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Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings

Emergency Radiology volume 14, pages 297–310 (2007)Cite this article

Abstract

This pictorial review discusses multi-detector computed tomography (MDCT) cases of non-vascular traumatic chest injuries, with a brief clinical and epidemiological background of each of the pathology. The purpose of this review is to familiarize the reader with common and rare imaging patterns of chest trauma and substantiate the advantages of MDCT as a screening and comprehensive technique for the evaluation of these patients. Images from a level 1 trauma center were reviewed to illustrate these pathologies. Pulmonary laceration, pulmonary hernia, and their different degrees of severity are illustrated as examples of parenchymal traumatic lesions. Pleural space abnormalities (pneumothorax and hemothorax) and associated complications are shown. Diaphragmatic rupture, fracture of the sternum, sternoclavicular dislocation, fracture of the scapula, rib fracture, and flail chest are shown as manifestations of blunt trauma to the chest wall. Finally, direct and indirect imaging findings of intrathoracic airway rupture and post-traumatic foreign bodies are depicted. The advantage of high quality reconstructions, volume rendered images, and maximal intensity projection for the detection of severe complex traumatic injuries is stressed. The limitations of the initial chest radiography and the benefits of MDCT authenticate this imaging technique as the best modality in the diagnosis of chest trauma.

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Authors and Affiliations

  1. Department of Radiology, LSUHSC-S, 1501 Kings Highway, Shreveport, LA, 71130, USA

    Guillermo P. Sangster, Alberto I. Carbo, Maureen G. Heldmann & Horacio B. D’Agostino

  2. Department of Pediatrics, LSUHSC-S, 1501 Kings Highway, Shreveport, LA, 71130, USA

    Hassan Ibrahim

  3. Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Aldo González-Beicos

  4. Diagnostico Maipú, Av. Maipú, 1668, Vicente López, Buenos Aires, Argentina

    Patricia Carrascosa & Miguel Nazar

Authors
  1. Guillermo P. Sangster
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  2. Aldo González-Beicos
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  3. Alberto I. Carbo
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  4. Maureen G. Heldmann
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  5. Hassan Ibrahim
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  6. Patricia Carrascosa
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  7. Miguel Nazar
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  8. Horacio B. D’Agostino
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Correspondence to Guillermo P. Sangster.

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Movie 1

Collar sign. MPR sagittal demonstrates a left traumatic hemidiaphragmatic rupture with herniation of the small bowel into the thoracic cavity causing pulmonary parenchymal collapse. A focal constriction of the bowel loops and mesentery is identified. A diaphragmatic discontinuity representing traumatic rupture is seen. Soft tissue emphysema and a left chest tube are noted. (mpg 6 045 116 kb)

Movie 2

Flail chest. MPR sagittal shows a multiple costal, chondro-costal, and sternal fractures. Soft tissue emphysema and pneumomediastinum are noted. Areas of parenchymal opacification representing pulmonary contusions and atelectasis. (mpg 7 650 380 kb)

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Sangster, G.P., González-Beicos, A., Carbo, A.I. et al. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol 14, 297–310 (2007). https://doi.org/10.1007/s10140-007-0651-8

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  • DOI: https://doi.org/10.1007/s10140-007-0651-8

Keywords

  • Blunt trauma
  • Chest
  • Multidetector computed tomography