MC 622 – Chest emergencies, A-136 A. Thoracic injuries (S.E. Mirvis)
A short preview of lecture A-136 ‘A. Thoracic injuries’, from the session MC 622 ‘Chest emergencies’ at ECR 2014, given by S.E. Mirvis from Baltimore, United States.
Friday, March 7, 14:00 – 14:30 / Room F1
Chest trauma is directly responsible for 25 % of all trauma deaths and is a major contributor in another 50 % of all trauma mortality. Blunt trauma, accounting for 90 % of chest injuries, is the third most common site of injury in polytrauma patients. Plain radiographs still have a role in recognition of some acute thoracic pathology that requires immediate further management, either diagnostically and/or therapeutically, such as tension pneumothorax, major transdiaphragmatic herniation, large hemothorax or obvious mediastinal hematoma. MDCT of the chest is now typically included in a whole body scan with IV contrast to facilitate rapid diagnosis on polytrauma cases using less radiation than selected segmental scans. MDCT is the well-proven diagnostic gold standard for chest injury evaluation. The major advantages of MDCT over other modalities include identification of active bleeding, direct signs of trachea or esophageal injury, direct evidence of major arterial vascular injury, such as pseudoanurysms, pneumo and hemopericardium, location and extent of lung contusion and laceration, and assessment for thoracic spine, shoulder girdle and rib fractures. Diaphragm injuries are well depicted by MDCT, especially on the left by identifying both the torn diaphragm edges, herniation and constriction of abdominal contents at the level of the torn diaphragm (collar sign), and direct contact of herniated structures with the posterior chest wall (dependent viscera). Tracheal injuries are suggested by diffuse and progressive pneumomediastinum, dilated tracheostomy cuff, ectopic endotracheal tube, and direct connection of mediastinal air with the trachea lumen. CT-angiography eliminates the majority of indications for diagnostic catheter angiography.