Risk Factors for Traumatic Injury Findings on Thoracic Computed Tomography Among Patients With Blunt Trauma Having a Normal Chest Radiograph

Chest computed tomography (CCT) is used to screen for injuries in hemodynamically stable patients with penetrating injury. We aim to determine the incidence of missed injuries detected on CCT after a negative chest radiograph (CXR) in patients with thoracic stab wounds. A 10-year retrospective review of a Level I trauma center registry was performed on patients with thoracic stab wounds. Patients who were hemodynamically unstable or did not undergo both CXR and CCT were excluded. Patients with a negative CXR were evaluated to determine if additional findings were diagnosed on CCT. Of 386 patients with stab wounds to the chest, 154 (40%) underwent both CXR and CCT. One hundred and fifteen (75%) had a negative screening CXR. CCT identified injuries in 42 patients (37%) that were not seen on CXR. Pneumothorax and/or hemothorax occurred in 40 patients (35%), of which 14 patients underwent tube thoracostomy. Two patients had hemopericardium on CCT and both required operative intervention. Greater than one-third of patients with a normal screening CXR were found to have abnormalities on CCT. Future studies comparing repeat CXR to CCT are required to further define the optimal diagnostic strategy in patients with stab wounds to chest after normal screening CXR.

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Computed Tomography of the Lungs in Acquired Immunodeficiency Syndrome

Acta Radiologica ◽

10.1177/028418518802900605 ◽

1988 ◽

Vol 29 (6) ◽

pp. 641-644 ◽

Cited By ~ 7

Author(s):

H. Hartelius ◽

J. Gaub ◽

L. Ingemann Jensen ◽

J. Jensen ◽

V. Faber

Keyword(s):

Computed Tomography ◽

Chest Radiograph ◽

Acquired Immunodeficiency Syndrome ◽

Diagnostic Procedures ◽

Etiologic Agent ◽

Normal Lung ◽

Normal Chest Radiograph ◽

Normal Chest ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Computed tomography of the chest was performed on 42 occasions as part of the diagnostic work-up in 26 homosexual men with, or suspected of the acquired immunodeficiency syndrome (AIDS). In 17 cases both the chest radiographs and the lung scans were abnormal, and bronchoscopy and/or lung biopsy established an etiologic diagnosis in the majority of these cases. In 9 cases CT of the lungs revealed unequivocal interstitial infiltration in the presence of a normal chest radiograph, and subsequently an etiologic agent was demonstrated in all these cases. In 9 cases, patients with symptoms indicative of pulmonary infection had both a normal chest radiograph and a normal lung scan, and in none of these cases did the clinical course or additional diagnostic procedures indicate the presence of current opportunistic lung infection. CT of the lungs seems to identify accurately those patients with severe HIV-related diseases in whom invasive diagnostic procedures such as bronchoalveolar lavage and/or lung biospy should be done.

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Utility of Thoracic Computed Tomography after Blunt Trauma: When is Chest Radiograph Enough?

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(09)79385-4 ◽

2010 ◽

Vol 2010 ◽

pp. 230-231

Author(s):

M. Mathru

Keyword(s):

Computed Tomography ◽

Blunt Trauma ◽

Chest Radiograph ◽

Thoracic Computed Tomography

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High resolution computed tomography in HIV patients with suspected Pneumocystis carinii pneumonia and a normal chest radiograph

Clinical Radiology ◽

10.1016/s0009-9260(96)80239-x ◽

1996 ◽

Vol 51 (10) ◽

pp. 689-693 ◽

Cited By ~ 29

Author(s):

P.J. Richards ◽

L. Riddell ◽

R.H. Reznek ◽

P. Armstrong ◽

A.J. Pinching ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Chest Radiograph ◽

Pneumocystis Carinii Pneumonia ◽

Pneumocystis Carinii ◽

High Resolution Computed Tomography ◽

Hiv Patients ◽

Normal Chest Radiograph ◽

Normal Chest

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Diagnosis of pulmonary cement embolism using only the bone window setting on computed tomography: a case report

Journal of International Medical Research ◽

10.1177/0300060520926005 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092600

Author(s):

Eun Chul Jang ◽

Wookyung Ryu ◽

Seong Yong Woo ◽

Jung Soo Kim ◽

Kyung-Hee Lee ◽

...

Keyword(s):

Computed Tomography ◽

Chest Radiograph ◽

Percutaneous Vertebroplasty ◽

Lung Field ◽

Chest Computed Tomography ◽

Bone Window ◽

Asymptomatic Patients ◽

Cement Embolism ◽

Normal Chest Radiograph ◽

Normal Chest

Pulmonary cement embolism (PCE) is one of several complications of percutaneous vertebroplasty and kyphoplasty. Generally, PCE can be easily diagnosed based on typical chest radiograph findings such as single or multiple radiographically dense opacities with a tubular or branch shape in the lung field along with a recent history of percutaneous vertebroplasty or kyphoplasty. These findings can be alarming and may be encountered on routine chest radiographs, even in asymptomatic patients. One study showed that PCEs that were not visualized on chest radiograph were also not shown on chest computed tomography. However, we encountered a patient with dyspnea who had normal chest radiograph findings but was diagnosed with PCE through only the bone window setting on chest computed tomography. The present case will be beneficial to all physicians examining older patients with dyspnea.

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Utility of Thoracic Computed Tomography after Blunt Trauma: When is Chest Radiograph Enough?

The American Surgeon ◽

10.1177/000313480907501023 ◽

2009 ◽

Vol 75 (10) ◽

pp. 966-969 ◽

Cited By ~ 2

Author(s):

Cristobal Barrios ◽

Darren Malinoski ◽

Matthew Dolich ◽

Michael Lekawa ◽

David Hoyt ◽

...

Keyword(s):

Computed Tomography ◽

Blunt Trauma ◽

Chest Radiograph ◽

Cost Savings ◽

Diagnostic Strategy ◽

Trauma Patients ◽

Occult Pneumothorax ◽

Thoracic Computed Tomography ◽

Aortic Injuries ◽

Additional Imaging

The purpose of this study was to identify the utility of thoracic computed tomography (TCT) in blunt trauma patients with a normal admission chest radiograph (CXR). A retrospective study was performed of 200 consecutive blunt trauma patients who received both CXR and TCT. One hundred and forty-three patients had a normal screening CXR; 36 of these patients (25%) had an abnormal TCT. TCT changed the management in only nine of these patients (6%): two required serial CXR for occult pneumothorax, four received additional imaging of the spine, and three were admitted to a monitored bed. Fifty-seven patients had an abnormal initial CXR. Of these, 41 (81%) had an abnormal TCT. TCT changed management in 21 (37%) of these patients: two aortic injuries identified, 12 aortic injuries excluded, two chest tubes placed, one patient taken to the Operating Room, and four patients required further diagnostic evaluation. TCT was significantly more likely to alter management in patients with an abnormal admission CXR (6% vs 37%, P < 0.001). TCT is of limited utility in patients with a normal admission CXR. A diagnostic strategy of obtaining TCT only in patients with abnormal CXR or high-risk mechanism of injury can result in significant cost savings without adversely affecting patient outcomes.

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