Traumatic Chest Wall Injuries

  • Michele Tonerini
  • Francesca Pancrazi
  • Silvia Lorenzi
  • Giulia Angelini
  • Giacomo Aringhieri
  • Piercarlo Rossi
  • Giuseppe Zocco


A chest wall injury can occur as the result of a blunt or a penetrating trauma and more than two-thirds of cases are determined by motor vehicle collisions (MVC). Other less common causes include falls from height, sport injuries, or blows from blunt objects. Minor chest wall injuries are represented by rib fractures (the most common findings), soft-tissue contusions, and hematomas that may be produced by arterial or venous bleeding. Major chest wall injuries include deep organs laceration and flail chest syndrome (seen in 6% of patients with rib fractures), an immediate life-threatening injury that require evaluation and treatment during the primary survey. Imaging plays a fundamental role in the diagnosis. Chest X-ray (CXR) is typically used as the first and, in most cases, as the only diagnostic technique. Multi-detector computed tomography (MDCT) must be performed in stable polytrauma patients or in doubtful cases at initial plain film study and has a very high sensibility and specificity; it can demonstrate significant disease in patients with negative initial CXR images, thus changing their clinical management. MRI plays a limited role in the diagnosis in the ED. In this chapter, we will treat imaging findings, natural history, and treatment of different traumatic conditions included in chest trauma such as rib fractures, first rib and lateral rib fractures, costochondral injuries, flail chest, sternal fractures, sternochondral injuries, and sternoclavicular dislocation; costovertebral dislocation, scapulo-thoracic dissociation, scapular fractures, and chest wall hematoma.


Trauma Trauma imaging Thoracic trauma Chest wall injuries Computed tomography (CT) 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Michele Tonerini
    • 1
  • Francesca Pancrazi
    • 2
  • Silvia Lorenzi
    • 2
  • Giulia Angelini
    • 2
  • Giacomo Aringhieri
    • 2
  • Piercarlo Rossi
    • 2
  • Giuseppe Zocco
    • 1
  1. 1.Department of Emergency SurgeryCisanello University HospitalPisaItaly
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity of PisaPisaItaly

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