Initial Thin-Section Chest CT Findings in Patients With Inhalation Injury

Abstract

PURPOSE: Thin-section computed tomography (CT) is better than normal chest radiograph in the detection of pulmonary lesion including smoke inhalation injury which is often non-specific on chest X-ray. Unfortunately, specific changes and findings in CT have not yet been described. The aim of this study is to identify and describe the most useful CT features in inhalation injury. METHODS: The patients with inhalation injury were consecutively recruited between August 2007 and December 2012. Inhalation injury was diagnosed by bronchoscope, and was classified with four grades; near normal, mild, moderate and severe. Thin-section CT scans of all patients were assessed by one observer and the lung lesion patterns seen were analyzed. RESULTS: 43 (47.8%) of the 90 patients were compatible with inhalation injury on CT scans; 28 (65.1%) have peribronchial ground glass opacity (GGO); and 14 (32.6%) have segmental or subsegmental consolidation; and 17 (39.5%) have atelectasis; and 12 (27.9%) have branching linear attenuation; and 7 (16.3) have bronchial wall thickening; and 5 (11.6%) have interlobular septal thickening; and 1 (2.3%) has bronchiectasis. Of 258 (6 lobes x 43 patients) involved lung locations, the numbers of most common CT findings were peribronchial GGO, 62 (24.0%), and were followed by segmental or subsegmental consolidation, 41 (15.9%). The age, sex, burn size, initial COHb and PF ratio showed no significant differences but initial CRP, CT scan date since admission and frequencies of respiratory complications (intubation, pneumonia, ARDS and MV application) were significantly higher in patients with positive CT findings than in those with negative. CONCLUSIONS: Initial thin-section chest CT helps to identify smoke inhalation injury after burn accident and positive findings were thought to be confronting more frequent respiratory complications in patients with smoke inhalation.