8.Chest Trauma

8/9/2019 8.Chest Trauma

1/51

Editors: Collins, Jannette; Stern, Eric J.

Title: Chest Radiology: The Essentials, 2nd Edition

Copyright 2008 Lippincott Williams & Wilkins

> Table of Contents > Chapter 8 - Chest Trama

Chapter 8Chest Trauma

Learning Objectives

!" #$entify a %i$ene$ me$iastinm on a posttramachest ra$iograph an$ state the $ifferential $iagnosisincl$ing aortic'arterial in(ry) *enos in(ry) an$fractre of sternm or thoracic spine+"

2" #$entify an$ $escribe the in$irect an$ $irect signs ofaortic in(ry on contrast-enhance$ chest compte$tomography CT+"

," #$entify) $escribe the featres of) an$ state thesignificance of chronic tramatic pse$oanerysm ofthe aorta on a chest ra$iograph) CT) or magneticresonance imaging"

" #$entify fractre$ ribs) cla*icle) spine) sternm) an$scapla on a chest ra$iograph or CT"

." /ame fi*e common cases of abnormal lngopacification on a posttrama chest ra$iograph or CT"

" #$entify an abnormally positione$ $iaphragm or lossof $efinition of a $iaphragm on a posttrama chestra$iograph an$ sggest the $iagnosis of rptre$$iaphragm"

1" ecogni3e an$ $escribe the signs of $iaphragmaticrptre on a chest CT"

8" #$entify pnemothora4) pnemopericar$im) an$

pnemome$iastinm on a chest ra$iograph or CT"5" #$entify the fallen lng sign on a chest ra$iograph or


2/51

CT an$ sggest the $iagnosis of tracheobronchialtear"

!0" #$entify a ca*itary lesion on a posttrama chestra$iograph or CT an$ sggest the $iagnosis of

laceration %ith pnematocele formation"!!" ecogni3e an$ $istingish bet%een laceration an$

contsion on a chest ra$iograph or CT"

6ach year in the 7nite$ tates) more than ,00)000patients are hospitali3e$ an$ 2.)000 people $ie as a$irect reslt of chest trama !+" Thoracic in(ry accontsfor 2.9 of all tramatic $eaths) an$ sbstantial chesttrama is a factor in .09 of fatal traffic acci$ents 2+":ost of the chest trama seen in ci*ilian poplations isblnt chest trama 509+) sally a reslt of motor*ehicle crashes an$ falls ,+" The inci$ence of penetratingtrama is stabili3ing or $ecreasing) an$ many penetrating%on$s to the chest can be treate$ by tbe thoracostomyalone +"

;fter a patient has been clinically e*alate$ an$stabili3e$) a chest ra$iograph is sally obtaine$" Thesera$iographs are often compromise$ by limite$ e4posrecapability) lo% lng *olmes) poor or absent patientcooperation) obscration of thoracic anatomy by portionsof e4ternal monitoring an$ spport $e*ices o*erlying thepatient) sboptimal patient positioning) an$ magnificationan$ $istortion of the me$iastinm" #n one st$y)

compte$ tomography CT+ %as sperior to spine chestra$iography in sho%ing fin$ings of chest trama) an$ theCT fin$ings inflence$ patient management in asignificant nmber of patients .+" This chapter re*ie%sthe chest ra$iographic an$ CT fin$ings of blnt trama tothe chest"

Aortic and reat !essel "njur#

Tramatic rptre of the aorta alone acconts for !9 offatalities reslting from motor *ehicle crashes) an$ 8.9


3/51

to 509 of patients %ith tramatic aortic rptre $iebefore reaching a me$ical facility +" #n clinical series)509 of aortic rptres occr at the aortic isthms) (st$istal to the origin of the left sbcla*ian artery 1)8)5)!0+


4/51

lympha$enopathy) an$ persistent left-si$e$ sperior *enaca*a !2+"

=otential pitfalls in CT interpretation incl$ehemome$iastinm case$ by sternal or *ertebral bo$y

fractre) left pleral effsion %ith left lo%er lobesbsegmental atelectasis ?@srron$ing? the aorta)plsation artifacts) atherosclerotic plaAes) prominent$cts arterioss) an$ pse$ointimal flaps secon$ary to*olme a*eraging of the left brachiocephalic *ein

as it crosses in front of the aortic arch" These pitfallsha*e become less of a problem %ith the se of

mlti$etector CT an$ fast scanning techniAes"

="!2

$"%&E '(). Aortic laceration. A:;nteroposterior

;=+ spine chest ra$iograph of a yong %oman aftera motor *ehicle crash sho%s nonspecific %i$ening ofthe me$iastinm" *:;ortogram sho%s aorticlaceration at the aortic isthms arrow+) the mostcommon site of aortic in(ry in patients %ho sr*i*e toreach a me$ical facility" eprinte$ %ith permissionfrom Collins B" Chest trama imaging in the intensi*ecare nit" Respir Care. !555!5+D!0?E!0,"+


5/51


6/51

%eeks to months to resol*e) sometimes %ith resi$alscarring


7/51

TA*LE '() CEST &A-"O&A+"CS"S O$ AO&T"C "J%&/

Wi$ening of the me$iastinmFbscration of the aortic arch;bnormal aortic contorJemothora4ib fractresTracheal shift to the rightLeft apical cap

Kepression of the left mainstem bronchs belo% 0$egrees/asogastric tbe $isplacement to the right=nemothora4=lmonary contsionWi$ene$ left paraspinos line


8/51

$"%&E '(0. -escending aortic laceration. A:;=spine chest ra$iograph sho%s $iffse opacity of bothhemithoraces" *:CT image sho%s periaortichematoma H+ an$ irreglar contor of the $escen$ingaorta arrow+" Coronal 1C2an$ sagittal 1-2reformatte$ CT images sho% a pse$oanerysm of the$escen$ing aorta arrows+"


9/51

$"%&E '(3. 4ediastinal hematoma. A:;= spine

chest ra$iograph of a patient in*ol*e$ in a motor*ehicle crash sho%s nonspecific %i$ening of theme$iastinm" *:CT scan sho%s bloo$ in theme$iastinm H+" /ote the preser*ation of a fat planebet%een the me$iastinal bloo$ an$ the normal aorta)%hich in the absence of sternal or spine fractrein$icates that the blee$ing %as *enos an$ notarterial"


10/51

$"%&E '(5. Aortic laceration. A:;= spine chest

ra$iograph of a patient in*ol*e$ in a motor *ehiclecrash sho%s a %i$e me$iastinm an$ an abnormalaortic contor" The trachea is $isplace$ to the right"*:CT scan sho%s bloo$ srron$ing the aorta) along%ith $isrption of the aorta at the le*el of the isthmsarrow+" C:agittal reformatte$ CT sho%s an aorticpse$oanerysm arrows+"


11/51

$"%&E '(6. 4ediastinal 7at. A:CT chest scot *ie%sho%s a %i$e me$iastinm" *:;4ial CT sho%sabn$ant me$iastinal fat F+) some normal lymph

no$es) an$ no aortic in(ry or me$iastinal mass"

$"%&E '(8. Lung laceration. A:;= spine chestra$iograph of a patient in*ol*e$ in a motor *ehicle

crash sho%s a %i$e pper me$iastinm an$ lack of$efinition of the aortic arch" *:CT sho%s airspaceopacity %ith central lcency) consistent %ith lacerationan$ pnematocele formation) a$(acent to the pperme$iastinm arrow+"


12/51

Tracheobronchial "njur#The inci$ence of tracheobronchial in(ry TH#+ is reporte$as 0"9 to !".9 in clinical series of ma(or blnt trama

2.+" Hlnt trama mst be se*ere to case air%ayrptre) an$ in(ry to other strctres sch as thethoracic cage) lngs) an$ great *essels is likely" When theintrathoracic trachea or bronchi are in(re$) the aorta isthe most commonly associate$ in(re$ strctre 2+" TH#is associate$ %ith a ,09 o*erall mortality

rate) mostly from associate$ in(ries 21+"


13/51

$"%&E '('. Concurrent subclavian arter# and

aortic injuries. A:;= spine chest ra$iograph of apatient in*ol*e$ in a motor *ehicle crash sho%s a %i$epper me$iastinm arrows+ an$ left%ar$ shift of thetrachea" *:CT scan sho%s me$iastinal hematoma H+an$ pse$oanerysm of the right sbcla*ian arteryarrow+" C:Coronal reformatte$ CT scan sho%s a rightsbcla*ian artery pse$oanerysm arrow+ (stbeyon$ its origin from the right brachiocephalic

artery" -:; more posterior coronal reformatte$ imagesho%s an acte laceration of the aorta arrow+"


14/51

$"%&E '(. +ulmonar# contusion. A:CT scan of a

-year-ol$ boy after a motor *ehicle crash sho%sbilateral peripheral areas of airspace opacity) anopacifie$ accessory a3ygos lobe) an$ a rightpnemothora4" *:CT at a le*el inferior to 1A2sho%sbilateral peripheral) nonsegmental areas of airspaceopacity typical of plmonary contsions" eprinte$%ith permission from Collins B" Chest trama imagingin the intensi*e care nit" Respir Care.!555!

5+D!0?E!0,"+


15/51

$"%&E '()


16/51

arrows+) representing resi$al scarring"

$"%&E '()). +ulmonar# laceration.CT scan of apatient in*ol*e$ in a motor *ehicle crash sho%s $enseopacity in the right lng %ith central lcenciesarrows+) consistent %ith laceration an$ pnematocele

formation an$ srron$ing hemorrhage" /ote a largeright pnemothora4 P+"

$"%&E '()0. +ulmonar# laceration.CT scan sho%s

a lo%-$ensity area %ith an air?Efli$ le*el in the rightpara*ertebral area arrow+) typical of a shearing type


17/51

ptre of the cer*ical trachea may occr as a?@clothesline in(ry? %hen the neck is e4ten$e$ onhigh-spee$ contact %ith ropes) %ires) or cables byin$i*i$als ri$ing many types of recreational *ehicles orrnning" Tracheal laceration may also occr in a motor*ehicle crash %hen the neck of a $ri*er strikes the top ofthe steering %heel) compressing the air%ay against the

of plmonary laceration" This shol$ not be confse$%ith a loclate$ pnemothora4"

$"%&E '()3. $at emboli=ation s#ndrome. A:;=spine chest ra$iograph of a yong %oman shortlyafter a motor *ehicle crash sho%s clear lngs" The

patient sstaine$ mltiple long bone fractres thatreAire$ open re$ction an$ internal fi4ation" /ote thehigh position of the en$otracheal tbe arrow+" *:;=spine chest ra$iograph obtaine$ 12 hors later sho%sbilateral airspace opacities) %ith a perihilar an$basilar pre$ominance) an$ sparing of the lng apices"eprinte$ %ith permission from Collins B" Chesttrama imaging in the intensi*e care nit" Respir

Care.!555 !5+D!0?E!0,"+


18/51

spine"

=athologically) tracheal in(ry most commonly presents asa trans*erse tear bet%een the tracheal rings or a

longit$inal tear in the posterior membranos segment"Complete separation of the trachea may occr) bt air%aycontinity can still be maintaine$ by peritracheobronchialtisse" #n(ry to the me$iastinal trachea or ma(or bronchipro$ces

pnemome$iastinm that rapi$ly e4ten$s into the neckan$ face) shol$ers) an$ chest %all


19/51

%ith rib fractres" =nemothora4 is seen in 09 to !009of cases of TH# ,0+) bt it may not be present if theoter a$*entitial slee*e of the bronchs remains intactan$ there is no air leak ,!+" #n most cases)

pnemothoraces %ill respon$ to chest tbe placement) sore-e4pansion of the lng $oes not e4cl$etracheobronchial in(ry" Jo%e*er) a pnemothora4 that$oes not resol*e %ith fnctioning tbe $rainage is thesine Aa non of me$iastinal air%ay in(ry ,2+"

$"%&E '()6. Acute tracheal injur#. A:CT scan ofa patient in*ol*e$ in a motor *ehicle crash sho%s anen$otracheal tbe %ithin the trachea solid arrow+ an$a cr*ilinear collection of air posterior to the trachea

dashed arrows+" *:CT scan at a more inferior le*el


20/51

;n in$ication of tracheal tear is ele*ation of the hyoi$bone abo*e the le*el of C,) as seen on a lateralra$iograph of the cer*ical spine ,,+" This occrs as areslt of in(re$ infrahyoi$ msclatre) casingnoppose$ ele*ation of the hyoi$ bone by sprahyoi$msclatre" ;nother sign of tracheal transection is acteo*er$istension of the en$otracheal tbe cff) to the point%here it e4cee$s the normal $iameter of the trachea


21/51

!19 to 09 ha*e highly sggesti*e ra$iographic fin$ings)1)8+" Chest ra$iographic fin$ings of rptre incl$ea normal appearing $iaphragm) pnemothora4)

$isplacement of stomach) li*er) spleen) colon) or smallbo%el into the thora4


22/51


23/51

C:CT at a le*el inferior to 1*2sho%spnemome$iastinm) %ith air otlining the aorta)sperior *ena ca*a) plmonary artery) an$ thyms"

$"%&E '()'. $allen lung sign. CT of a patient %ithan acte tramatic fractre of the right main bronchssho%s a large right pnemothora4 P+) a right chest

tbe arrow+) an$ collapse$ ?@fallen right lng?

FL+ positione$ in the posterior an$ lateral righthemithora4" /ormally %ith pnemothora4) thecollapse$ lng recoils in%ar$ to%ar$ the hilm"

$"%&E '(). $ractured bronchus intermedius.CT


24/51

of a yong %oman in*ol*e$ in a motor *ehicle crashsho%s leakage of air from a fractre$ bronchsinterme$is to the pleral space arrows+ an$

me$iastinm arrowheads+) reslting in pnemothora4an$ pnemome$iastinm) respecti*ely" eprinte$%ith permission from Collins B" Chest trama imagingin the intensi*e care nit" Respir Care.!555!5+D!0?E!0,+"

$"%&E '(0


25/51

$"%&E '(0). -iahragm ruture.;= spine chestra$iograph of a patient in*ol*e$ in a motor *ehiclecrash sho%s a mass in the left lo%er hemithora4representing herniate$ non?Eair-fille$ stomach)sperior $isplacement of an intragastric nasogastrictbe arrow+) an$ right%ar$ shift of the me$iastinm"

TA*LE '(0 &A-"OLO"C $"-"SO$ -"A+&A4 &%+T%&E

Findings on chest radiographyKisplacement of stomach) li*er) spleen) colon) or

small bo%el into the thora4perior $isplacement of an intragastric

nasogastric tbe#psilateral pleral effsionHasilar opacity casing inability to *isali3e the

$iaphragm#rreglar or lmpy $iaphragm contor


26/51

Kirect signsDKiaphragmatic $iscontinity#ntrathoracic herniation of ab$ominal contents

Waistlike constriction of bo%el ?@collarsign? +

Kepen$ent *iscera sign#n$irect signsD

Li*er lacerationJemoperitonemJemothora4plenic lacerationenal contsionLo%er lobe atelectasisLo%er rib fractres

="!,

$"%&E '(00. %nreaired diahragm ruture. A:


27/51

:lti$etector CT has been sho%n to be sefl in makingthe $iagnosis of acte $iaphragm rptre) an$ it issperior to con*entional CT becase *olmetric $ataacAisition pro*i$es high-Aality sagittal an$ coronalreconstrctions" ;cAisition of $ata $ring a singlebreath-hol$ $ecreases slice misregistration .0+"#n$i*i$al $iagnostic sensiti*ity for $etecting

$iaphragmatic rptre on CT scanning is .9 to 1,9)an$ specificity is 89 to 509 .!+" :ost in(ries in*ol*ethe posterolateral aspect of the $iaphragm" Kirect CTfin$ings associate$ %ith acte rptre incl$e$iaphragmatic $iscontinity


28/51

normal increase in $iaphragmatic $efects %ith age that isnot relate$ to trama .,+


29/51


30/51


31/51

conseAence"

+leural 4ani7estations o7 ChestTrauma=nemothora4 is seen on chest ra$iography in almost09 of patients %ith blnt chest trama an$ in p to209 of patients %ith penetrating chest in(ries .5)0+"The most common case in blnt t rama is assme$ to bea rib fractre that penetrates the *isceral pleraho%e*er) pnemothora4 in the absence of rib fractres isoccasionally seen in a$lts an$ is commonly seen inchil$ren" =leral air %ill rise to the most non$epen$entportion of the thora4D at the ape4 in the pright patientan$ at the anterior) ca$al aspect of the pleral space inthe spine patient" a$iographic signs of pnemothora4in the spine patient incl$e a+ the $eep slcs sign)%hich is a $eep) lcent costophrenic slcs


32/51

an$ posterior aspects of the hemi$iaphragm" CT is mchmore sensiti*e for $iagnosing pnemothora4 in the spinepatient than is chest ra$iography !)2+ an$ i$entifiespnemothoraces that cannot be seen on con*entional

spine ra$iographs in !09 to .09 of patients %ho ha*esstaine$ blnt trama to the chest !)2),+"

$"%&E '(08. &ib 7ractures and 7lail chest. CT of apatient in*ol*e$ in a motor *ehicle crash sho%s aloclate$ right hemothora4) right chest %allhematoma) an$ nmeros fractre$ right ribs"


33/51

=nemome$iastinm may occr in association %ithpnemothora4" #t can be $iagnose$ on chest ra$iographsby the

presence of abnormal lcencies in the me$iastinm thathighlight the contors of the aorta an$ plmonary arteryan$ $isplace the me$iastinal plera laterally) an$ by the?@continos $iaphragm sign)? %hich is pro$ce$ bythe presence of air bet%een the pericar$im an$ the$iaphragm" =nemome$iastinm can be easily i$entifie$on chest CT an$ may signal the presence of an n$erlyinglaceration of the pharyn4) esophags) or tracheobronchial

air%ay"

$"%&E '(09. Sternal 7racture.CT sho%s acomminte$ fractre of the sternm arrow+ an$retrosternal hematoma H+" /ote preser*ation of the

fat plane bet%een the hematoma an$ the great*essels"

="!,

$"%&E '(0'. Sternal 7racture.agittal reformatte$CT sho%s a fractre of the sternm arrow+ an$posterior $isplacement of the inferior fractre

fragment from the manbrim"


34/51

=leral effsions that $e*elop in the acte posttramaticsetting sally represent hemothora4) an$ a rapi$lye4pan$ing pleral effsion is most likely to be case$ byarterial blee$ing" CT can be helpfl in $istingishinghematoma from other pleral collections by sho%ing thehigh CT attenation of bloo$ +


35/51

$"%&E '(3


36/51


37/51

Cardiac TraumaThe heart an$ pericar$im are fairly %ell protecte$ fromnonpenetrating in(ry) an$ $ocmente$ tramatic in(ryis ncommon" The chest ra$iograph plays a relati*elyminor role in the e*alation of myocar$ial in(ry" #tsgreatest *ale is in $etecting associate$ in(ries) sch as

rib fractres) sternal fractres) an$ plmonary contsion"

ra$iograph sho%s a large left apical) lateral) an$basilar pnemothora4 an$ associate$ right%ar$ shiftof the me$iastinm"

$"%&E '(33. -ee sulcus sign" ;= spine chestra$iograph sho%s a large left basilar pnemothora4arrows+ $espite a left chest tbe" This case illstratesthe importance of incl$ing the entire lng base on

spine chest ra$iographs" Fther%ise) the presence orsi3e of a large basilar pnemothora4 may not be


38/51

api$ accmlation of bloo$ in the pericar$ial space cancase car$iac tampona$e an$ se*ere hemo$ynamiccompromise" He$si$e sonographic e*alation of the heartis the metho$ of choice to Aickly an$ nonin*asi*ely$etect pericar$ial fli$" CT is also *ery sensiti*e for

$etecting pericar$ial fli$ an$ may in$icate pericar$ialhemorrhage) as $etermine$ by the high CT attenation ofthe fli$


39/51

*al*e apparats can reslt in congesti*e heart failre":itral regrgitation from the latter may case asymmetricplmonary e$ema) classically of the right pper lobe as areslt of the $irection of the regrgitant (et"

=nemopericar$im can occr %hen air enters throgh apericar$ial $isrption in the presence of pnemothora4


40/51

Car$iac contsion may reslt from blnt chest trama in89 to 19 of patients .)+" The $iagnosis is sallyma$e from electrocar$iography) nclear car$iac imaging)or echocar$iography" The right *entricle is the mostfreAently in(re$) as it comprises almost three timesmore e4pose$ anterior srface of the heart than $oes theleft *entricle !+" Chest ra$iography an$ CT can sho%seAelae of car$iac contsion) sch as congesti*e heartfailre) *entriclar anerysm) or massi*e car$iacenlargement"

Esohageal "njur#6sophageal tears are more common in patients %ithpenetrating trama an$ occr in fe%er than !9 of blnttrama cases 1+" Thoracic esophageal tears fromtrama are case$ almost e4clsi*ely by gnshot %on$s!+" 6sophageal $isrption can occr from crshing ofthe esophags bet%een the spine an$ trachea) traction

from hypere4tension) an$ $irect penetration by cer*icalspine fractre fragments 8+" :ost tears occr in thecer*ical an$ pper thoracic esophags) bt they also mayoccr (st abo*e the gastroesophageal (nction" Thethoracic esophags lies to the left of the trachea at thethoracic inlet bt mo*es to the right as it passesposterior to the aortic arch at the le*el of the carina" Theesophags crosses back to the left as it enters the

stomach" ;ccor$ingly) rptres of the mi$- to $istalesophags sally present %ith a right-si$e$ pleral

chest ra$iograph of a patient in*ol*e$ in a motor*ehicle crash sho%s air srron$ing the heart P+"/ote right pnemothora4) bilateral parenchymal

opacification) an$ bilateral sbctaneos emphysema"*:CT sho%s pnemopericar$im P+) bilateralpnemothoraces) pnemome$iastinm) pleraleffsion) an$ sbctaneos emphysema"


41/51

effsion) an$ effsions case$ by rptre at thegastroesophageal (nction occr more commonly on theleft"

Chest ra$iography in patients %ith esophageal rptrecan sho% persistent se*ere pnemome$iastinm orpnemothora4) pleral effsion) a %i$ene$ paraspinalline) an$ retrocar$iac lng opacification" CT scans cansho% similar fin$ings) in a$$ition to leakage of oralcontrast from the $isrpte$ esophags into theme$iastinm or pleral space an$ changes ofme$iastinitis" The areas of greatest esophageal

thickening on CT often

$"%&E '(39. *roncho(leural(cutaneous 7istula.

A:;= pright chest ra$iograph of a 25-year-ol$ manin*ol*e$ in a motor *ehicle crash sho%s mltiple rightrib fractres creating a ?@flail chest)? pleralopacification consistent %ith hemothora4) opacificationof the right lng from parenchymal in(ry) an$nmeros collections of air %ithin the soft tisses ofthe right chest %all arrows+" *:CT sho%scommnication bet%een the air%ays an$ chest %allhematoma arrows+" eprinte$ %ith permission fromCollins B" Chest trama imaging in the intensi*e carenit" Respir Care.!555 !5+D!0?E!0,"+


42/51

represent the le*el of perforation" The perforation itself)ho%e*er) may be obscre$ by e$ema) an$ hemorrhagean$ is sally not *isali3e$" The $iagnosis is confirme$

at floroscopy sing %ater-solble contrast material or%ith en$oscopy"

So7t Tissue "njuries o7 the Chest?allThe chest %all has a rich *asclar net%ork establishe$ bythe intercostal an$ internal mammary arteries" ibfractres can lacerate intercostal arteries or *eins) tear

intercostal mscles) or reslt in blee$ing from the ra%srface of the bone" #n a$$ition) branches of the lateralthoracic artery that spply the pectoral mscles an$anastomose %ith chest %all *essels can be lacerate$ an$blee$" ; large amont of bloo$ can collect in thesbctaneos or e4trapleral spaces of the chest)especially in the el$erly becase of skin an$sbctaneos tisse la4ity" CT scanning can easily

$istingish chest %all from parenchymal or me$iastinalin(ry) %hereas this $ifferentiation may not be possible%ith chest ra$iography" Fn CT) soft tisse hematomas ofthe chest %all are rea$ily $istingishe$ from parenchymalin(ry) an$ sbctaneos air is $istingishe$ frompnemothora4" CT scanning sho%s broncho-pleral-ctaneos fistlae) %hich may not be appreciate$ on thechest ra$iograph


43/51

gol$ stan$ar$ for the $iagnosis of acte aortic in(ry" CTpro*i$es a look at the entire chest in a$$ition to theaorta) %hich is a $istinct a$*antage o*er con*entionalaortography" #n a$$ition to sho%ing fractres) CT also

sho%s relate$ soft tisse in(ries) sch as great *esselin(ry from fractre-$islocation of the cla*icle an$splenic'li*er laceration from a$(acent rib fractres" #nsome cases) CT sho%s $irect signs of t racheobronchial)esophageal) or $iaphragmatic in(ry" Chest CT can beperforme$ Aickly on all trama patients %ho are referre$for ab$ominal CT as a means of $etecting serios chestin(ries early"

&e7erences

!" shettry M) Holman :" Chest trama";ssessment) $iagnosis) an$ management" Clin ChestMed.!55!.D!,1?E!"

$"%&E '(3'. *reast hematoma.CT of a %omanin*ol*e$ in a motor *ehicle crash sho%s a high-attenation collection of bloo$ in the right breastarrows+) a reslt of shearing stress pro$ce$ by a

seat belt"


44/51


45/51

!!" :ir*is 6) Hi$%ell B) H$$emeyer 67) et al" Maleof chest ra$iography in e4cl$ing tramatic aorticrptre" Radiology. !581!,D81?E5,"

!2" Jarley K=) :ena #" Car$iac an$ *asclar seAelaeof sternal fractres" Tra!ma.!582D..,?E..."

!," =armley C


46/51

2!" Toombs HK) an$ler C:) Lester G" Compte$tomography of chest trama" Radiology.!58!!0D1,,?E1,8"

22" Wagner H) Cra%for$ WF Br) chimpf =="Classification of parenchymal in(ries of the lng"Radiology. !588!1D11?E82"

2," Joff B) hotts K) 6$$y M;) :orris B; Br" Ftcomeof isolate$ plmonary contsion in blnt tramapatients" (m "!rg. !550D!,8?E!2"

2"


47/51

ma(or bronchi" Thorac Cardio&asc "!rg.!5.5,8D.8?E80"

,!" Chesterman BT) atsangi =/" ptre of the

trachea an$ bronchi by close$ in(ry" Thora).!52!D2!?E21"

,2" elly B=) Webb W) :ol$er =M) et al" :anagementof air%ay trama" #" Tracheobronchial in(ries" (nnThorac "!rg.!58.0D..!?E..."

,," =olansky ;) esnick K) offerman ;) Ka*i$son

T:" Jyoi$ bone ele*ationD a sign of trachealtransection" Radiology. !58!.0D!!1?E!20"

," ollins B) Tocino #" 6arly ra$iographic signs oftracheal rptre" (R (m Roentgenol.!585!8D5.?E58"

,." Fh )


48/51

(R (m Roentgenol. !582!,8D,,?E,1"

0" 6strera ;) Lan$ay :B) :cClellan$ /" Hlnttramatic rptre of the right hemi$iaphragmD

e4perience in !2 patients" (nn Thorac "!rg.!58.,5D.2.?E.,0"

!" Gorin ;) Gar3on ;;" Kiagnostic problems intramatic $iaphragmatic hernia" Tra!ma.!51!D20?E,!"

2" Joo$ :" Tramatic $iaphragmatic hernia" (nn

Thorac "!rg.!51!!2D,!!?E,2"

," earney =;) ohana W) Hrney 6" Hlntrptre of the $iaphragmD mechanism) $iagnosis an$treatment" (nn %merg Med.!585!8D!,2?E!,,0"

" Wienceck G) Wilson


49/51


50/51

Thorac $maging.!5812D!?E!!"

.8" Jarris K) Jarris BJ Br" The pre*alence an$significance of misse$ scaplar fractres in blnt chest

trama" (R (m Roentgenol. !588!.!D11?E1.0"

.5" ;shbagh KG) =eters G/) Jalgrimson


51/51

Documents

8.Chest Trauma