CT scans are highly effective at detecting injuries from blunt chest trauma. In a study of 100 patients with blunt chest trauma evaluated using CT scans, the most common injuries detected were pneumothorax in 28 patients, rib fractures in 53 patients, and lung contusions in 15 patients. CT scanning allows for rapid assessment of chest and potential abdominal injuries and is the preferred method for evaluating blunt chest trauma due to its high sensitivity and ability to detect a variety of injury types in a single exam.

1. ROLE OF COMPUTED TOMOGRAPHY(CT) SCANIN
PATIENTS WITHBLUNTCHEST TRAUMA
AUTHOR: DR. HITESH RAJYA
GUIDE: DR. NALIN G. PATEL
VENUE: M.K. SHAH MEDICAL COLLEGE & RESEARCH CENTER
INTERVENTIONAL RADIOLOGY
CME & LIVE WORKSHOP

2. INTRODUCTION
Chest trauma is classified as blunt or penetrating, with blunt trauma being the cause of most
thoracic injuries. The main difference in penetrating trauma is opening the thoracic cavity,
created either by stabbing or gunshot wounds, which is absent in blunt chest trauma.
Following head and extremities injuries, Blunt thoracic injuries are the third most common
injury in polytrauma patients.Generally, blunt chest trauma is directly responsible for 25% of
all trauma deaths and is a major contributor in another 50% of trauma-related deaths.
Several studies have shown that CT scanning is accurate in visualising intrathoracic injuries,
such as Pneumothorax,haemothorax and lung contusions.In addition the availability, reliability
and low complication rate of CT scans has lead to its widespread use in the evaluation of blunt
trauma.

3. AIMS & OBJECTIVES
● Assessment of blunt chest trauma patients with radiographic finding
suggestive of pneumothorax, rib fractures, effusion and suspected lung injuries.

4. MATERIALAND METHODS
• A retrospective review of patients with blunt chest trauma who were treated in
the trauma centre and who had received chest CT scan. Data collection extracted
from medical records.
• A cases of 100 patients were included in the study with the age group between
18-49 years and out of 100 patients, 80 were males and 20 were females with
mean age group 42.5 year. Patients referred from the trauma centre with blunt
chest trauma due to road traffic accidents and high velocity trauma. The hospital
staff collects data of all trauma patients who were transferred-into the trauma
centre with blunt chest trauma.

5. RESULTS
The most common mode of injury in blunt thoracic trauma was motor
vehicle accidents. 60 patients presented within six hours of injury, 20 within 6-
12 hours, 15 within 12-24 hours and remaining 5 after 24 hours.
45 patients underwent CT within 2-6 hours, 25 within 6-12 hours, 20 within
1-7 days and 10 after seven days.Various signs and symptoms were chest pain
or tenderness, respiratory distress, surgical emphysema, decreased air entry,
vomiting and abdominal guarding.

6. Pneumothorax was detected in 28 patients (figure 1 and 2), 19 patients had
associated rib fracture and 11 patients had associated pleural effusion. 11 patients
were associated with subcutaneous emphysema ( figure 3). In 19 patients,
underlying lung parenchymal injury was present.
FIGURE 1and 2.Pneumothorax FIGURE 3.Subcutaneous
Emphysema

7. Hemothorax was detected in 15 patients on CT scan ( figure 4).
Pneumomediastinum was detected in 3 patients (figure 5), while
pneumopericardium was not seen in any case.
FIGURE 4.Hemothorax FIGURE 5.Pneumomediastinum

8. Pulmonary contusion was detected in 15 patients (figure 6).Out of 100 patients of blunt
thoracic trauma, pulmonary laceration was detected in 3 patients (figure 7). Rib fracture
was detected on CT scan in 53 patients (figure 8).
FIGURE 6.Lung Contusion FIGURE 7.Lung Laceration FIGURE8.Rib Fracture
With Contusion

9. Clavicle fractures were detected in 11 patients on CT scan(figure 9). Scapular fractures
were detected in 7 patients on CT scan(figure 10). Sternal fractures were detected in 6
patients on CT ( figure 11).
FIGURE 9. clavicle fracture FIGURE 10. Scapula Fracture FIGURE 11. Sternum fracture

10. DISCUSSION
• In this study, CT chest scanning was significantly more effective in detecting Pneumothorax
and haemopneumothorax,lung contusions and mediastinal haematomas.CT chest scan was also
significantly better at detecting fractured ribs, scapulas, sternums and vertebrae.
• Rib fracture occur in 56% of patients with major blunt chest trauma.10 Fractures of the lower
ribs should increase the suspicion for spleen, liver and renal injury.
• Fractures of sternum are frequent, occurring in 1.5% to 4% of blunt chest trauma.
• Clavicular fractures from blunt chest trauma accounts for 3% of all dislocations.
• Fractures involving the thoracic outlet, upper ribs, sternum, scapula and clavicle are significant
because they are accompanied by brachial plexus/vascular injury in 3% to 15% of patients.

11. Abnormality No. of Abnormalities
Pneumothorax 28
Hemothorax 15
Pneumomediastinum 3
Subcutaneous emphysema 11
Lung Contusion 15
Lung Laceration 3
Rib Fractures 53
Clavicle Fractures 11
Scapula Fractures 7
Sternal Fractures 6

12. • Pneumomedistinum represents extra alveolar air in the mediastinum, a
consequence of both blunt and penetrating trauma.Computed tomography
imaging is much more sensitive for detection of pneumomediastinum particularly
adjacent to the central pulmonary arteries, and aorta.
• Pulmonary contusion is seen in 30% to 70% of patients.
• Pulmonary laceration frequently accompanies pulmonary contusion.

13. CONCLUSION
Computed Tomography(CT) Scan is the modality of choice for rapid
assessment of emergency chest trauma patients where associated abdominal
injuries can be scanned in one sitting with high sensitivity and specificity.

14. REFERENCES
1. Shanmuganathan K, Matsumoto J (2006) Imaging of penetratingchest trauma. Radiol Clin North
Am 44:225–238, Review
2. Kaewlai R, Avery LL, Asrani AV, Novelline RA (2008) MultidetectorCT of blunt thoracic trauma.
Radiographics 28:1555–1570
3. Scaglione M, Pinto A, Pedrosa I, Sparano A, Romano L (2008)Multi-detector row computed
tomography and blunt chest trauma.Eur J Radiol 65:377–388
4.The American College of Surgeons Committee on Trauma Leadership (2007) In: Clark DE, Fantus
RJ (eds) National Trauma Data Bank (NTDB) Annual Report 2007. American College of
Surgeons, Chicago, IL, pp 1–64
5. Shah JV, Solanki MI. Analytic study of chest injury. IJSS J Surg 2015;1:5-9.
6. Wicky S, Wintermark M, Schnyder P, Capasso P, Denys A. Imaging of blunt chest trauma. Eur Radiol
2000;10:1524-38.

15. Thank you