Thoracic Trauma

2020 ◽  
Author(s):  
William E. Baker ◽  
Ron Medzon
Keyword(s):  
Blunt Trauma ◽  
Thoracic Trauma ◽  
Flail Chest ◽  
Penetrating Trauma ◽  
Pulmonary Contusion ◽  
X Ray ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Chest X Ray ◽  
Lung Point

More than 85% of blunt and penetrating trauma to the thorax results in injury to the lungs or ribs. Among civilians, blunt trauma is the most common mechanism, while penetrating trauma is the most common among military sectors. This review describes the assessment and stabilization, diagnosis, treatment and disposition, and outcomes of thoracic trauma. Videos shows the “lung point” sign on M-mode and two-dimensional ultrasonography, and a transthoracic echocardiogram clip of pericardial clot and tamponade due to a gunshot wound. Figures show a sonogram showing the “lung point sign”, a chest x-ray and computed tomographic scan demonstrating right-sided hemothorax in a patient with a right chest stab wound, and a three-dimensional computed tomographic scan and chest x-ray of a blunt trauma patient with displaced fractures of the left lateral sixth to ninth ribs. Tables list types of injuries, NEXUS chest decision instrument imaging criteria, level 2 evidence-based recommendations for the management of pulmonary contusion and flail chest by the Eastern Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma practice guidelines for managing issues with pulmonary contusion and flail chest, and the Vancouver simplified and University of Washington grading systems for blunt aortic injury. This review contains 2 videos, 4 highly rendered figures, 10 tables, and 94 references.

scholarly journals Comparison of occult pneumothorax and pneumothorax cases in thoracic trauma: A descriptive, cross-sectional study

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Semra Aslay
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Thoracic Trauma ◽  
Tension Pneumothorax ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Chest Computed Tomography ◽  
X Ray ◽  
Occult Pneumothorax ◽  
Chest X Ray

Background: The emergency department usually takes a supine posteroanterior (PA) chest X-ray imaging in trauma patients. In some cases, pneumothorax is not seen in the chest X-ray because of the patient's position. These cases are called occult pneumothorax. Misdiagnosis of occult pneumothorax in the emergency department may lead to complications such as tension pneumothorax. This study aimed to update patients’ features with occult pneumothorax due to blunt or penetrating trauma. Methods: In this study, data of 615 thoracic trauma patients admitted to the emergency department between January 2008 and December 2010 were evaluated. In total, 157 patients had undergone both chest X-ray and chest computed tomography and were diagnosed with pneumothorax. Of the 157 patients, 52 were excluded due to some criteria. Data of 105 patient, including their characteristics, trauma types, accompanying traumas, etiology of the chest trauma, chest X-ray findings, and computed chest tomography results were recorded. Data obtained were compared with the results of similar studies conducted in the last 10 years. Chest computed tomography was considered the gold standard for the diagnosis of pneumothorax. Results: The mean patient age was 36.19 ± 14.74 years. Occult pneumothorax was detected in 8 of 105 patients, giving a 7.6% overall incidence of occult pneumothorax. A traffic accident was the most common cause of etiology. All occult pneumothorax cases were caused by blunt trauma, and tube thoracostomy was performed in all of them. No significant differences were found between pneumothorax and occult pneumothorax cases concerning the etiology, accompanied trauma, intervention types, and trauma reasons (p < 0.05). Conclusions: This study supports the incidence of occult pneumothorax reported in the literature. When a patient is admitted with thoracic trauma, a physician should carefully evaluate the patient through supine chest X-ray examination. Only one misdiagnosis in trauma patients can be lead to many unintentional clinical and forensic results.

scholarly journals Chest X-ray as a screening tool for blunt thoracic trauma in children

2013 ◽  
Vol 21 (S1) ◽  
Author(s):  
NL Yanchar ◽  
K Woo ◽  
M Brennan ◽  
C Palmer ◽  
M Ee ◽  
...  
Keyword(s):  
Thoracic Trauma ◽  
Screening Tool ◽  
Blunt Thoracic Trauma ◽  
X Ray ◽  
Chest X Ray

scholarly journals Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Michael Paplawski ◽  
Swapna Munnangi ◽  
Jody C. Digiacomo ◽  
Edwin Gonzalez ◽  
Ashley Modica ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Tube ◽  
Rib Fractures ◽  
Tube Placement ◽  
Chest Tubes ◽  
Chest Tube Placement ◽  
X Ray ◽  
Factors Associated ◽  
Occult Pneumothorax ◽  
Chest X Ray

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

scholarly journals Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Gregory J. Roberts ◽  
Lewis E. Jacobson ◽  
Michelle M. Amaral ◽  
Courtney D. Jensen ◽  
Louis Cooke ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Ct ◽  
Physical Exam ◽  
Trauma Patients ◽  
Cross Sectional ◽  
X Ray ◽  
Cross Sectional Imaging ◽  
Normal Chest ◽  
Chest X Ray ◽  
Sectional Imaging

Abstract Background High morbidity and mortality rates of trauma injuries make early detection and correct diagnosis crucial for increasing patient’s survival and quality of life after an injury. Improvements in technology have facilitated the rapid detection of injuries, especially with the use of computed tomography (CT). However, the increased use of CT imaging is not universally advocated for. Some advocate for the use of selective CT imaging, especially in cases where the severity of the injury is low. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Scores (ISS) to determine the utility of torso CT in this patient cohort. Methods A retrospective review of non-intubated, adult blunt trauma patients with an initial GCS of 14 or 15 evaluated in an ACS verified level 1 trauma center from July 2012 to June 2015 was performed. Data was obtained from the hospital’s trauma registry and chart review, with the following data included: age, sex, injury type, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. The statistical tests conducted in the analysis of the collected data were chi-squared, Fischer exact test, and ANOVA analysis. Results There were 2306 patients included in this study, with a mean ISS of 8. For patients with a normal chest exam that had a chest CT, 15% were found to have an occult chest injury. In patients with a negative chest exam and negative chest X-ray, 35% had occult injuries detected on chest CT. For patients with a negative abdominal exam and CT abdomen and pelvis, 16% were found to have an occult injury on CT. Lastly, 25% of patients with normal chest, abdomen, and pelvis exams with chest, abdomen, and pelvis CT scans demonstrated occult injuries. Asymptomatic patients with a negative CT had a length of stay 1 day less than patients without a corresponding CT. No incidents of contrast-induced complications were recorded. Conclusions A negative physical exam combined with a normal chest X-ray does not rule out the presence of occult injuries and the need for torso imaging. In blunt trauma patients with normal sensorium, physical exam and chest X-ray, the practice of obtaining cross-sectional imaging appears beneficial by increasing the accuracy of total injury burden and decreasing the length of stay.

scholarly journals The spectrum and outcome of blunt trauma related enteric hollow visceral injury

2018 ◽  
Vol 100 (4) ◽  
pp. 290-294 ◽  
Author(s):  
W Bekker ◽  
VY Kong ◽  
GL Laing ◽  
JL Bruce ◽  
V Manchev ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Delayed Diagnosis ◽  
Free Fluid ◽  
Visceral Injury ◽  
X Ray ◽  
Median Delay ◽  
Chest X Ray ◽  
Hollow Visceral Injury

Introduction This audit focused on patients who sustained enteric injury following blunt abdominal trauma. Methods Our prospectively maintained electronic registry was interrogated retrospectively, and all patients who had sustained blunt abdominal trauma between December 2011 and January 2016 were identified. Results Overall, 2,045 patients had sustained blunt abdominal trauma during the period under review. Seventy per cent were male. The median age was 28 years. Sixty patients (2.9%) sustained a small bowel injury (SBI). Thirty-five of these were peritonitic on presentation. All patients with a SBI had a chest x-ray and free air was present in seven. In 18 patients with a SBI, computed tomography (CT) was performed, which revealed isolated free fluid in 12 and free intraperitoneal air in 5. In five cases, the CT was normal. A total of 32 patients (1.5%) sustained blunt duodenal trauma (BDT). All patients with BDT had a chest x-ray on presentation. Free intraperitoneal air was not present in any. CT was performed on 17 patients with BDT. This revealed isolated free fluid or retroperitoneal air in 12. The median delay between injury and presentation for these enteric injures was 15.5 hours (interquartile range [IQR]: 8–25 hours) while between presentation at hospital and operation, the median delay was 6 hours (IQR: 3–13 hours). Conclusions Blunt trauma related enteric hollow visceral injury remains associated with delayed diagnosis and significant morbidity. It can be caused by a disparate array of mechanisms and is difficult to diagnose even with modern imaging strategies.

scholarly journals Our Experience in the Treatment of Severe Thoracic Trauma.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Fadil Gradica ◽  
Daniela Xhemalaj ◽  
Agron Dogjani ◽  
Lutfi Lisha ◽  
Dhimitraq Argjiri ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Chest Wall ◽  
Thoracic Trauma ◽  
Flail Chest ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Morbidity Rate ◽  
Tracheal Rupture ◽  
Chest Wall Trauma ◽  
Thoracoabdominal Approach

Background: Severe thoracic trauma is main cause of deaths in US about 10-20 % of deaths. Causes of severe thoracic Trauma are :Penetrating trauma,Gunshot wounds,Stab wounds ;Lower mortality rate   less massive, less multiorgan injury Gunshot wounds on the chest is the most lethal – 50% .Only 7-10% undergoes hospitalization prior to death .Death due to heart & great vessel injuries. Aim of study: Analyses of patients with Severe Thoracic Trauma ,Initial Evaluation and Management analyses of our cases period of time 2004-2017 treated in thoracic surgery service Material and methods: 95 patients are treated in our hospital during July  2004- July 2017 timeframe. Male to  female was  ratio 3:1. Age of presentation  9-71 years old, mean age presentation 49  years old. Blunt chest wall trauma 36 (38%) and  penetraiting  chest wall trauma 59 (62%) patients. Ribs  and sternal fractures , two  or  more costal fractures in 15 (15.7%) patients  (flail chest 7 patients );unilateral pneumothorax  34 (35.7%) patients ,bilaterally  pmeumothorax 10 (10.5%) patients;massive hemothorax 12 (12.6%) patients , pneumomediastin et subcutaneous emphysema 6 (6.31%) patients Hammans syndrome, lung contusion and parenchimal pulmonary hemathoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients ,tracheal rupture 1 (1%) patient. Results: Only  medical treatment in 22 (23%) patients,unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18  (18.9%) patients ;thoracotomy  in 29(30.5%) patients ,wedge resection,lung hemostasis and aerostasis from lung lacerations, bronchial  lobar  rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell  incision in 1 (1%)  patient;,thoracoabdominal approach 2 ( 2%) patients. flail chest wall  stabilization 7 (7.3%) patients by vicryl suture  ,steel wire suture 3(3%)patients,titanium plate 3(3%) patient.By VATS are treated 2(2.1%) patients.Mean hospital stay was 11 days (average 3-36 days).Morbidity rate in 6 (6.3%)patients , mortality was on 5  (5%)patients. Conclusion: Most common injury locations was  lung and chest wall and  less common abdominal and cranial trauma.Surgical and intensive treatment are very important and with low mortality rate.

scholarly journals Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

2017 ◽  
Vol 6 (1) ◽  
pp. 30-34
Author(s):  
Luca GA Pivetta ◽  
Cristiano Below ◽  
Giovanna Z Rondini ◽  
Jacqueline AG Perlingero ◽  
José C Assef ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
X Rays ◽  
Chest Drainage ◽  
X Ray ◽  
Clinical Criteria ◽  
Chest X Ray ◽  
Low Probability ◽  
Excessive Number

ABSTRACT Background There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients. Objective To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment. Materials and methods This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age ≤ 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission. Results Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age < 60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage. Conclusion A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed. How to cite this article Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

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