Blunt chest trauma: An audit of injuries diagnosed by the MDCT examination

Abstract

Background/Aim. Multidetector computed tomography (MDCT) characterized by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. Methods. This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. Results. Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. Conclusion. Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.Uvod/ Cilj. Multidetektorska kompjuterizovana tomografija (MDCT) koja se odlikuje brzinom i preciznoscu sve vise se koristi u odeljenjima urgentne medicine. Cilj istrazivanja bio je da se utvrde najcesce povrede grudnog kosa, udruzene vantorakalne povrede, kao i da se ustanovi ishod lecenja. Metode. Ova prospektivna studija obuhvatila je 61 bolesnika sa tupom traumom. Svakom bolesniku uradjen je CT grudnog kosa, kao deo inicijalne dijagnostike. Procenjen je broj povreda po organima i organskim sistemima grudnog kosa. Evidentiran je uzrok povrede, duzina i ishod lecenja, kao i prisustvo povreda u drugim regijama. Rezultati. Povreda grudnog kosa bila je udruzena sa drugim regijama kod 80,3% bolesnika i to najcesce sa povredama ekstremiteta ili kostiju karlice kod 54.1% bolesnika, potom sa povredama glave kod 39,3% bolesnika. Kod 90,9% bolesnika sa smrtnim ishodom postojale su pridruzene povrede grudnog kosa. Lezije plucnog parenhima, pleuralni izlivi i frakture rebara bile su najcesce povrede kod 77,1%, 65,6% i 63,9% bolesnika, respektivno. Zakljucak. Tupa trauma grudnog kosa je znacajan problem prevashodno kod muskarca u cetrdesetim godinama i obicno je uzrokovana saobracajnim nezgodama. U slucaju pneumomedijastinuma ili medijastinalnog hematoma, savetuje se koriscenje 3D rekonstrukcija u postavljanju dijagnoze potencijalne traheobronhijalne povrede i povrede grudne aorte. Povecana rezolucija CT skenera dala je veliki broj nalaza koji su tesko vidljivi na radiografiji, narocito u slucaju povrede plucnog parenhima i pleure. Trebalo bi imati na umu medjutim, da nijedna tehnika snimanja ne moze da bude jedini faktor pri odlucivanju o hirurskom lecenju.