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Vassalou EE, Perysinakis I, Klontzas ME, de Bree E, Karantanas AH. Performance of thoracic ultrasonography compared with chest radiography for the detection of rib fractures using computed tomography as a reference standard. Skeletal Radiol 2024:10.1007/s00256-024-04658-8. [PMID: 38499892 DOI: 10.1007/s00256-024-04658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard. MATERIALS AND METHODS Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann-Whitney U test and Fisher's exact test. RESULTS Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures' detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P < .001) in detecting individual rib fractures. Most fractures involved the 4th-9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries. CONCLUSION Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT.
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Affiliation(s)
- Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece.
- Department of Medical Imaging, General Hospital of Sitia, Xserokamares, 72300, Sitia, Crete, Greece.
| | - Iraklis Perysinakis
- Department of Surgical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
| | - Eelco de Bree
- Department of Surgical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
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Brahme IS, LaRoque MC, Paull TZ, Cole PA. The True-Blue technique: Enhanced chondral assessment of the chest wall. J Orthop Res 2024; 42:678-684. [PMID: 37867256 DOI: 10.1002/jor.25719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
There is a growing understanding and identification of costal cartilage injuries, however, diagnosis of these injuries remains difficult. We present a novel radiodensity based coloring technique, termed the True-Blue technique, to manipulate 3D CT imaging and more accurately diagnose costochondral injuries.
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Affiliation(s)
- Indraneel S Brahme
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota, USA
| | - Michael C LaRoque
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota, USA
| | - Thomas Z Paull
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota, USA
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota, USA
- HealthPartners Orthopaedics & Sports Medicine, Bloomington, Minnesota, USA
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Capelastegui A, Oca R, Iglesias G, Larena JA. MRI in suspected chest wall fractures: diagnostic value in work-related chest blunt trauma. Skeletal Radiol 2024; 53:275-283. [PMID: 37417996 DOI: 10.1007/s00256-023-04399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To describe and analyze MRI findings in suspected early fractures of the chest (ribs and sternum) and assess if this technique can add value in occupational medicine. MATERIALS AND METHODS In this retrospective study, we reviewed 112 consecutive patients with work-related mild closed chest trauma who underwent early thoracic MRI, when there was not a clear fracture on radiograph or when the symptoms were intense and not explained by radiographic findings. MRI was evaluated by two experienced radiologists independently. The number and location of fractures and extraosseous findings were recorded. A multivariate analysis was performed to correlate the fracture characteristics and time to RTW (return-to-work). Interobserver agreement and image quality were assessed. RESULTS 100 patients (82 men, mean age 46 years, range 22-64 years) were included. MRI revealed thoracic wall injuries in 88%: rib and/or sternal fractures in 86% and muscle contusion in the remaining patients. Most patients had multiple ribs fractured, mostly at the chondrocostal junction (n=38). The interobserver agreement was excellent, with minor discrepancies in the total number of ribs fractured. The mean time to return-to-work was 41 days, with statistically significant correlation with the number of fractures. Time to return-to-work increased in displaced fractures, sternal fractures, extraosseous complications, and with age. CONCLUSION Early MRI after work-related chest trauma identifies the source of pain in most patients, mainly radiographically occult rib fractures. In some cases, MRI may also provide prognostic information about return-to-work.
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Affiliation(s)
- Ana Capelastegui
- Department of Radiology, Mutualia, Bilbao, Spain.
- Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain.
| | - Roque Oca
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Osatek Deusto, Bilbao, Spain
| | - Gotzon Iglesias
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Cruces Hospital, Barakaldo, Spain
| | - Jose Alejandro Larena
- Department of Radiology, Mutualia, Bilbao, Spain
- Department of Radiology, Osatek Galdakao-Usansolo, Galdakao, Spain
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Bauman ZM, Binkley J, Pieper CJ, Raposo-Hadley A, Orcutt G, Cemaj S, Evans CH, Cantrell E. Discrepancies in rib fracture severity between radiologist and surgeon: A retrospective review. J Trauma Acute Care Surg 2021; 91:956-960. [PMID: 34407008 DOI: 10.1097/ta.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chest computed tomography (CT) scans are important for the management of rib fracture patients, especially when determining indications for surgical stabilization of rib fractures (SSRFs). Chest CTs describe the number, patterns, and severity of rib fracture displacement, driving patient management and SSRF indications. Literature is scarce comparing radiologist versus surgeon rib fracture description. We hypothesize there is significant discrepancy between how radiologists and surgeons describe rib fractures. METHODS This was an institutional review board-approved, retrospective study conducted at a Level I academic center from December 2016 to December 2017. Adult patients (≥18 years of age) suffering rib fractures with a CT chest where included. Basic demographics were obtained. Outcomes included the difference between radiologist versus surgeon description of rib fractures and differences in the number of fractures identified. Rib fracture description was based on current literature: 1, nondisplaced; 2, minimally displaced (<50% rib width); 3, severely displaced (≥50% rib width); 4, bicortically displaced; 5, other. Descriptive analysis was used for demographics and paired t test for statistical analysis. Significance was set at p = 0.05. RESULTS Four hundred and ten patients and 2,337 rib fractures were analyzed. Average age was 55.6(±20.6); 70.5% were male; median Injury Severity Score was 16 (interquartile range, 9-22) and chest Abbreviated Injury Scale score was 3 (interquartile range, 3-3). For all descriptive categories, radiologists consistently underappreciated the severity of rib fracture displacement compared with surgeon assessment and severity of displacement was not mentioned for 35% of rib fractures. The mean score provided by the radiologist was 1.58 (±0.63) versus 1.78 (±0.51) by the surgeon (p < 0.001). Radiologists missed 138 (5.9%) rib fractures on initial CT. The sensitivity of the radiologist to identify a severely displaced rib fracture was 54.9% with specificity of 79.9%. CONCLUSION Discrepancy exists between radiologist and surgeon regarding rib fracture description on chest CT as radiologists routinely underappreciate fracture severity. Surgeons need to evaluate CT scans themselves to appropriately decide management strategies and SSRF indications. LEVEL OF EVIDENCE Prognostic/Diagnostic Test, level III.
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Affiliation(s)
- Zachary M Bauman
- From the Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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Park SB, Lim CH, Chang WH, Hwang JH, Lee JY, Kim YH, Park JM. Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain. Nuklearmedizin 2021; 61:16-24. [PMID: 34768299 DOI: 10.1055/a-1549-5910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated the diagnostic performance of single photon emission computed tomography (SPECT)/computed tomography (CT) as a combination of functional and anatomic imaging, in patients with unspecified chest wall pain. METHODS Fifty-two patients with unspecified chest wall pain and no history of recent major traumatic events or cardiac disease were included. The number and location of radioactive chest wall lesions were evaluated on both planar images and SPECT/CT. The clinical diagnosis was made based on all of the clinical and imaging data and follow-up information. RESULTS Chest wall diseases were diagnosed in 42 patients (80.8 %). SPECT/CT showed abnormal findings in 35 (67.3 %) patients with positive predictive value (PPV) of 97.1 %. SPECT/CT revealed 56 % more lesions than planar bone scan (P = 0.002) and most of the abnormal radioactive lesions (94.6 %) showed combined morphological changes on the matched CT component. When comparing between age subgroups (< 60 y vs. ≥ 60 y), the prevalence of chest wall disease and diagnosis rate of fracture was significantly higher in the older age group. On SPECT/CT, the older age group showed higher frequency of having abnormal finding (95.8 % vs. 42.9 %, P < 0.001) and significantly more lesions were detected (a total of 189 vs. 32, P = 0.003). CONCLUSION SPECT/CT showed good diagnostic performance and proved to have higher sensitivity, detecting 56 % more lesions than planar bone scan. A negative result could be helpful for excluding pathologic chest wall disease. SPECT/CT might be recommended for integration in to the diagnostic workup in patients with unspecified chest wall pain, especially in patients ≥ 60 y of age, considering the high disease prevalence and the high frequency of positive results.
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Affiliation(s)
- Soo Bin Park
- Department of nuclear medicine, Soonchunhyang University Hospital, Yongsan-gu, Korea (the Republic of)
| | - Chae Hong Lim
- Department of nuclear medicine, Soonchunhyang University Hospital, Yongsan-gu, Korea (the Republic of)
| | - Won Ho Chang
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Yongsan-gu, Korea (the Republic of)
| | - Jung Hwa Hwang
- Department of radiology, Soonchunhyang University Hospital, Yongsan-gu, Korea (the Republic of)
| | - Ji Young Lee
- Nuclear Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea (the Republic of)
| | - Young Hwan Kim
- Department of nuclear medicine, Kangbuk Samsung Hospital, Jongno-gu, Korea (the Republic of)
| | - Jung Mi Park
- Department of nuclear medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Korea (the Republic of)
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Patel NG, Patel DM, Patel MV, Patel MM, Patel TR, Patel SY. Diagnostic Value of Dynamic High-frequency Ultrasound for the Slipping Rib and Twelfth Rib Syndrome: A Case Series with Review. Curr Med Imaging 2021; 17:459-463. [PMID: 33019936 DOI: 10.2174/1573405616666201005114406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND High-frequency ultrasound (HFUS) is a mobile, radiation-free imaging tool for the diagnosis of musculoskeletal disorders. We aim to demonstrate the diagnostic value of dynamic HFUS for undiagnosed lower chest, upper abdomen, and loin pain with this case series. CASE SERIES A cricketer presented with long-standing left-sided dull ache lower chest and upper abdominal pain, aggravated on exertion and leaning forward. His previous laboratory and previous imaging tests were unrevealing. Dynamic HFUS of his left ribs during hooking maneuver demonstrated slipping of the eighth rib over the seventh rib associated with clicking. He also reported tenderness over this region. He was diagnosed with slipping rib syndrome (SRS), and was treated with the eighth nerve block under the HFUS guidance. The second and third cases presented with chronic undiagnosed waxing and waning loin pain despite extensive laboratory and radiological workup. Both patients demonstrated twelfth rib HFUS probe tenderness in a sitting position with a specific movement that reproduced the pain during the dynamic HFUS study. The diagnosis of twelfth rib syndrome (TRS) was confirmed and treated successfully with a local intercostal nerve block. REVIEW OF THE LITERATURE HFUS is the most underutilized imaging tool for the diagnosis of unexplained upper abdominal and lower chest pain syndromes. We identified only a few such reported cases managed with the help of HFUS. CONCLUSION The dynamic HFUS is a valuable imaging modality for the undiagnosed lower chest, upper abdominal, or loin pain.
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Affiliation(s)
- Nalin G Patel
- Department of Radiology, Dr. M.K. Shah Medical College and Research Center, Ahmedabad, India
| | | | | | - Maitri M Patel
- GCS Medical College, and Hospital and Research Center, Ahmedabad, India
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Napier D. Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study. SONOGRAPHY 2019. [DOI: 10.1002/sono.12176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Donna Napier
- Department of Medical ImagingRoyal Brisbane and Women's Hospital Brisbane Australia
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Banga A, Mohanka M, Mullins J, Bollineni S, Kaza V, Huffman L, Peltz M, Bajona P, Wait M, Torres F. Incidence and variables associated with 30-day mortality after lung transplantation. Clin Transplant 2019; 33:e13468. [PMID: 30578735 DOI: 10.1111/ctr.13468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/25/2018] [Accepted: 12/05/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the introduction of the lung allocation score (LAS), sicker patients are prioritized for lung transplantation (LT). There is a lack of data regarding variables independently associated with 30-day mortality after LT. METHODS We queried the UNOS database for adult patients undergoing LT between 1989 and 2014. Patients with dual organ or previous transplantation and those with missing survival data were excluded. Mortality during the first 30 days after LT was the primary outcome variable. RESULTS The yearly trends indicate a statistically significant reduction in the 30-day mortality during the study period (P < 0.001, overall mortality: 5.5%) which has continued in the post-LAS era (P = 0. 014, overall mortality: 3.6%). Among patients with 30-day mortality, "primary non-function" (n = 118, 72.8%) was reported as the most common etiology. Transplant indication of vascular diseases, history of non-transplant cardiac or lung surgery, mean pulmonary pressures >35 mm Hg, disabled functional status, ECMO support, high LAS, ischemic time >6 hours, and blunt injury as the mechanism of donor death are independently associated with 30-day mortality. CONCLUSION The incidence of early mortality after LT continues to decline in the post-LAS era. Apart from the mechanism of donor death and ischemic time, early mortality appears to be primarily driven by the recipient characteristics.
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Affiliation(s)
- Amit Banga
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manish Mohanka
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jessica Mullins
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Srinivas Bollineni
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vaidehi Kaza
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lynn Huffman
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthias Peltz
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pietro Bajona
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Wait
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fernando Torres
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries. Am J Emerg Med 2018; 37:864-868. [PMID: 30287128 DOI: 10.1016/j.ajem.2018.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, the accuracy of bedside thoracic ultrasonography (TUSG) performed by emergency physicians with patients in the supine position was compared with that of thoracic computed tomography (TCT) for the determination of thoracic injuries due to trauma. METHODS Patients who suffered the multiple traumas, whose thoracic trauma was identified on physical examination or TCT imaging were included in the study. TUSG was performed following a physical examination by the emergency physician who managed the trauma patient. Subcutaneous emphysema, pneumothorax, pulmonary contusions (PCs), hemothorax, pericardial effusion and tamponade, sternal and clavicular fractures and rib fractures were identified by TUSG. TCT imaging was performed after the ultrasonography examination was completed. RESULTS Eighty-one patients were included in the study. TCT scans showed subcutaneous emphysema in 16 (19.8%) patients, pneumothorax in 21 (25.9%), PCs in 27 (33.3%), hemothorax in 20 (24.7%), sternum and clavicular fractures in 6 (7.4%) and rib fractures in 21 (25.9%). The sensitivity and specificity of ultrasonography varied for detecting the following pathologies: subcutaneous emphysema (56% and 95%), pneumothorax (86% and 97%), hemothorax (45% and 98%), PCs (63% and 91%), sternal fractures (83% and 97%), clavicular fractures (83% and 100%) and rib fractures (67% and 98%), respectively. CONCLUSION In conclusion, ultrasound was found to be highly specific but only moderately sensitive for the identification of thoracic injuries.
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