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Fallen lung sign in a traumatic partial bronchial tear: A case report. Respir Med Case Rep 2022; 36:101596. [PMID: 35198368 PMCID: PMC8850795 DOI: 10.1016/j.rmcr.2022.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
The fallen lung sign describes the lung collapse at the dependent region away from the hilum. It is usually a specific sign for complete bronchial tear. We present a case of a young patient post mechanical ventilation for a traumatic head injury with unexpected CT thorax findings of fallen lung secondary to a partial bronchial tear. The patient was managed conservatively with specific ventilator strategy and successfully discharged home. Partial bronchial tear with fallen sign is a very rare cases reported.
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Schibilsky D, Driessen A, White WJ, Lefering R, Paffrath T, Bouillon B, Walker T, Schlensak C, Mutschler M. Traumatic tracheobronchial injuries: incidence and outcome of 136.389 patients derived from the DGU traumaregister. Sci Rep 2020; 10:20555. [PMID: 33239731 PMCID: PMC7688962 DOI: 10.1038/s41598-020-77613-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
To describe the incidence, therapy and outcome of traumatic tracheobronchial injuries (TTBI) in trauma patients with multiple injuries derived from the DGU TraumaRegister. We analyzed the data on all patients listed on the TraumaRegister DGU (TR-DGU) in Germany between 2002 and 2015 aged 16 years or older and with an Injury Severity Score (ISS) of ≥ 9. We analyzed the data on 136,389 trauma patients, 561 of whom had suffered tracheobronchial injuries (0.4%). The majority were male (73.4%) and had a mean age of 43.7 years. In total, 84.0% of all TTBI injuries occurred secondary to blunt trauma, caused mainly by accidents (71.2%). TTBI was accompanied by several concomitant thoracic injuries such as pneumo- (41.2%) and hemothorax (23.2%), lacerations (7.8%) and contusions (32.3%) of the lung, as well as multiple rib fractures (29.6%). The severity of injury was classified via the abbreviated injury scale (AIS): 39.3% with AIS = 3, 51.3% with AIS = 4 and 60% with AIS = 5 patients underwent surgical interventions. The mortality of patients with tracheobronchial injuries was higher: 24.6%, versus 13.7% in all patients (control group). This high percentage reflects their generally severe injury burden through concomitant injuries. The incidence of TTBI in this large cohort of trauma patients is very low. However, its high mortality rate emphasizes its importance. Mortality was associated with higher ISS and AIS scores. Higher rates of concomitant injuries were therefore associated with a higher mortality rate. TTBI injuries revealed a higher rate of progression to surgical management, with 35% undergoing surgery within the first 24 h. This excessive mortality rate demonstrates a high overall injury burden in patients with TTBI and high mortality of associated injuries. A surgical intervention's impact on mortality cannot be assessed in this study, as it would need to be investigated in a case-matched study.
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Affiliation(s)
- David Schibilsky
- University Heart Center Freiburg, Bad Krozingen, Hugstetterstr. 55, 79106, Freiburg, Germany.,Faculty of Medicine, University Freiburg, Freiburg, Germany
| | - Arne Driessen
- Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - William James White
- Department of Trauma and Orthopaedic Surgery, Chelsea and Westminster Hospital, NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Rolf Lefering
- IFOM-Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Köln, Germany
| | - Thomas Paffrath
- Klinik für Orthopädie, Unfallchirurgie & Sporttraumatologie, Krankenhaus Köln Merheim, Universität Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Köln, Germany
| | - Bertil Bouillon
- Klinik für Orthopädie, Unfallchirurgie & Sporttraumatologie, Krankenhaus Köln Merheim, Universität Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Köln, Germany
| | - Tobias Walker
- Universitätsklinik für Thorax-, Herz- und Gefäßchirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Christian Schlensak
- Universitätsklinik für Thorax-, Herz- und Gefäßchirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Manuel Mutschler
- Klinik für Orthopädie, Unfallchirurgie & Sporttraumatologie, Krankenhaus Köln Merheim, Universität Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Köln, Germany
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Wei P, Yan D, Huang J, Dong L, Zhao Y, Rong F, Li J, Tang W, Li J. Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review. BMC Anesthesiol 2019; 19:149. [PMID: 31399024 PMCID: PMC6689158 DOI: 10.1186/s12871-019-0812-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Tracheobronchial lacerations from trauma can be life-threatening and present significant challenges for safe anesthetic management. Early recognition of tracheal injuries and prompt airway control can be lifesaving. Case presentation A 56-year-old man with no significant medical history presented with difficulty breathing after a blunt trauma to his chest to the emergency room and was diagnosed with dislocation of the first rib and tracheal laceration after a chest tomography (CT) study. Subcutaneous emphysema in neck area quickly worsened indicating continuous air leak. Emergent surgical repair was scheduled. General anesthesia with maintaining spontaneous ventilation was performed and a 5.5 mm endotracheal tube was placed under the guidance of flexible bronchoscopy. Depth of anesthesia was maintained to achieve a Bispectral Index Score of 40–60. Once the offending first rib was removed, a 7.5 mm endotracheal tube was inserted distal to the laceration site with the guidance of flexible bronchoscopy. Once confirmed location of the endotracheal tube, cisatracurium was administered intravenously and the patient was managed on mechanical ventilation with interval positive pressure ventilation. The operation was successful and he was transferred to the ICU intubated. He then received elective surgical repairs for sternum fracture, multiple rib fractures and hemopneumothorax under general anesthesia on day 5 after the first surgery and was extubated on postoperative day 7. The subsequent course was uneventful. Comprehensive rehabilitation was done for 2 weeks and he was discharged home on postoperative day 41. Conclusions Early diagnosis and multidisciplinary collaborations are keys to the successful management of this patient. Flexible bronchoscopy is particularly useful in airway management for urgent trachea tracheal laceration repair.
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Affiliation(s)
- Penghui Wei
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Dong Yan
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Lili Dong
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Ying Zhao
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Fei Rong
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Jing Li
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Wenxi Tang
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China.
| | - Jianjun Li
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China.
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Hong SB, Lee JY, Lee J, Choi KB, Suh JH. Right Main Bronchus Rupture Presenting with Pneumoperitoneum. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:216-219. [PMID: 29854669 PMCID: PMC5973221 DOI: 10.5090/kjtcs.2018.51.3.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/10/2023]
Abstract
We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.
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Affiliation(s)
- Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ji Yoon Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kuk Bin Choi
- The 8th Mechanized Infantry Division, The 3rd Republic of Korea Army
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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Saad R, Gonçalves R, Dorgan V, Perlingeiro JAG, Rivaben JH, Botter M, Assef JC. Tracheobronchial injuries in chest trauma: a 17-year experience. ACTA ACUST UNITED AC 2018; 44:194-201. [PMID: 28658339 DOI: 10.1590/0100-69912017002014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/01/2016] [Indexed: 11/22/2022]
Abstract
Objective to discuss the clinical and therapeutic aspects of tracheobronchial lesions in victims of thoracic trauma. Methods we analyzed the medical records of patients with tracheobronchial lesions treated at the São Paulo Holy Home from April 1991 to June 2008. We established patients' severity through physiological (RTS) and anatomical trauma indices (ISS, PTTI). We used TRISS (Trauma Revised Injury Severity Score) to evaluate the probability of survival. Results nine patients had tracheobronchial lesions, all males, aged between 17 and 38 years. The mean values of the trauma indices were: RTS - 6.8; ISS - 38; PTTI - 20.0; and TRISS - 0.78. Regarding the clinical picture, six patients displayed only emphysema of the thoracic wall or the mediastinum and three presented with hemodynamic or respiratory instability. The time interval from patient admission to diagnosis ranged from one hour to three days. Cervicotomy was performed in two patients and thoracotomy, in seven (77.7%), being bilateral in one case. Length of hospitalization ranged from nine to 60 days, mean of 21. Complications appeared in four patients (44%) and mortality was nil. Conclusion tracheobronchial tree trauma is rare, it can evolve with few symptoms, which makes immediate diagnosis difficult, and presents a high rate of complications, although with low mortality.
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Affiliation(s)
- Roberto Saad
- - Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery, São Paulo, São Paulo State, Brazil
| | - Roberto Gonçalves
- - Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery, São Paulo, São Paulo State, Brazil
| | - Vicente Dorgan
- - Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery, São Paulo, São Paulo State, Brazil
| | | | - Jorge Henrique Rivaben
- - Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery, São Paulo, São Paulo State, Brazil
| | - Márcio Botter
- - Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery, São Paulo, São Paulo State, Brazil
| | - José César Assef
- - Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery, São Paulo, São Paulo State, Brazil
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Dancer SC, Van Der Zee J, Kirberger RM. Computed tomographic findings in a Bluetick Coonhound with a longitudinal thoracic tracheal tear. Vet Radiol Ultrasound 2018; 61:E12-E16. [PMID: 29430776 DOI: 10.1111/vru.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/05/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022] Open
Abstract
A 9-year-old intact male Bluetick Coonhound presented for progressive subcutaneous emphysema of 5 days' duration due to a suspected tracheal tear. Cervical computed tomography (CT) and thoracic CT were performed after failure to identify the tracheal tear with tracheoscopy. A longitudinal tracheal tear was identified starting 4.3 cm cranial to the tracheal bifurcation and extending caudally over a distance of 3.6 cm. Severe pneumomediastinum, subcutaneous emphysema, and retroperitoneal gas were also present. A follow-up CT 7 days postoperatively confirmed the successful repair of the tear with partial resolution of the presurgical secondary pathology and the patient recovered uneventfully.
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Affiliation(s)
- Sumari C Dancer
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Johannes Van Der Zee
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Robert M Kirberger
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Ershadi R, Hajipour A, Vakili M. Complete cricotracheal transection due to blunt neck trauma without significant symptoms. J Surg Case Rep 2017; 2017:rjx111. [PMID: 28698792 PMCID: PMC5499895 DOI: 10.1093/jscr/rjx111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/26/2017] [Accepted: 06/02/2017] [Indexed: 12/28/2022] Open
Abstract
Laryngotracheal injuries are relatively rare but their mortality rate is fairly high. Complete disruption of trachea is extremely rare and a systematic approach is needed for early diagnosis and favourable outcome. The patients symptoms and physical signs do not necessarily correlate with the severity of the injuries and this case report highlights it. This is a case report of 25-year-old man who arrived to the emergency department 8 h after a motor accident in which a rope was wrapped around his neck. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed. A computed tomographic scan showed distortion of cricotracheal framework. Flexible bronchoscopy showed cricotracheal transaction. Immediately, the endotracheal tube was advanced distal to the transection site under bronchoscopic guide and then after neck exploration primary end-to-end cricotracheal anastomosis was performed.
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Affiliation(s)
- Reza Ershadi
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Asghar Hajipour
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohamadrahim Vakili
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
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Carillo GAO, Fontan EMG. Traumatic massive tension pneumothorax due to a break in the middle lobe bronchus. Emerg Med J 2014; 31:871. [PMID: 24398171 DOI: 10.1136/emermed-2013-203392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Akiba T. Utility of three-dimensional computed tomography in general thoracic surgery. Gen Thorac Cardiovasc Surg 2013; 61:676-84. [DOI: 10.1007/s11748-013-0336-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Indexed: 02/06/2023]
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Mirka H, Ferda J, Baxa J. Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging 2012; 3:433-49. [PMID: 22865481 PMCID: PMC3443276 DOI: 10.1007/s13244-012-0187-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 07/10/2012] [Indexed: 12/28/2022] Open
Abstract
Background Chest traumas are a significant cause of mortality and morbidity, especially in the younger population.MethodsDiagnostic imaging plays a key role in their management. Multidetector computed tomography (MDCT) is the most important imaging method in this field. Its advantages include especially high speed and high geometric resolution in any plane.ResultsThe method allows us to view large parts of the body with minimal motion artifacts and to create accurate multiplanar and three-dimensional (3D) reformations, which make the diagnosis significantly more accurate. Because of its advantages MDCT has become the first-choice method in high-energy traumas.ConclusionThis article summarises the position of MDCT in the diagnostic algorithm of chest injuries, technical aspects of the examination and imaging findings in traumas of the individual chest compartments. Teaching Points • Diagnostic imaging plays a key role in the management of high-energy chest trauma. • MDCT is the most important imaging method in this kind of injury, as detailed information can be acquired in a short acquisition time. • Multiplanar and three-dimensional (3D) reformattings make the diagnosis significantly more accurate.
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Affiliation(s)
- Hynek Mirka
- Department of Imaging methods, Charles University and University Hospital in Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic,
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Lee EY, Restrepo R, Dillman JR, Ridge CA, Hammer MR, Boiselle PM. Imaging Evaluation of Pediatric Trachea and Bronchi: Systematic Review and Updates. Semin Roentgenol 2012; 47:182-96. [DOI: 10.1053/j.ro.2011.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Soler X, Sell R, Maestre J, Ruiz-Manzano J. Bronchial rupture by an unusual mechanism of thoracic hyperextension. J Emerg Med 2009; 42:535-7. [PMID: 19406603 DOI: 10.1016/j.jemermed.2009.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/27/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheobronchial disruption usually occurs in the setting of blunt chest trauma and may be overlooked due to co-existing injuries and non-specific symptoms. OBJECTIVES Review the mechanism, diagnosis, and therapeutic management of tracheobronchial disruption. CASE REPORT We present a case of a young woman with a bronchial rupture 3 weeks after accidental strangulation. Initial diagnosis was delayed due to the unusual presentation. She presented with acute respiratory failure and hemodynamic collapse after slowly progressive shortness of breath with exertion. CONCLUSIONS This case report provides an overview of the clinical features of bronchial disruption by highlighting the varying degrees of clinical presentation and management. Urgent bronchoscopy is indicated for diagnosis, and surgical intervention for treatment.
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Affiliation(s)
- Xavier Soler
- Department of Pulmonary Medicine, Centro Médico Teknon, Barcelona, Spain
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Moore MA, Wallace EC, Westra SJ. The imaging of paediatric thoracic trauma. Pediatr Radiol 2009; 39:485-96. [PMID: 19151969 DOI: 10.1007/s00247-008-1093-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 10/23/2008] [Accepted: 11/25/2008] [Indexed: 12/30/2022]
Abstract
Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity.
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Affiliation(s)
- Michael A Moore
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Abstract
All original research contributions published in Critical Care in 2007 in the field of respirology and critical care medicine are summarized in this article. Fifteen papers were grouped in the following categories: acute lung injury and acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury, imaging, and other topics.
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Affiliation(s)
- Lorenzo Del Sorbo
- Department of Anesthesia and Intensive Care, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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