Visceral injury is most often caused by high velocity energy waves disrupting crucial tissue structures and planes while passing through the thoracic cavity, rather than compression of the chest wall directly impinging on those structures.
Systematically Look for the Injuries to be discussed in the following slides.
AVOID “satisfaction of search” by noting injuries as you come across them and continuing your systematic search to the end. (ie don’t let that amazing flail chest distract you from the barely contained aortic tear.)
Caudad displacement of Left Main Bronchus Rightward deviation of trachea Rightward deviation of NG tube Caudad dispalcement of left main bronchus Loss of distinction of Aortic Arch Normal paratracheal stripe
Low number of false negatives. Too many false positives using widened mediastinum criterion.
Should be considered based on mechanism of injury and positive CXR findings.
Reveals other causes of mediastinal hematoma
Faster than angiography with fewer personnel required
Sensitivity 92-100% Specificity 100%*
Can be used as sole diagnostic tool to evaluate for aortic injury.**
Traditional Gold Standard
Sensitivity and Specificity 90-100%
* 1. Scaglione M. Pinto A. Pinto F. Romano L. Ragozzino A. Grassi R. Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma. European Radiology. 11(12):2444-8, 2001.
2. Parker MS. Matheson TL. Rao AV. Sherbourne CD. Jordan KG. Landay MJ. Miller GL. Summa JA. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. American Journal of Roentgenology. 176(5):1267-72, 2001
**S. W. Downing, J. S. Sperling, S. E. Mirvis, M. G. Cardarelli, T. B. Gilbert, T. M. Scalea, and J. S. McLaughlin Experience with spiral computed tomography as the sole diagnostic method for traumatic aortic rupture Annals of Thoracic Surgery , August 1, 2001; 72(2): 495 - 502.