Title: Chest Wall, Lung, and Pleural Space Trauma
Authors: Miller LA
Journal: Radiologic Clinics of North America (2006)
Chest radiographs are useful to identify chest trauma such as mediastinal hematoma, pneumothorax, pulmonary contusion, and
bony trauma but can underestimate the severity of the injury.
Computerized tomography (CT) is often more sensitive than routine chest x-ray and is a useful tool in the trauma patient.
Multidetector CT (MDCT) adds high-quality multiplanar reformations that can be easily obtained and add to the diagnosis and
management of these patients.
Blunt chest trauma can result in serious life-threatening injuries so a high index of suspicion coupled with careful use of imaging
modalities is key to the early identification and treatment of these injuries.
Pulmonary contusion is caused by chest wall compression against the lung, shearing of lung tissue across bony structures, puncture
by rib fracture, or tearing from prior pleural adhesions; it is more evident on CT than radiograph. Figure 1-2
Pulmonary laceration is a traumatic disruption of the lung architecture that results in formation of a cavity that is filled with air or
blood and is also more readily seen on CT than radiography. Figure 3
Pneumothorax occurs in 30-40% of patients after blunt chest trauma, is more easily seen on CT than chest radiography, and may
require treatment with chest tube placement if >20% or if tension pneumothorax develops. Figure 4-7
Hemothorax is seen approximately 50% of patients who sustain blunt chest trauma; CT is helpful in detecting the site of active
bleeding. Figure 9-10
Rib Fractures are the most common skeletal injury in blunt chest trauma, occurring in approximately 50% of patients;
Flail chest occurs when there are at least two fracture sites on each of three or more consecutive rib and traumatic pulmonary
herniation may occur as a result of severe blunt chest trauma. Figure 11-12
Sternal fracture occur in 3-8% of patients with blunt chest trauma, most commonly at the body or manubrium.
Sternoclavicular dislocation are most commonly anterior with posterior dislocations being a cause of serious morbidity. Figure 13
Scapular fractures are typically related to high-velocity motor vehicle collisions and falls and most are treated non-operatively unless
the glenoid or scapular neck are involved.
Scapulothoracic dissociation (STD) is a rare injury that most commonly results from motorcycle collision with the upper extremity
appearing flaccid and pulseless as a result of subclavian or axillary artery and brachial plexus injury or avulsion. Figure 14
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