Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 483-487

Role of computed tomography in detection of complications of blunt chest trauma


Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menufia, Egypt

Date of Submission12-Mar-2014
Date of Acceptance05-Jul-2014
Date of Web Publication31-Aug-2015

Correspondence Address:
Ramadan S Abd El Khalek
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Quesna el balad, Quesna, Menoufia Governorate, Menufia 32631
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163906

Rights and Permissions
  Abstract 

Objective
The aim of the study was to study the role of computed tomography (CT) in detection of complications of blunt chest trauma patients.
Background
Thoracic injuries are significant causes of morbidity and mortality in trauma patients. Injuries to the thorax are the third most common injuries in trauma patients, next to injuries to the head and extremities. Therefore, prompt diagnosis of blunt vascular injuries is imperative.
Patients and methods
This study included 100 patients, 66 male patients and 34 female patients with age distribution from 2 to 65 years. This study was conducted during the period from November 2012 to December 2013 at Menofyia University Hospitals and Shebin El Kom Educational Hospital. All patients subjected to blunt chest trauma presented to Menofyia Emergency Hospital and Shebin El Kom Educational Hospital during this given period were examined clinically. Those who had findings that suspect chest trauma on clinical examination underwent plain X-ray and CT examination. Finally, we compared between X-ray and CT in detection of complications of blunt chest trauma.
Results
CT has been shown to be useful for the evaluation of vascular, pulmonary, airway, skeletal, and diaphragmatic injuries as well. CT has overall greater sensitivity than radiography in the detection of pulmonary lacerations and pneumothoraces. In addition, it may be indicated in cases of suspected tracheobronchial injury .
Conclusion
Chest radiograph serves as the principle screening test for immediate assessment of the thorax after blunt chest trauma, whereas CT scanning, particularly with spiral capability, is highly sensitive than the supine chest X-ray at detecting intrathoracic injuries.

Keywords: blunt trauma, chest, computed tomography


How to cite this article:
El Wakeel MA, Abdullah SM, Abd El Khalek RS. Role of computed tomography in detection of complications of blunt chest trauma. Menoufia Med J 2015;28:483-7

How to cite this URL:
El Wakeel MA, Abdullah SM, Abd El Khalek RS. Role of computed tomography in detection of complications of blunt chest trauma. Menoufia Med J [serial online] 2015 [cited 2020 Feb 16];28:483-7. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/483/163906


  Introduction Top


Injuries of the thorax are a major cause of morbidity and mortality in blunt trauma patients. Radiologic imaging plays an important role in the work-up of patient with thoracic trauma. The chest radiograph is the initial imaging study obtained but computed tomography (CT) is now used frequently in the evaluation of chest trauma [1] .

CT is being used with increasing frequency in the evaluation of blunt chest trauma and is indicated primarily in the assessment of traumatic aortic injury. CT has also proved useful in assessment of other acute injuries including tracheobronchial disruption, diaphragmatic tears, and bone fractures. In addition, CT has been shown to be superior to chest radiography in detecting pulmonary lacerations and pneumothoraces [2] .

Chest injuries include pneumothorax, pneumomediastinum, hemothorax, which is the most common cause of shock in blunt chest trauma, lung contusions, lacerations and atelectasis, rib fractures in 56% of patients, sternoclavicular dislocation, sternal fractures, injuries, and scapular fracture [3] .


  Patients and methods Top


This study included 100 patients, 66 male patients and 24 female patients with age distribution from 2 to 65 years.

All patients were subjected to the following:

  1. History taking:


    1. Age and sex of the patients.
    2. Type and cause of the trauma.
    3. The duration since it happened.


  2. Clinical examination:


    1. Evaluation of the vital signs.
    2. Chest examination: searching for signs that suspect trauma, including hematoma, rib click denoting rib fracture, and surgical emphysema.
  3. Plain chest X-ray (CXR).
  4. CT:
CT chest was performed for patients with findings that suspect chest trauma in their clinical examination at the CT unit of the emergency hospital of Menofyia University Hospitals using single slice Toshiba 'Asteion' power helical CT scanner (Toshiba, Japan).

CT with contrast was performed if needed when there is suspicion of great vessels or cardiac injuries.

The χ2 -test was used to assess the statistical significance of difference between two means. The P value was calculated from special tables, and hence the significance of the results was determined from the t distribution tables.

P value greater than 0.05 was considered insignificant difference, P value less than 0.05 significant difference, P value less than 0.01 highly significant difference, and P value less than 0.001 very highly significant difference.


  Results Top


[Table 1] shows X-ray demonstrating bony thoracic cage fracture in 39 cases (39%), whereas CT demonstrated fracture in 48 cases (48%). There was significant difference between X-ray and CT scanning regarding bony thoracic cage fracture-positive findings (P < 0.05).
Table 1 Comparison between X-ray and computed tomography regarding positive finding in bony thoracic cage fractures

Click here to view


[Table 2] shows 86 cases (86%) demonstrated by CT to have pleural diseases in the form of pneumothorax and hemothorax, whereas 56 cases (56%) demonstrated by X-ray to have pleural diseases in the form of pneumothorax and hemothorax. There was significant difference between X-ray and CT scanning regarding pleural positive findings including hemothorax and pneumothorax (P < 0.001) [Figure 1] [Figure 2] [Figure 3]{a,b,c,d}).
Figure 1: Radiographic findings (a)revealed left-sided hemothorax and underlying lung collapse.Computed tomography of the chest (b,c,d) revealed left-sided hemothorax, lung contusion, left pneumothorax, and chest tube insertion.

Click here to view
Figure 2: Computed tomography findings (a,b)revealed right-sided pneumothorax and underlying lung collapse. Radiographic findings(c) revealed right-sided pneumothorax and underlying lung collapse. The arrow head point to the collapsed lung, the arrow point to the tension pnemothorax

Click here to view
Figure 3: Computed tomography findings (a,b,c)revealed right-sided hemothorax, Traumatic aortic dissection in the descending aorta, and surrounding hematoma. Radiographic findings(d) revealed rightsided hemothorax

Click here to view
Table 2 Comparison between X-ray and computed tomography regarding positive finding in pleural pathological changes

Click here to view


[Table 3] shows 16 cases of hemopericardium detected by CT (16%), whereas X-ray revealed enlarged cardiac silhouette in seven cases (7%). There was significant difference between X-ray and CT scanning regarding pericardium-positive findings including hemopericardium and pneumopericardium (P < 0.05).
Table 3 Comparison between X-ray and computed tomography regarding positive finding in pericardial pathological changes

Click here to view


[Table 4] shows CXR demonstrating lung contusions in 31 cases (31%), whereas CT demonstrated fracture in 45 cases (45%). There was significant difference between X-ray and CT scanning regarding lung-positive findings including lung contusions and lacerations (P < 0.05).
Table 4 Comparison between X-ray and computed tomography regarding positive finding in lung pathological changes

Click here to view


[Table 2] illustrates six cases (6%) demonstrated by CT to have vascular injury, whereas only two of them showed widening of mediastinum by X-ray. There was significant difference between X-ray and CT scanning regarding positive finding in vascular injury such as aortic injury (P < 0.05) [Table 5].
Table 5 Comparison between X-ray and computed tomography regarding positive finding in vascular pathological changes

Click here to view



  Discussion Top


The purpose of this study was to recommend appropriate imaging for patients with blunt chest trauma. These patients are most often imaged in the emergency room, and thus emergency radiologists play a substantial role in prompt, accurate diagnoses that, in turn, can lead to life-saving interventions.

In a study by Oikonomou and Prassopoulos [4] , they found that blunt chest trauma is directly responsible for 25% of all trauma deaths and is a major contributor in another 50% of trauma-related deaths. Moreover, chest trauma is the second most common cause of death, following only head trauma.

In our study, we examined 100 patients presenting with various symptoms and signs of blunt chest trauma. CXR and CT were used to evaluate these patients.

The male patients were affected more frequently (82%) than female patients (18%). This is in agreement with the study by Al-Koudmani and colleagues [5],[6],[7] who stated that mostly male patients are affected. This may be attributed to the higher male-to-female ratio as male individuals are more mobile with active participation in high risk-taking activities.

Our study showed also that the peak incidence of chest trauma is between 20 and 45 years. This is in agreement with the study by Oikonomou and Prassopoulos and colleagues [4],[8] , who stated that the most common cause of death in the young age group between 15 and 44 years is chest trauma. This may be attributed to low economic states in our country that make this group of population working the entire day more than one job exposing them to accidents more than other groups.

In our study, the most common cause of chest trauma was motor vehicle accidents, which was reported in 80 patients (80%). This is in agreement with the study by Mayberry and colleagues [9],[10] , who stated that motor vehicle accidents are the common cause of blunt chest trauma (37%) followed by fall from a height (23%), and blows from blunt objects such as animal kicks are less common causes. This may be attributed to economic factors in our country that motivate most of the population to use motorcycles as means for transportation in addition to nonstrict traffic rules for speed limits and safety measures.

Pain was the most common presentation in our study, which was recorded in 72 patients (72%), whereas dyspnea was the second one, which was recorded in 66 patients (66%). These findings are consistent with those of Lema et al. [11] who found that 71% of chest trauma patients were presented with pain and chest wall tenderness. Studies by Carrero and colleagues [12],[13],[14] have reported similar results.

In our study, X-ray demonstrate bony thoracic cage fracture in 39 cases (39%), whereas CT demonstrated fracture in 48 cases (48%), which is consistent with the studies by David and colleagues [15],[16] who documented that chest CT is the best and significantly more sensitive radiological method than CXR in the detection of thoracic cage fractures.

In our study, X-ray demonstrated diaphragmatic rupture in two cases (2%) and CT also demonstrated the same two cases (2%) showing diaphragmatic rupture, which is consistent with the study by Traub et al. [10] who documented that chest CT is not significantly different in sensitivity method than CXR in the detection of diaphragmatic rupture. This is against the study by Bhullar and Block [17] who stated that CT scan with coronal reconstruction improves the detection of small diaphragmatic injuries missed by CXR, whereas CT scan with axial views adds little to CXR alone for the diagnosis of large defects (>8 cm). The difference was because in our study the defects in the diaphragms were large in size.

In our study, X-ray demonstrated lung contusions in 31 cases (31%), whereas CT demonstrated lung contusions in 45 cases (45%), which is consistent with the studies by Traub and colleagues [10],[18] who documented that chest CT is more sensitive than CXR in the detection of lung contusions; CT detected lung contusion in 31% of patients, whereas X-ray detected lung contusion in 16% of cases.

In our study, six cases (6%) were demonstrated by CT to have vascular injury (four aortic dissection and two subclavian vein injury), whereas only two of them showed widening of mediastinum by X-ray, which is consistent with the studies by Nagy and colleagues [19],[20] who documented that chest CT has established itself as the best screening and diagnostic modality for aortic injury; spiral or helical computed tomographic scanners have an extremely high negative predictive value and may be used alone to rule out blunt injury to the aorta.

In our study, 86 cases (86%) were demonstrated by CT to have pleural diseases in the form of pneumothorax 14 cases (14%), 10 of them were unilateral (10%) and four of them were bilateral (4%); hemothorax 46 cases (46%), 38 of them were unilateral (38%) and eight were bilateral (8%); and hemopneumothorax 26 cases (26%). However, 56 cases (56%) were demonstrated by X-ray to have pleural diseases in the form of pneumothorax 10 cases (10%), eight of them were unilateral (8%), and two of them were bilateral (2%); hemothorax 40 cases (40%), 35 of them were unilateral (35%) and five were bilateral (5%); and hemopneumothorax six cases (6%). This was in agreement with the studies by Rowan and colleagues [21],[22] who documented that chest CT is more sensitive than CXR in the detection of hemothorax and pneumothorax and stated that, in 67 patients (65%), CT detected major chest trauma complications that have been missed on X-ray, such as contusion (n = 33), pneumothorax (n = 27), hemothorax (n = 21), displaced chest tube (n = 5), diaphragmatic rupture (n = 2), and myocardial rupture (n = 1), and, in 14 patients, CXR and thoracic computed tomography (TCT) showed the same pathologic results.

In our study, 16 cases of hemopericardium were detected by CT (16%), whereas X-ray revealed enlarged cardiac silhouette in seven cases (7%) and left hemothorax in other two cases (2%). This is in agreement with the studies by O'Connor and colleagues [23],[24] who documented that chest CT is more sensitive than CXR in the detection of hemopericardium, as they stated that CT has sensitivities of 97-99.3% and specificities of 87.1-99.8% and routine use before angiography resulted in cost savings.

Traub et al. [10] concluded in his study that chest CTCT is the diagnostic modality of choice with respect to blunt chest trauma. It is considered as the most informative, most sensitive, and most specific method.

Yazkan and colleagues [16],[19],[21] agreed that CT is the imaging modality of choice in evaluation of blunt chest trauma.

Although there was limited number of cases in our study, we can conclude that CT chest is strongly recommended for all cases with blunt chest trauma, as CT scan is significantly more likely to yield additional information than a CXR alone.


  Conclusion Top


At the end of this work, it can be concluded that chest radiograph serves as the principle screening test for immediate assessment of the thorax after blunt chest trauma, whereas CT scanning, particularly with spiral capability, is highly sensitive than routine CXR in visualizing lung contusions, pneumothorax, and hemothorax. Early CT influences therapeutic management in a significant number of patients. We therefore recommend CT in the initial diagnostic work-up of patients with multiple injuries and with suspected chest trauma because early and exact diagnosis of all thoracic injuries along with sufficient therapeutic consequences may reduce complications and improve outcome of severely injured patients with blunt chest trauma.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Zinck SE, Primack SL. Radiographic and CT findings in blunt chest trauma. J Thorac Imaging 2000; 15 :87-96.  Back to cited text no. 1
    
2.
Van Hise ML, Primack SL, Israel RSC, Müller NL. CT in blunt chest trauma: indications and limitations. Radiographics 1998; 18 :1071-1084.  Back to cited text no. 2
    
3.
Kerns SR, Gay SP. CT in blunt chest trauma. Am J Roentgenol 1990; 60 :50-154.  Back to cited text no. 3
    
4.
Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging 2011; 2 :281-295.  Back to cited text no. 4
    
5.
Al-Koudmani I, Darwish B, Al-Kateb K, Taifour Y. Chest trauma experience over eleven-year period at Al-Mouassat university teaching hospital-Damascus: a retrospective review of 888 cases. J Cardiothorac Surg 2012; 7 :35.  Back to cited text no. 5
    
6.
Dalal S, Vashisht M, Dahiya R. Prevalence of chest trauma at an Apex Institute of North India: a retrospective study. Internet J Surg 2008; 18 :1.  Back to cited text no. 6
    
7.
Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop 2009; 33 :1425-1433.  Back to cited text no. 7
    
8.
Mirka H, Ferda J, Baxa J. Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging 2012; 3 :433-449,   Back to cited text no. 8
    
9.
Mayberry JC. Imaging in thoracic trauma: the trauma surgeon's perspective. J Thorac Imaging 2000; 15 :76-86.  Back to cited text no. 9
    
10.
Traub M, Stevenson M, McEvoy S, Briggs G, Kai LoS, Leibman S, et al. The use of chest computed tomography versus chest x-ray in patients with major blunt trauma. Injury 2007; 38 :43-47.  Back to cited text no. 10
    
11.
Lema K, Chalya PL, Mabula JB, Mahalu W, et al. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania. J Cardiothorac Surg 2011; 6 :7.  Back to cited text no. 11
    
12.
Carrero R, Wayne M. Chest trauma. Emerg Med Clin North Am 1989; 7 :389-418.  Back to cited text no. 12
    
13.
Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma 1997; 42 :973-979.  Back to cited text no. 13
    
14.
Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg 2001; 67 :660-664.  Back to cited text no. 14
    
15.
David H, Benjamin S, John P, Robert F. CT diagnosis of rib fractures and the prediction of acute respiratory failure, J Trauma 2008; 64 :905-911.  Back to cited text no. 15
    
16.
Yazkan R, Ergene G, Tulay CM, Güneº S, Han S. Comparison of chest computed tomography and chest X-ray in the diagnosis of rib fractures in patients with blunt chest trauma. J Acad Emer Med 2012; 11 :171-175.  Back to cited text no. 16
    
17.
Bhullar IS, Block EJ. CT with coronal reconstruction identifies previously missed smaller diaphragmatic injuries after blunt trauma. Am Surg 2011; 77:55-58.  Back to cited text no. 17
    
18.
Marts B, Durham R, Shapiro M, Mazuski JE, Zuckerman D, Sundaram M, et al. Computed tomography in the diagnosis of blunt thoracic injury. Am J Surg 1994; 168 :688-692.  Back to cited text no. 18
    
19.
Nagy K, Fabian T, Rodman G, Fulda G, Rodriguez A, S Mirvis. Guidelines for the diagnosis and management of blunt aortic injury: an EAST practice management guidelines work group. J Trauma 2000; 48 :1128-1143.  Back to cited text no. 19
    
20.
Shkrum MJ, McClafferty KJ, Green RN, Nowak ES, Young JG. Mechanisms of aortic injury in fatalities occurring in motor vehicle collisions. J Forensic Sci 1999; 44 :44-56.  Back to cited text no. 20
    
21.
21 Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S. Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT - initial experience. Radiology 2002; 225 :210-214.  Back to cited text no. 21
    
22.
Trupka A, Waydhas C, Hallfeldt K. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 1997; 43 :405-412.  Back to cited text no. 22
    
23.
O'Connor JV, Byrne C, Scalea TM Griffith BP, Neschis DJ. Vascular injuries after blunt chest trauma: diagnosis and management. Scand J Trauma Resusc Emerg Med 2009; 17 :42.  Back to cited text no. 23
    
24.
Stern EJ, Frank MS. Acute traumatic hemopericardium: Am J Roentgenol 1994; 16:1305-1306.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
Acknowledgements
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1445    
    Printed17    
    Emailed0    
    PDF Downloaded186    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]