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Sternal fractures. (a) Axial CT scan (soft-tissue window) shows a sagittally oriented fracture of the manubrium (arrow) with a retrosternal hematoma (arrowheads). (b) Sagittal reformatted CT image (soft-tissue window) obtained in a different patient reveals a transverse fracture of the body of the sternum (arrow) with a retrosternal hematoma (arrowheads). The latter finding is more difficult to appreciate on axial scans.
Source publication
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, m...
Citations
... They are lesions of alveolar walls and blood capillaries that result in alveolar and interstitial hemorrhage. The initial injury promotes a sequence of pathophysiologic events involving inflammation, increased capillary permeability, interstitial edema, ventilation-perfusion mismatch, and decreased lung complacency [4]. The extension of initial lung involvement is associated with patient outcomes [5]. ...
... PC typically presents as ill-defined ground-glass opacities (GGOs) (Fig. 1a) or airspace consolidations (ACs) (Fig. 1b) with a non-segmental distribution [4]. They may be nodular, confluent, or patchy, although the association of these patterns in the same patient is common [7] (Fig. 1c). ...
... After trauma, PC is detected immediately by CT and within 6-24 h by chest radiography. The opacities become more overt during the initial 48 h; then they begin to regress, with complete clearing in 7-10 days [4,14]. If pulmonary opacities are present in initial chest radiography before the expected time of appearance, an alternative diagnosis comprising previous diseases, post-traumatic aspiration, or atelectasis must be considered. ...
Pulmonary contusions and lacerations are the main types of pulmonary parenchymal traumatic lesions. They are responsible for significant morbidity, and mortality. It may be challenging to differentiate them from other causes of pulmonary abnormalities in trauma patients, even using chest radiography. Nevertheless, there are specific computerized tomography findings that allow the better characterization of these entities. They are didactically described and explained here, using illustrative cases from a Brazilian tertiary trauma center. Also, some recent advances and discoveries in the scientific literature are commented on. All emergency radiologists must be familiarized with the findings presented here, providing more specific diagnoses, and better care to usually critical patients.
... Early detection of acute spinal fractures in the emergency setting allows for the appropriate management of these injuries. For at least the recent decade, the multidetector computed tomography (MDCT) has been shown to be a reliable method to assess for spinal fractures (5)(6)(7)(8)(9)(10). Specific spinal reformats with 1-3 mm slices, bone algorithms, and sagittal and coronal reformats can improve the sensitivity for these fractures (11). ...
Purpose
The purpose of this study is to utilize a two-material decomposition to quantify bone marrow edema on a dual-energy computed tomography (DECT) scanner at the cervical, thoracic, and lumbar spine acute fractures in correlation with short tau inversion recovery (STIR) hyperintensity on magnetic resonance imaging (MRI) in comparison with the normal bone marrow.
Materials and methods
This retrospective institutional review board–approved study gathered patients over 18 years old who had acute cervical, thoracic, or lumbar spinal fractures scanned on a DECT scanner. Those who had a spinal MRI done with bone marrow STIR hyperintensity within 3 weeks of the DECT were included. The water (calcium) and fat (calcium) density (mg/cm ³ ) measurements of the region of interest of the bone marrow were obtained at a normal anatomic equivalent site and at the fracture site where STIR hyperintensity was noted on MRI. A statistical analysis was performed using the paired t -test and Wilcoxon signed rank test ( p > 0.05).
Results
A total of 20 patients met the inclusion criteria (males n = 17 males, females n = 3). A total of 32 fractures were analyzed: 19 cervical and 13 thoracolumbar. There were statistically significant differences in the water (43 ± 24 mg/cm ³ ) and fat (36 ± 31 mg/cm ³ ) density (mg/cm ³ ) at the acute thoracic and lumbar spine fractures in correlation with edema on STIR images (both paired t -test <0.001, both Wilcoxon signed ranked test p < 0.01). There were no significant differences in the water (−10 ± 46 mg/cm ³ ) or fat (+7 ± 50 mg/cm ³ ) density (mg/cm ³ ) at the cervical spine fractures.
Conclusion
The DECT two-material decomposition using water (calcium) and fat (calcium) analyses has the ability to quantify a bone marrow edema at the acute fracture site in the thoracic and lumbar spine.
... It is a round or oval cyst, single or multiple, filled with air, blood or both. It is usually surrounded by a contusion in the acute setting (Fig. 21) [37]. ...
Background
Cavitary lung lesions are frequent findings on imaging, with the most common sources being malignancies and infections. They have multiple etiologies and differential diagnoses, which can have overlapping imaging characteristics, posing a diagnostic difficulty.
Main body of the abstract
This article is an educational pictorial essay highlighting the pitfalls and differential diagnoses of lung cavities, and focusing on the typical imaging patterns, the clinical and biological contexts of each etiology, illustrated by images that were extracted from the images archiving system of our radiology department.
Short conclusion
The radiologist should be aware of all etiologies of cavitary lung lesions, including the less frequent ones, and be familiar with their imaging patterns and characteristics, which aids in establishing the diagnosis or, at the very least, narrowing down the evoked diagnoses.
... 16 Computed tomography is good at figuring out the site of tracheal or bronchial injury as tears in the wall directed to the cartilage rings or on the posterior membrane. 13 Sometimes, as an indirect sign, an overall bronchial laceration could be seen in CT scans where lung called fallen lung. 10, 14 ...
... And, when there's a sternal fracture, it can cause a serious mediastinal hematoma. 13 On chest radiography, detecting sternal fractures on the frontal chest X-ray is rare. Lateral X-rays can detect sternal fractures better but have limited diagnostic sensitivity. ...
... Axial CT scans are not useful in detecting sternal fractures because the injury is paralleled to axial CT scans. 10, 13 Regarding the sternoclavicular joint and clavicle, it is rarely affected by blunt thoracic trauma, but a massive blunt trauma in the chest could make sternoclavicular joints dislocate forward or backward. 19 Anterior dislocation could be managed with conservative therapy using closed reduction, while posterior dislocation has a high risk for other vital chest organs such as the lungs, heart, and esophagus. ...
Previous comparative studies revealed that a substantial proportion of blunt chest trauma often goes unnoticed when evaluated \with chest X-rays. The computed tomography scan, therefore, could play an important role in the initial assessment of patients following blunt chest trauma. This review aims to highlight the findings of chest computed tomography scans and compare them to chest radiography in patients with thoracic trauma resulting from blunt trauma. A systematic search across diverse online databases was performed in PubMed, MEDLINE, and Embase databases. The study selection process was guided by inclusion criteria that focused on individuals afflicted with chest injuries following accidents, engaged in a direct comparison of the diagnostic efficacy of chest CT scans and conventional chest X-rays, and was available in English. In the medical literature, chest radiography and CT imaging provide essential insights to guide clinical decision-making. The precise ability to distinguish between typical and atypical indications of damage across both superficial and deeper anatomical structures holds considerable importance during the initial assessment of such cases. A systematic approach, exemplified through the proposed "outside-in" sequence, offers a proficient strategy to evaluate all potential injuries comprehensively. This approach streamlines the evaluation process, ultimately empowering the medical team to promptly and effectively identify and manage these injuries.
... The most common condition following blunt thoracic trauma is rib fractures with a rate of 50% [7]. Morphologically, ribs are classified as typical or atypical. ...
... It accounts for approximately 20% to 25% of all trauma cases and is the third most common cause of death in all ages [1][2][3]. Thoracic trauma occurs in approximately two-thirds of patients with polytrauma [1,[4][5][6]. However, early mortality can exceed 50% when the injuries are severe, such as extensive pulmonary parenchymal injury, tension hemopneumothorax, and tracheobronchial and traumatic aortic injuries [5,7]. ...
... However, in the chest CT era, cystic cavities of pulmonary lacerations can now be identified easily even on initial CT examinations (Fig. 8) [10,11]. Pulmonary lacerations can produce a Swiss cheese appearance when the cavities are numerous and partially filled with hematoma [4,11]. According to Wagner et al. [11], pulmonary lacerations can be classified into four types: compression rupture type that occurs at the central lung, compression shearing type that occurs at the paraspinal lung, rib-penetrating type that occurs at the sites of inwardly displaced fractured ribs, and adhesive lung tear type that occurs randomly at any site of lung adhesion. ...
Radiologists and trauma surgeons should monitor for early killers among patients with thoracic trauma, such as tension pneumothorax, tracheobronchial injuries, flail chest, aortic injury, mediastinal hematomas, and severe pulmonary parenchymal injury. With the advent of cutting-edge technology, rapid volumetric computed tomography of the chest has become the most definitive diagnostic tool for establishing or excluding thoracic trauma. With the notion of "time is life" at emergency settings, radiologists must find ways to shorten the turnaround time of reports. One way to interpret chest findings is to use a systemic approach, as advocated in this study. Our interpretation of chest findings for thoracic trauma follows the acronym "ABC-Please" in which "A" stands for abnormal air, "B" stands for abnormal bones, "C" stands for abnormal cardiovascular system, and "P" in "Please" stands for abnormal pulmonary parenchyma and vessels. In the future, utilizing an artificial intelligence software can be an alternative, which can highlight significant findings as "warm zones" on the heatmap and can re-prioritize important examinations at the top of the reading list for radiologists to expedite the final reports.
... There were no cases of tracheobronchial, esophageal, or cardiovascular injury ( Table 4). This was in accordance with Kaewlai et al. [16] who stated that tracheobronchial injuries are usually rare in day-to-day clinical scenarios as most cases succumb even prior to the arrival in the hospital and from other associated injuries to vital structures. Also, a study by Dua et al. [17] showed no evidence of any cardiac injuries in all of their 88 patients with sternal fractures. ...
Background:
Traumatic injuries to the chest are a frequent cause of mortality among young individuals. Imaging plays a crucial role in the management of thoracic trauma, providing essential details for accurate diagnosis and treatment.
Objective:
To assess the respective contributions of radiography and CT in cases of chest trauma.
Settings and design:
We assessed 64 subjects, gathering findings from both CT scans and radiographic imaging. The results were organized into a table, considering various variables such as subcutaneous emphysema, rib fractures, clavicular fractures, sternal fractures, scapular fractures, vertebral fractures, pneumothorax, pneumomediastinum, hemothorax, lung contusions, diaphragmatic injuries, and lung herniations. We analyzed the incidence and mode of injury for each variable. Additionally, we compared the sensitivity and specificity of radiographs to CT scans.
Results:
The leading cause of chest trauma was road traffic accidents (RTAs) (67.2%). The most common age groups affected were 18-30 years (31.3%) and 30-40 years (25%). Rib fractures (73.4%), contusions (70.3%), and hemothorax (62.5%) were the most frequently observed findings. Comparing the detection rates of contusions, rib fractures, hemothorax/pleural effusions, pneumothorax/pneumomediastinum, radiographs exhibited lower sensitivity than CT scans (p-value < 0.05 for all comparisons).
Conclusions:
In the assessment of trauma patients, chest radiographs continue to serve as the primary screening method, while CT scans are the preferred imaging technique. CT scans are preferable to radiographs in subjects who are clinically stable, providing valuable information. However, for subjects who are unstable, CT scans become even more indispensable, as they offer critical insights into their condition.
... За даними досліджень, у цивільного населення тупа травма є причиною 25 % смертей. Найчастіше вона спричинена дорожньо-транспортною пригодою або нещасними випадками під час будівництва [13]. У цивільного на селення частка пневмотораксу і переломів ре бер є однаковою у структурі травм грудної клітки на відміну від травм, пов'язаних з бойовими діями, але ниж чою частка контузії легень, імовірно, через меншу кількість вибухів [17]. ...
Combat-related thoracic trauma is a significant cause of morbidity and mortality in all military operations. Penetrating, blunt, and explosive wounds are the most common mechanisms of injury. Visualization diagnosis plays a key role in the treatment. This review discusses the visualization signs of chest injuries from blunt trauma and blast trauma. Objective was to study in detail the mechanisms and visualization signs of non-penetrating combat-related thoracic trauma. 235 literature sources were found in the PubMed system by the query Thoracic AND Trauma AND Combat, 34 of which were selected for further detailed study. In modern warfare, thoracic trauma accounts for 8.6—16.0 % of casualties. Chest X-ray and CT are the visualization methods most commonly used in the evaluation of polytrauma patients from combat and peacetime. Chest X-ray can be quickly obtained in a patient with blunt trauma and emergency conditions that include tension pneumothorax, large hemothorax, chest compression, and others. Chest CT is an important component of trauma visualization. Compared to chest X-ray, chest CT identifies 20 % more pathology, and occult chest trauma due to blunt force trauma can be identified in 71 % of patients. CT provides 38—81 % additional diagnoses compared to chest X-ray.Thoracic trauma is often diagnosed in places of combat. As medical imaging technology moves closer to combat areas, this tool is becoming increasingly available to aid in the diagnosis and rapid treatment of combat-related thoracic trauma. Clinical and surgical management of the traumatized patient relies on skills learned in modern civilian training and honed in war. However, imaging of blunt and explosive injuries may be different in civilian and military settings. The distinct injury pattern and atypical imaging findings of blunt trauma and blast lung injury are important to recognize at an early stage because of the severity of this pathology and the impact of an accurate diagnosis on clinical management.We present our own observations of patients who were treated at the Military Medical Clinical Center of the Northern Region (Kharkiv) in 2022 for nonpenetrating combatrelated thoracic trauma.
... The manifestations in the chest CT are patchy airspace opacities and consolidations with non-segmental distribution and subpleural sparing. 4 The radiological manifestation of contusion and lung opacities in chest CT scan of trauma patients with incidental COVID-19 pneumonia is relatively similar. Patchy peripheral consolidation and GGO are common findings among both groups. ...
BACKGROUND: Chest traumas continue to constitute about 30% of all traumas and contribute to 25-50% of trauma-related deaths. COVID-19 has its primary pathophysiologies in the lung, and can worsen the morbidity and mortality of chest trauma if it occurs concomitantly. AIM: To Examine the profile and outcome of chest trauma across the peri-COVID-19 period. MATERIALS AND METHOD: A retrospective analysis of cases of chest trauma in the peri-COVID-19 period (mid-Nov 2019 to mid-March 2022) at GMC Doda. RESULTS: Eighty-five cases of chest trauma met inclusion criteria within the 28 months period, M:F = 7.5:1, age range 3-80years, mean age (38.60±17.40years) and median age of 37years. There were 54 (63.5%0) cases of blunt chest trauma and 31 (36.5%) cases of penetrating chest trauma. Thirty-one (36.5%) patients sustained haemothorax, 9 (10.6%) pneumothorax, 14 (16.5%) haemopneumothorax, 21 (24.7%) rib fractures, and 10 (11.8%) chest wall lacerations. Fifty-one (60%) patients had isolated chest trauma while the remaining 34 (40%) had associated injuries in one or more other organ systems. Closed thoracostomy tube drainage was definitive treatment in 48 (56.5%) patients while emergency thoracotomy was done in 5 (6%) patients. The treatment administered in the remaining 32 (37%) patients included intercostal nerve block for chest pain from rib fractures, wound exploration and wound repair. In the series, 75 (88%) had complete recovery, six (7%) patients left against medical advice, and four (5%) in-hospital mortality was recorded. CONCLUSION: The profile of chest trauma in the peri-COVID-19 period in our centre differed from the pre-COVID-19 years with a higher mortality figure. Management protocol also necessitated certain modifications.
... Rib fractures, as the most frequent complication of blunt thoracic injuries, do not require hospitalization or further treatment at an approximate rate of 75% but may constitute the risk of developing delayed complications such as pneumothorax, haemothorax, or atelectasis (2)(3)(4). Mortality rates up to 30% have been reported for multiple rib fractures resulting in a flail chest and associated extra-thoracic organ injuries (5)(6)(7). Although the principle of management for a great majority of rib fractures involves analgesia and delicate observation of patients, the follow-up of outpatients is crucial to notice the potentially delayed complications. ...
Objective:The rib fracture, which is one of the most common consequences of chest trauma, can cause respiratory distress, and even mortality if not properly treated. There’s still limited data on the length and frequency of follow-ups in terms of the challenges that may arise after an uneventful follow-up. The focus of this research is to standardize the optimal follow-up time in patients with rib fracture.Methods:Patients with isolated chest trauma who were admitted to the Emergency Department or were referred to the Thoracic Surgery Clinic from other hospitals within a year were included in our study. The study did not include any patients who needed thoracic intervention. Rib fracture complications were observed both during and after hospitalization.Results:Complications did not develop in the majority of patients during hospital follow-up and discharge, but haemothorax was the most prevalent (21.4-12.2%) within the first 72 hours and at discharge.Conclusion:Patients with rib fractures who are followed up and discharged may develop fatal consequences. When patients with recent rib fracture present to the emergency department, the emergency room physician should be alert about long-term problems.
