injury in patients with a shoulder girdle injury were 31.5%, 3.9%, and 36.8%, respectively, and were significant when compared with nonshoulder girdle injuries (P < 0.001). The two most severe injury combinations included a sternum injury with either a clavicle or scapula fracture. CONCLUSIONS Shoulder girdle injuries are strongly associated with great vessel, thoracic, and head injuries. In the presence of a sternum injury with a clavicle fracture or any open clavicle fracture, we recommend the routine use of a contrast-enhanced spiral thoracic computed tomography scan to aid in the diagnosis of a great vessel injury.
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CT imaging of blunt chest trauma. Insights Imaging 2011; 2:281-295. [PMID: 22347953 PMCID: PMC3259405 DOI: 10.1007/s13244-011-0072-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/28/2010] [Accepted: 01/27/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND: Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects. METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted. RESULTS: The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care. CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.
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Chimutengwende-Gordon M, Khan WS, Sidhu J, Longo UG, Maruthainar N. Advanced trauma life support radiographic trauma series: part 2--the chest radiograph. J Perioper Pract 2010; 20:430-435. [PMID: 21265401 DOI: 10.1177/175045891002001202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The chest radiograph is used as a screening test to exclude significant thoracic injuries in cases of major trauma. A systematic approach to reviewing chest radiographs is necessary for accurate interpretation. Radiographic findings should be considered together with clinical assessment.
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Affiliation(s)
- Mukai Chimutengwende-Gordon
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London
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Diagnostic accuracy, biohazard safety, and cost effectiveness-the Lodox/Statscan provides a beneficial alternative for the primary evaluation of patients with multiple injuries. ACTA ACUST UNITED AC 2010; 69:826-30. [PMID: 20938269 DOI: 10.1097/ta.0b013e3181bb86ce] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lodox/Statscan is a new digital X-ray machine with a low dose of radiation exposure that provides rapid, whole-body scans. In the setting of acute trauma management, the importance of image study is well recognized. Here, we report the accuracy of diagnoses made using Lodox/Statscan in patients with multiple injuries. We analyze the cost effectiveness, biohazard safety, and detection rate for treatment using the Lodox/Statscan and evaluate whether it is a viable alternative to the conventional trauma X-ray. METHODS We retrospectively reviewed patients who received a Lodox/Statscan between November 2007 and January 2009. All patients who had received both a Lodox/Statscan and a computed tomographic (CT) scan were enrolled. The CT scan was used to make the final diagnosis. The detection rate for treatment, sensitivity, and specificity of the Lodox/Statscan in diagnosis was analyzed. RESULTS One hundred eighty-four patients were eligible for the study during the 15-month study period. The detection rates for treatment using the Lodox/Statscan for pneumothorax, pelvic fracture, cervical spine injury, and thoracic-lumbar spine injury were 95%, 96.0%, and 57.1%, and 100%, respectively. CONCLUSION In our series, the Lodox/Statscan provided similar quality images and conventional series to the CT scans. Although the Lodox/Statscan missed some injuries, most of the subsequent treatments were not changed. Overall, there were several advantages to using this system, including the short interval of study, low-radiation exposure, and low cost. The Lodox/Statscan could therefore be used as an alternative to the traditional trauma X-ray for evaluation of acute trauma patients.
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Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. Radiographics 2008; 28:1555-70. [PMID: 18936021 DOI: 10.1148/rg.286085510] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Thoracic injuries are significant causes of morbidity and mortality in trauma patients. These injuries account for approximately 25% of trauma-related deaths in the United States, second only to head injuries. Radiologic imaging plays an important role in the diagnosis and management of blunt chest trauma. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician.
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Affiliation(s)
- Rathachai Kaewlai
- Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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24
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Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol 2008; 65:377-88. [DOI: 10.1016/j.ejrad.2007.09.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 09/07/2007] [Accepted: 09/08/2007] [Indexed: 11/21/2022]
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The Prognostic Significance of Pulmonary Contusions on Initial Chest Radiographs in Blunt Trauma Patients. Eur J Trauma Emerg Surg 2007; 34:148-53. [DOI: 10.1007/s00068-007-7027-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 07/14/2007] [Indexed: 10/22/2022]
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Sangster GP, González-Beicos A, Carbo AI, Heldmann MG, Ibrahim H, Carrascosa P, Nazar M, D'Agostino HB. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol 2007; 14:297-310. [PMID: 17623115 DOI: 10.1007/s10140-007-0651-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
This pictorial review discusses multi-detector computed tomography (MDCT) cases of non-vascular traumatic chest injuries, with a brief clinical and epidemiological background of each of the pathology. The purpose of this review is to familiarize the reader with common and rare imaging patterns of chest trauma and substantiate the advantages of MDCT as a screening and comprehensive technique for the evaluation of these patients. Images from a level 1 trauma center were reviewed to illustrate these pathologies. Pulmonary laceration, pulmonary hernia, and their different degrees of severity are illustrated as examples of parenchymal traumatic lesions. Pleural space abnormalities (pneumothorax and hemothorax) and associated complications are shown. Diaphragmatic rupture, fracture of the sternum, sternoclavicular dislocation, fracture of the scapula, rib fracture, and flail chest are shown as manifestations of blunt trauma to the chest wall. Finally, direct and indirect imaging findings of intrathoracic airway rupture and post-traumatic foreign bodies are depicted. The advantage of high quality reconstructions, volume rendered images, and maximal intensity projection for the detection of severe complex traumatic injuries is stressed. The limitations of the initial chest radiography and the benefits of MDCT authenticate this imaging technique as the best modality in the diagnosis of chest trauma.
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Affiliation(s)
- Guillermo P Sangster
- Department of Radiology, LSUHSC-S, 1501 Kings Highway, Shreveport, LA 71130, USA.
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Rivas LA, Múnera F, Fishman JE. Multidetector-Row Computerized Tomography of Aortic Injury. Semin Roentgenol 2006; 41:226-36. [PMID: 16849052 DOI: 10.1053/j.ro.2006.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luis A Rivas
- Department of Radiology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
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Bruckner BA, DiBardino DJ, Cumbie TC, Trinh C, Blackmon SH, Fisher RG, Mattox KL, Wall MJ. Critical Evaluation of Chest Computed Tomography Scans for Blunt Descending Thoracic Aortic Injury. Ann Thorac Surg 2006; 81:1339-46. [PMID: 16564268 DOI: 10.1016/j.athoracsur.2005.11.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2005] [Revised: 10/24/2005] [Accepted: 11/03/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although aortography has been the long-held "gold standard" for diagnosis of traumatic blunt aortic injury, advances in imaging technology offer less-invasive, more-rapid, and potentially more cost-effective evaluation. The purpose of this study was to review this hospital's experience with the screening and diagnosis of blunt aortic injury with emphasis on the critical evaluation of computed tomography (CT) scans for defining descending thoracic aortic injury. METHODS A retrospective single-center analysis of all patients undergoing aortography to evaluate for blunt aortic injury between January 1, 1997, and August 31, 2004, was performed. A policy of relying on CT scans to definitively diagnose blunt aortic injury was not in force, and all patients with positive, equivocal, and negative screening CT scans with significant injury mechanism underwent subsequent aortography; this contributed to an unbiased analysis. A subgroup of patients imaged with the latest generation multislice CT scanners (July 1, 2003, to August 31, 2004) was separately analyzed with rapid three-dimensional reconstruction. RESULTS Of 856 aortograms, 206 (24.1%) were preceded by chest CT scan. Of 31 patients with confirmed aortic injury, 20 had undergone CT scan with 16 positive for definite injury, 3 positive for possible injury, and 1 false-negative study. Of the 206 patients scanned, 114 (55.3%) showed possible injury, 76 (36.9%) were negative, and 16 (7.8%) were positive. Only 3 of the 114 with possible injury (2.6%) were true positives whereas 1 of the 76 negative scans (1.3%) was a false negative and all 16 positive scans were true positives. These data for CT scan imaging result in a sensitivity of 95%, a specificity of 40%, a positive predictive value of 15%, and a negative predictive value of 99%. CONCLUSIONS Chest CT is an acceptable screening tool based on prerequisite high sensitivity and ease of performance in the trauma patient suspected of having a descending thoracic aortic injury. Although the excellent negative predictive value resulted in an algorithm change at this institution, there were a significant number of equivocal scans that required subsequent aortography. Three-dimensional software reconstruction of the aorta can aid in diagnosing blunt aortic injury when findings are equivocal, but there will continue to be artifacts and limitations that require aortography for clarification.
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Affiliation(s)
- Brian A Bruckner
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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Ng CJ, Chen JC, Wang LJ, Chiu TF, Chu PH, Lee WH, Wong YC. Diagnostic value of the helical CT scan for traumatic aortic injury: Correlation with mortality and early rupture. J Emerg Med 2006; 30:277-82. [PMID: 16677977 DOI: 10.1016/j.jemermed.2005.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 04/08/2005] [Accepted: 08/04/2005] [Indexed: 11/28/2022]
Abstract
To evaluate the value of helical computed tomography of the thorax (HCTT) as a definitive tool for diagnosing traumatic aortic injury, this study retrospectively examined 53 patients with blunt thoracic injuries and HCTT during a 5-year period. All CT scans were reviewed for direct signs of aortic injury and correlated with aortography or surgery. Correlations between clinical parameters, as well as combinations of direct signs and individual signs, and mortality were analyzed in all traumatic aortic injury (TAI) cases. Direct signs were seen on the HCTT in 25 cases and 22 had TAI. All false positive results came from the group with only a single direct sign depicted on HCTT. Among individual direct signs examined, intimal flap and luminal thrombus were the most specific (100%), whereas irregular aortic contour was the most sensitive (100%). A combination of > or = 3 direct signs (p = 0.006) and periaortic contrast material extravasation significantly correlated with early rupture and mortality (p = 0.002). In conclusion, intimal flap on HCTT is both the most specific and sensitive sign for TAI. TAI patients with > or = 3 direct signs, including periaortic contrast material extravasation, may not require aortography before immediate surgery.
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Affiliation(s)
- Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Simeone A, Freitas M, Frankel HL. Management Options in Blunt Aortic Injury: A Case Series and Literature Review. Am Surg 2006. [DOI: 10.1177/000313480607200107] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blunt aortic injury (BAI) is a devastating consequence of high-energy trauma. The majority of its victims do not survive; those who do generally have significant associated injury. The standard treatment of BAI has been emergent replacement or repair of the damaged aorta via a posterolateral thoracotomy, with or without perfusion adjuncts. In addition to the substantial morbidity and mortality secondary to multisystem traumatic injuries, patients surviving to reach the operating room have been exposed to the risks related to their surgical treatment, namely death, paraplegia, hemorrhage, transfusion, organ dysfunction, prolonged intensive care unit stays, and extensive rehabilitation requirements. Contributions to the literature over the past several years have provided support for changing practice patterns in the management of BAI. Aggressive control of blood pressure has made it safe to delay high-risk interventions in patients with complex injuries. Advanced perfusion strategies using little or no anticoagulation appear to have positively affected bleeding complications and neurologic risk. Finally, endovascular stent grafting, though not yet rigorously evaluated in BAI, has been shown to be feasible and effective in the short term. This case presentation and literature review will examine treatment options and propose a management algorithm.
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Affiliation(s)
- Alan Simeone
- From the Department of Surgery, Yale University, New Haven, Connecticut
| | - Marilee Freitas
- From the Department of Surgery, Yale University, New Haven, Connecticut
| | - Heidi L. Frankel
- From the Department of Surgery, Yale University, New Haven, Connecticut
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Chen MYM, Miller PR, McLaughlin CA, Kortesis BG, Kavanagh PV, Dyer RB. The Trend of Using Computed Tomography in the Detection of Acute Thoracic Aortic and Branch Vessel Injury after Blunt Thoracic Trauma: Single-Center Experience Over 13 Years. ACTA ACUST UNITED AC 2004; 56:783-5. [PMID: 15187742 DOI: 10.1097/01.ta.0000063407.47520.f7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to review the trend of using chest computed tomography (CT) and aortography in evaluating patients with blunt thoracic trauma. METHODS A total of 85 patients who had blunt aortic injury diagnosed by chest CT, aortography, or both were included in this study. RESULTS Aortography was the dominant modality before 1998, and the use of chest CT has increased to 50% of patients with aortic injuries as of 2001. Isolated aortic, branch vessel, or combined injuries were found in 71 (84%), 11 (13%), and 3 (4%) patients, respectively. All 14 patients with branch vessel injuries were diagnosed by aortography. Ninety-eight percent of patients with aortography were true-positives, and 20% of patients with chest CT had indirect signs of aortic injury. CONCLUSION Our institution has increased the use of chest CT to evaluate blunt thoracic trauma. Patients with indirect signs of aortic injuries shown on chest CT require further evaluation. In our experience, angiography remains the optimal diagnostic modality for evaluating aortic branch vessel injuries.
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Affiliation(s)
- Michael Y M Chen
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1088, USA.
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Affiliation(s)
- Reuven Rabinovici
- Section of Trauma and Surgical Critical Care, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
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Abstract
The introduction of CT imaging in the 1970s revolutionized all aspects of medical care, perhaps nowhere more so than in the evaluation of acutely injured patients. Just as single-slice helical scanning was a great advance over conventional CT, the capabilities of MSCT are proving to be dramatically superior to single-slice methods. Improved contrast bolus imaging, thinner slices, and isotropic voxels should enable the trauma radiologist to identify both major organ system disruption and subtle injuries more promptly. Multiplanar and three-dimensional reconstructions, a forte of MSCT, facilitate rapid communication of disease states with surgeons and others involved in the care of injured patients. In many centers, whole-body CT is beginning to supplant plain films of the chest and spine in the evaluation of severe trauma victims; the cost-effectiveness of such methods is still under evaluation.
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Affiliation(s)
- Luis A Rivas
- Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, West Wing 279, 1611 Northwest 12th Avenue, Miami, FL 33136, USA
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Cleverley JR, Barrie JR, Raymond GS, Primack SL, Mayo JR. Direct findings of aortic injury on contrast-enhanced CT in surgically proven traumatic aortic injury: a multi-centre review. Clin Radiol 2002; 57:281-6. [PMID: 12014874 DOI: 10.1053/crad.2001.0908] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the contrast-enhanced CT findings in surgically proven traumatic aortic injury (TAI). MATERIALS AND METHODS We searched the trauma registries of three academic medical centres from 1994 to 2000 and found 34 patients with surgically proven TAI that received pre-operative contrast-enhanced chest CT. Two chest radiologists recorded by consensus the size and location of direct (pseudoaneurysm, intimal flap) and indirect (mediastinal haematoma) findings of TAI. The imaging findings were correlated with surgical reports. RESULTS Direct findings of aortic injury (pseudoaneurysm or intimal flap) were seen on contrast enhanced CT in all patients and confirmed at surgery. Specifically, a pseudoaneurysm was seen in 33 (97%), presenting either as a focal bulge in 22 (65%) or as more diffuse aneurysmal enlargement in 11 (32%). An intimal flap was identified in 31 cases (91%). A periaortic haematoma was seen in 31 cases (91%). In the three patients without periaortic haematoma, the only indications of aortic injury were a focal pseudoaneurysm in two (6%) and an intimal flap in one (3%). CONCLUSION In this series of surgically proven TAI, direct findings of aortic injury were seen in all cases. Aortic tear occurred without mediastinal haematoma in 9% (3/34) of patients.
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Affiliation(s)
- Joanne R Cleverley
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Malhotra AK, Fabian TC, Croce MA, Weiman DS, Gavant ML, Pate JW. Minimal aortic injury: a lesion associated with advancing diagnostic techniques. THE JOURNAL OF TRAUMA 2001; 51:1042-8. [PMID: 11740248 DOI: 10.1097/00005373-200112000-00003] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the increasing use of high-resolution diagnostic techniques, minimal aortic injuries (MAI) are being recognized more frequently. Recently, we have used nonoperative therapy as definitive treatment for patients with MAI. The current study examines our institutional experience with these patients from July 1994 to June 2000. METHODS All patients suspected of blunt aortic injury (BAI) by screening helical CT (HCT) underwent confirmatory aortography with or without intravascular ultrasound (IVUS). MAI was defined as a small (<1 cm) intimal flap with minimal to no periaortic hematoma. RESULTS Of the 15,000 patients evaluated by screening HCT, 198 (1.3%) were suspected of having BAI. BAI was confirmed in 87 (44%), and 9 (10%) of these had MAI. The initial aortogram was considered normal in five of the MAI patients. The correct diagnosis was made by IVUS (four patients), and video angiography (one patient). One MAI patient had surgery, and two (22%) died of causes not related to the aortic injury. Follow-up studies were done on the six MAI patients that were discharged. In two, the flap had completely resolved, and in one it remained stable. The remaining three patients formed small pseudoaneurysms. CONCLUSION Ten percent of BAI diagnosed with high resolution techniques have MAI. These intimal injuries heal spontaneously and hence may be managed nonoperatively. However, the long-term natural history of these injuries is not known, and hence caution should be exercised in using this form of treatment.
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Affiliation(s)
- A K Malhotra
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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Keough V, Pudelek B. Blunt chest trauma: review of selected pulmonary injuries focusing on pulmonary contusion. AACN CLINICAL ISSUES 2001; 12:270-81. [PMID: 11759554 DOI: 10.1097/00044067-200105000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary injuries resulting from blunt chest trauma remain a common clinical entity for critical care and emergency nurses. In this article, the epidemiology and mechanism of injury most often observed in patients with blunt chest trauma are reviewed. Selected pulmonary injuries are discussed in terms of mechanism of injuries, assessment and diagnostic modalities, standard therapies, and cutting-edge therapies used today with a focus on pulmonary contusion. Many advances and experimental therapies currently used in the management of the patient with severe lung injuries are discussed. A case study is presented highlighting a complicated case of a blunt chest injury resulting in severe pulmonary contusion.
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Affiliation(s)
- V Keough
- Loyola University Chicago, Niehoff School of Nursing, Chicago, Illinois, USA
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