Radiographic Findings in Blunt Chest Trauma

Soft Tissue Radiographic Findings in Blunt Chest Trauma
By:Jonathan Yarris MSIV

Trauma
* Trauma is the leading cause of death in patients < 40 years
* 4th leading COD overall
* 80% of trauma is due to blunt mechanisms

Blunt Chest Trauma (BCT)
* Seen in about ½ of blunt trauma cases
* ~20% of trauma deaths attributable to BCT
* Etiology: typically deceleration injury
* Radiographic evaluation should begin immediately after initial trauma team assessment

Approach to Trauma Radiographs
* Initial exclusion of life threatening injuries
* Followed by search for less critical injuries
* Life threatening Injuries:
Pneumothorax
Deep Sulcus Sign
Tension Pneumothorax
Tension PTX
Pulmonary Contusion
Laceration
Laceration with Pneumatocele
Hematoma
Pulmonary hematoma
Pneumatocele
Pulmonary Contusion with pneumatocele
Blunt Cardiac Injury (BCI)
Hemopericardium
Great Vessel Injury
Thoracic Aorta Injury
Intimal Flap with double lumen
Airway Injury
* Tracheobronchial tears are uncommon
* Leads to persistent PTX
* Specific Symptom: persistent PTX after chest tube placement
* Finding: “Fallen Lung Sign”, pneumomediastinum, pneumopericardium, sub cut. Emphysema
* ET Tube balloon inflation >2.8cm implies tracheal rupture
Pneumomediastinum
* Etiology: alveolar, tracheobronchial or esophageal rupture
* Most common cause: alveolar rupture due to sudden increased intra-alveolar pressure (Macklin Effect) with air tracking centrally
* Findings:
o Air outlining mediastinal soft tissues and parietal pleura.
o Continuous diaphragm sign
Pneumomediastinum
Pneumopericardium with tamponade
Esophageal Injury
Other
* Skeletal injuries:
* Diaphragm injuries:

Radiographic Findings in Blunt Chest Trauma.ppt