Computed tomography in the diagnosis of blunt thoracic injury.
BACKGROUND
Computed tomography (CT) is an important diagnostic modality in the evaluation of blunt head and abdominal injuries, but it has not been routinely used to evaluate blunt chest trauma.


METHODS
One hundred seventy stable patients with blunt thoracic trauma were evaluated with chest x-ray (CXR), and subsequently by CT.


RESULTS
Of a total of 131 fractures, 53% were identified on initial CXR, 39% on CT, and 26% were not seen on either study. Twenty-one pneumothoraces were seen on CT but not on CXR. Chest tubes were placed in 8 patients and 12 patients were observed without incident. One hemothorax identified by CT scan alone required treatment. Four of 6 diaphragmatic injuries were seen on CT and 2 on CXR. Parenchymal abnormalities were apparent in 189 lung fields on CT and in 66 lung fields on CXR. Most represented atelectasis and did not require treatment. Altogether, CT scanning resulted in changes in management for 11 patients (6%).


CONCLUSIONS
Although CXR is less sensitive in detecting parenchymal and pleural injuries than CT, the majority of the injuries identified by CT alone are minor and require no treatment. CXR remains the primary modality for diagnostic evaluation of blunt thoracic trauma.
Department of Surgery, St. Louis University Health Sciences Center, Missouri 63110-0250.
B
B
Marts
R
R
Durham
M
M
Shapiro
J E
JE
Mazuski
D
D
Zuckerman
M
M
Sundaram
W B
WB
Luchtefeld
D000328:Adult; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012421:Rupture / Q000000981:diagnostic imaging; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*