The document summarizes various investigations used for thoracic trauma, including clinical examination, chest radiograph, ultrasound (EFAST), CT scan, and thoracentesis. A chest radiograph is the initial investigation and can reveal abnormalities like pneumothorax, hemothorax, lung pathology, and skeletal injuries. An ultrasound uses sonar to detect cardiac tamponade, free blood, and lung contusions. A CT scan provides detailed three-dimensional images of the chest and abdomen to reliably diagnose major thoracic injuries like lung contusions, hemothorax, and pneumothorax. Thoracentesis is a minimally invasive procedure used to remove fluid or air from the lungs for diagnostic and therapeutic purposes.

1. Investigation FOR thoracic trauma
Guided by :
department of surgery
Late Baliram kashyap memorial government medical College
Presented by BARKHA GOLECHHA
BATCH: 2018

3. introduction
The routine examination in emergency
department of injury to chest is based on:
•Clinical examination
•Chest radiograph

4. Other investigation are:
• Ultrasound-extended focused assessment with sonar
for trauma(eFAST)
• Computed tomography scan (CT Scan)
• Thoracentesis

5. Clinical examination

6. Chest radiograph:
• Simplest intial investigation
• Indication
Pt is hemodynamically unstable
Spine is at risk
• AP view an anteroposterior view and SUPINE chest
radiogram.

7. • Provide information :
tracheal deviation
• Lung and mediastinal pathology
skeletal injury

8. Normal ap view of chest x-ray

9. In thoracic injury
• Radiograph is performed in ERECT position as
This will best reveal :
• a small pneumothorax
• Fluid meniscus
• Air fluid level
• Presence of free gas under the diaphragm indicating presence of
hollow abdominal viscus perforation.
❖ 300 ml of blood may pool
behind the domes of the
diaphragm,
And may not be visible in
erect view.

10. absence of broncho-
vascular marking
(Right side)

11. • Mediastinal shift
towards opposite
side_ heart and
trachea is shifted
towards opposite
side.
• Absent broncho
vascular marking
• Collapsed lung
• Depressed
hemidiaphragm
tension pneumothorax

12. Hemothorax
● Cancave miniscus of fluid
level is seen.

13. hydropnemothorax
● Air fluid
level are
seen

14. Fracture of bronchus
● lung collapse in
inferior and
lateral position

15. Flail chest
According to ATLS” Fracture of Two or more consecutive ribs at two
or more places”.

16. rib
fracture
● Break in the
continuaty
of the bone.

17. Cardiac tamponade
● Increase in size
cardiac shadow

18. Ultrasound – extended focused assessment with sonar for
trauma
• The technique uses sonar assessment in the
chest, looking for a cardiac tamponade or free
blood .
• Contusion of lung.

19. Position of probe

20. Sea shore sign

21. Hemothorax

23. Pericardial effusion

24. Pulmonary contusion
● Hypoechoic
consolidation

25. • Computed tomography scan The computed tomography
(CT) scan with contrast allows for three-dimensional
reconstruction of the chest and abdomen, as well as of
the bony skeleton.
• Most reliable examination for major injury in thoracic
trauma.
• CT scanning has replaced angiography as the
diagnostic modality of choice for the assessment of the
thoracic aorta and mediastinal vessels
Ct scan

26. Lung contusion and atelectasis

27. Hemothorax

28. pneumothorax

29. Thoracentesis
● Thoracentesis is a procedure to remove
fluid or air from around the lungs.
● Thoracentesis is a minimally invasive
procedure.
● Thoracentesis can be both diagnostic as
well as therapeutic.

31. triangle Of safety

32. ● Hemothorax: bloody fluid
● Pneumothorax: gush of air
● Hydrothorax: fluid
Findings

33. Thank you