Contents lists available at ScienceDirect

The Egyptian Journal of Radiology and Nuclear Medicine

journal homepage: www.elsevier.com/locate/ejrnm

Spectrum of MDCT findings in blunt chest trauma patients at a tertiaryhealth care University Hospital: A single-centre experience

Youssriah Yahia Sabri, MDa,⁎, Mona Ahmed Fouad Hafez, MDa,Yasmine Hamdy El Hinnawy, MDb, Mohamed Abdel Moneim Salim Mostafa, MSca

a Diagnostic Radiology and Intervention Department, Kasr-Alainy Hospital, Cairo University, Egyptb Pulmonary Department, Kasr-Alainy Hospital, Cairo University, Egypt

A R T I C L E I N F O

Keywords:MDCTTraumaChestLung

A B S T R A C T

Purpose: Evaluate MDCT findings in patients with blunt chest trauma with a demographic evaluation of numberand percentage of each pattern over 6 months at University Hospital.Patients and methods: This study involved 125 patients, including 90 males and 35 females with a mean age of51.4 years. They were exposed to blunt chest trauma and were referred to the emergency radiology department.All patients were subjected to clinical examinations with medical history interview, plain chest X-ray, and MDCTof the chest with 3D reconstruction.Results: Road traffic accidents were the most common mechanism of trauma, accounting for 56.8% of the 125cases. Chest pain was the most common clinical presentation, observed in 76%. Both sides of the body wereaffected in 41.6%; the right side was affected in 29.6%; and the left side was affected in 28.8%. Radiologicalfindings among the patients in the order of frequency were pleural injuries in 72% of the patients, parenchymallung injuries in 56.8%, chest wall injuries in 40.8%, mediastinal injuries in 11.2%, diaphragmatic injuries in4.8% and tracheo-bronchial injuries in 1.6% of the patients.Conclusion: Chest trauma may cause significant morbidity, and MDCT could lead to critical changes in a patient'smanagement.

1. Introduction

Multi-detector computed tomography (MDCT) is the preferredimaging modality for the evaluation of poly-trauma patients. It offersmulti-planar and three-dimensional reconstructions and is generallymore sensitive and specific than chest radiography. It has been shownto change patient management in up to 20% of patients with abnormalinitial chest radiography [1].

MDCT can be used to evaluate a wide variety of thoracic injuries,including chest wall bony injuries such as rib fractures, which are themost common injuries in blunt chest trauma; clavicle fractures with orwithout sternoclavicular dislocation [2]; fractures resulting from high-energy deceleration, such as sternal and scapular fractures [3]; anddorsal spine fractures, in which MDCT plays a major role in guidingclinical management [4].

Chest wall soft tissue injuries include surgical emphysema [5] andsoft tissue contusion, which may result in arterial or venous haema-toma, with the latter often being self-limiting and slow-growing [6].

Pleural space injuries include haemothorax with arterial bleedingcauses more significant progressive increase in volume and mass thanvenous haemorrhage [7], pneumothorax, which is the second mostcommon finding in cases of blunt chest trauma [8], and hydro-pneu-mothorax, which is the concurrent presence of a pneumothorax and ahydrothorax (i.e., air and fluid) in the pleural space [9].

Injuries of the lung parenchyma appear as pulmonary contusions,which are the most common lung injury [10]; pulmonary lacerations,which are obvious tears in the lung parenchyma, and rare complica-tions such as lung torsion and lung herniation can also be detected [11].Injuries of the trachea and bronchi are also rare findings [12].

Diaphragmatic injuries can be caused by chest or abdominal trauma[13]. CT scan sensitivity for blunt diaphragmatic injury can be im-proved from approximately 60% with conventional CT scans to77–100% with MDCT, with a specificity of approximately 93–98%using MDCT [14].

Mediastinal injuries can cause pneumo-mediastinum [15] andmediastinal haematoma; rarely, blunt oesophageal trauma can also

https://doi.org/10.1016/j.ejrnm.2018.04.009Received 21 November 2017; Accepted 15 April 2018

Peer review under responsibility of The Egyptian Society of Radiology and Nuclear Medicine.⁎ Corresponding author at: Diagnostic Radiology and Intervention Department at Cairo University Medical School, Kasr-Alainy Hospital at Kasraliny Street, Radiology Department,

Egypt.E-mail address: yyysabri@hotmail.com (Y.Y. Sabri).

The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

Available online 23 June 20180378-603X/ © 2018 The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).

T

http://www.sciencedirect.com/science/journal/0378603Xhttps://www.elsevier.com/locate/ejrnmhttps://doi.org/10.1016/j.ejrnm.2018.04.009https://doi.org/10.1016/j.ejrnm.2018.04.009mailto:yyysabri@hotmail.comhttps://doi.org/10.1016/j.ejrnm.2018.04.009http://crossmark.crossref.org/dialog/?doi=10.1016/j.ejrnm.2018.04.009&domain=pdf

occur [16].Pericardial injuries, such as haemopericardium [17] and pneumo-

pericardium, are rarely seen with blunt chest trauma, but if they areextensive, they may cause cardiac tamponade [18].

The aim of this study was to evaluate the findings of MDCT in pa-tients with blunt chest trauma in conjunction with a demographicevaluation of the number and percentage of each pattern over 6monthsat Kasr Al-Ainy University Hospital.

2. Patients and methods

This study involved 125 patients, including 90 males (72%) and 35females (28%) with an age range of 2–75 years (meanage= 51.4 years). Most of the patients were in the age group of21–40 years (n= 74 patients, 59.2%).

They were exposed to blunt chest trauma and referred to theEmergency Radiology Department at Kasr Al-Ainy Hospital for MDCT ofthe chest over a period of 6months from September 2016 to February2017, with the following inclusion and exclusion criteria.

2.1. Inclusion criteria

All cases with blunt chest trauma as either the sole presentation oras part of poly-traumatic insults were included in this study.

2.2. Exclusion criteria

Patients requiring emergency surgery and patients who were hae-modynamically unstable were excluded.

This study was conducted according to the guidelines of the ethicscommittee of Cairo University and was approved by our institutionalreview board. Informed written consents were obtained from the re-latives of all participants in this study.

2.3. Methods

All patients were subjected to the following:

(1) A thorough clinical examination with a medical history review andgeneral and chest evaluations.

(2) Plain chest X-ray with anteroposterior (AP; supine) views.(3) Non-contrast MDCT of the chest was performed in all patients in the

Emergency Radiology Unit using a 16-multislice GE bright speed CTscanner with the following parameters: helical acquisition, 120 kV,25mA, helical thickness of 1.25mm, 1-mm interval, FOV of351mm down from the level of the renal arteries up to the root ofthe neck, and total exposure time of 0.8 s during a breathhold.Mediastinal window and lung window axial images with cor-onal and sagittal reconstruction were obtained. Oral contrast wasgiven in cases of suspected oesophageal injuries.

(4) Virtual CT bronchography: three-dimensional reconstructions basedon surface and volume renderings were conducted for two patientswith suspected tracheo-bronchial injuries.

(5) Associated injury assessment by abdominal ultrasound (US) orbrain CT according to the patient’s condition.

3. Results

The most common mechanisms of blunt chest trauma were roadtraffic accidents in 56.8% (n= 71 patients) of the cases, followed byfalling from height in 40% (n=50 patients) of the cases and directblow to the chest in 3.2% (n= 4 patients) of the cases.

Interventions that were applied included endotracheal tube inser-tion in the Emergency Department in 20 patients (16%), chest tubeplacement prior to MDCT scan in 34 patients (27.2%), and central ve-nous line placement and nasogastric feeding tube insertion in 24(19.2%) and 12 (9.6%) patients, respectively.

The most common clinical presentations were chest pain (n=95patients) (76%), dyspnoea (n=88 patients) (70.4%), local chest ten-derness (n= 30 patients) (24%) and haemoptysis (n= 25 patients)(20%). More than one presentation was encountered in some patients.

Regarding the affected side, both sides were affected in 52 patients(41.6%), the right side was affected in 37 patients (29.6%), and the leftside was affected in 36 patients (28.8%).

The positive radiological findings among the patients in the orderof frequency (Fig. 1) were pleural injuries in 90 patients (72%), par-enchymal lung injuries in 71 patients (56.8%), chest wall injuries in 51patients (40.8%), mediastinal injuries in 14 patients (11.2%), dia-phragmatic injuries in 6 patients (4.8%) and tracheo-bronchial injuriesin 2 patients (1.6%). The numbers and percentages of MDCT findings in

0

10

20

30

40

50

60

70

80

90

Fig. 1. Number of positive radiological findings among patients.

Y.Y. Sabri et al. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

639

125 blunt chest trauma patients are displayed in Table 1.

3.1. Chest wall injuries were detected in 51/125 (40.8%) patients

3.1.1. Bony chest wall injuriesRib fractures (Fig. 2a) were detected in 28 patients (22.4%), in-

cluding 15 patients with right-sided fractures (53.6%), 11 patients withleft-sided fractures (39.3%) and 2 patients with fractures on both sides(7%). Rib fracture was detected in only one patient in the childhood agegroup.

Sternal fracture was detected in 2 patients (1.6%), clavicular frac-tures (Fig. 4b) were detected in 3 patients (2.4%), including two caseswith left-sided fractures and one case with a right-sided fracture, andscapular fractures (Fig. 3a) were detected in 5 patients (4%, three cases

with right-sided fractures and two cases with left-sided fractures). Allscapular fractures were located at the scapular body and did not reacharticular surfaces. Dorsal spine fractures (Fig. 3b) were detected in 3patients (2.4%; in two cases, a compression fracture occurred at thelevel of T12/L1; retro-pulsion causing spinal cord compression andneurological deficits was detected in only one case).

3.1.2. Soft tissue chest wall injuriesSurgical emphysema (Fig. 4b) was detected in 34 patients (27.2%;

16 cases on the left side, 12 cases on the right side and 6 cases on bothsides).

Chest wall haematoma was detected in 13 patients (10.4%; 9 caseson the right side, 3 cases on the left side and one case on both sides). Allcases of chest wall haematomas were related to fractured ribs.

3.2. Pleural space injuries were detected in 90/125 (72%) patients

Pleural fluid collection (Fig. 2c) was detected in 53 patients(42.4%; 14 cases on the left side, 16 cases on the right side and 23 caseson both sides).

Pneumothorax (Fig. 4a) was detected in 21 patients (16.8%) andwas classified as follows: simple pneumothorax was detected in 16patients (7 cases on the left side, 7 cases on the right side and 2 cases onboth sides) and tension pneumothorax was detected in 5 cases (3 caseson the left side and 2 cases on the right side).

Hydropneumothorax was detected in 21 patients (16.8%; 12 caseson the left side, 8 cases on the right side and one case on both sides).

3.3. Lung parenchymal injuries were detected in 71/125 (56.8%) patients

Lung contusion (Fig. 4a) was detected in 71 patients (56.8%; 17cases on the left side, 25 cases on the right side and 29 cases on bothsides). Thirty-two cases presented with consolidation, 27 cases pre-sented with ground glass opacifications, and 12 cases presented withboth types of lesions. Six cases showed only centrally distributed le-sions, and the remaining cases showed mainly peripheral lesions.

Lung laceration (Fig. 2b) was detected in 7 patients (5.6%; 4 caseson the left side and 3 cases on the right side).

Table 1The numbers and percentages of MDCT findings in 125 blunt chest traumapatients.

Radiological findings Number andpercentage of cases

Thoracic Wall Injuries: Rib fracture 28 (22.4%)Sternal fracture 2 (1.6%)Clavicular fracture 3 (2.4%)Scapular fracture 5 (4%)Dorsal spine fracture 3 (2.4%)Surgical emphysema 34 (27.2%)Chest wall haematoma 13 (10.4%)

Pleural Injuries Pleural fluid collection(haemothorax)

53 (42.4%)

Simple pneumothorax 16 (12.8%)Tension pneumothorax 5 (4%)Hydropneumothorax 21 (16.8%)

Lung ParenchymalInjuries

Lung contusion 71 (56.8%)Lung laceration 7 (5.6%)

Mediastinal Injuries Pericardial collection(haemopericardium)

3 (2.4%)

Pneumo-pericardium 1 (0.8%)Oesophageal injuries 2 (1.6%)Pneumo-mediastinum 8 (6.4%)

Tracheo-bronchial Injuries 2 (1.6%)Diaphragmatic Injuries 6 (4.8%)

Fig. 2. A 25-year-old male was involved in a motor vehicle accident. He complained of localized chest wall tenderness and dyspnoea and exhibited diminished breathsounds on the left side. 3D VRT reconstruction of the bony chest wall shows fractures of the left 4th, 5th and 6th ribs (red arrows) (a). Axial MDCT of the lung windowshows left apical lobe lung laceration (b). Axial MDCT of the mediastinal window shows pleural fluid collection on the left side (c).

Y.Y. Sabri et al. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

640

3.4. Mediastinal injuries were detected in 14/125 (11.2%) patients

Pneumo-mediastinum was detected in 8 patients (6.4%), hae-mopericardium (pericardial collection) was detected in 3 patients(2.4%), pneumo-pericardium was detected in 1 patient (0.8%) andoesophageal injuries were suspected in 2 patients (1.6%).

3.5. Diaphragmatic injuries (Fig. 5) were detected in 6 (4.8%) patients

Three cases showed left-sided diaphragmatic herniation, and threecases showed right-sided diaphragmatic herniation.

3.6. Tracheo-bronchial injuries (Fig. 6) were detected in 6 (4.8%) patientswere suspected in 2 (1.6%) patients

One case showed partial avulsion of the right main bronchus, andanother case showed complete avulsion of the left main bronchus withthe fallen lung sign noted. Both cases were confirmed by three-di-mensional virtual bronchography.

4. Discussion

Chest trauma is the third most common type of trauma followingtrauma to the head and extremities. The most common causes are trafficaccidents, which account for 70–80% of all significant blunt chesttrauma cases, falls and acts of violence [19]. In this study, road traffic

Fig. 3. A 50-year-old male reported fallingfrom height, with localized dorsal spinetenderness and limited mobility of the rightupper limb. No neurological deficits werenoted. On MDCT, 3D VRT reconstructedimages show (a) Comminuted fracture linesat the left scapula reaching its medial andlateral borders with gapping and displace-ment at the fracture ends and intact gleno-humeral and acromioclavicular articulationswith smooth articular surfaces. Sagittal re-construction MDCT image of the bonewindow shows (b) multilevel vertical frac-ture lines at the middle aspect of the T4through T7 spinous processes. No evidenceof encroachment upon the spinal canal wasnoted.

Fig. 4. A 45-year-old male patient was involved in a motor vehicle accident. He complained of left-sided chest pain and exhibited diminished breath sounds. MDCTwith axial cuts of the (a) lung window show left-sided pneumothorax with posterior relaxation collapse of the corresponding lung and mild shifting of the med-iastinum to the right side with bilateral basal lobe patchy ground glass opacities primarily on the left side (lung contusions). The mediastinal (b) window showssurgical emphysema at the root of the neck and fracture of the medial one-third of the left clavicle with a corresponding haematoma.

Y.Y. Sabri et al. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

641

Fig. 5. A 30-year-old male with a history of blunt chest trauma presented with complaints of dyspnoea and exhibited diminished breath sounds on the right side. CTsagittal (a) and coronal (b) reconstruction of the soft tissue window shows herniation of the liver (hump sign on the right image and hour glass sign on the left image)and presence of the small bowel and most of the large bowel (dependent viscera sign) in the right side of the chest through a diaphragmatic defect, with shifting of themediastinum to the contralateral side. A diaphragmatic tear with visceral herniation was noted.

Fig. 6. A 25-year-old male with a history of a severe car accident. A CT scan of the lung window at the level of the carina (a), 2D coronal plane image (b), minimumintensity projection (c) and virtual bronchoscopy (d) revealed the normal bifurcation of the right and left main bronchi (blue arrows) with partial right mainbronchus avulsion just after the bifurcation (white arrows). Small pin hole connection discovered in virtual bronchography between main stem bronchus and rightlung (black arrow) with good aeration of the lung. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of thisarticle.)

Y.Y. Sabri et al. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

642

accidents were the most common cause of trauma, accounting for56.8% of the cases, followed by fall from height, which occurred in 40%of the patients.

Blunt chest trauma is more common in young males. A total of 70%of patients exposed to blunt chest trauma were males, and 60% of thepatients were in the age group of 20–40 years [20]. These results areconsistent with those of the present study, as 90 patients (72%) weremale and 35 patients (28%) were female (ratio 2.5:1), with most of thepatients (59.2%) in the age group of 20–40 years (59.2%).

Pulmonary contusions were the most common parenchymal lunginjury detected, with a prevalence of 17–70%. Chest MDCT is highlysensitive in identifying pulmonary contusions and may help predict theneed for mechanical ventilation [7]. It provides an accurate estimationof the injury extent. Features on CT are dependent on injury severity:ground glass opacity is an indication of mainly interstitial damage withpartial alveolar filling, whereas consolidation is indicative of severealveolar damage, often associated with lacerations. The distributionmainly involves peripheral areas of the lung, with no lobar or segmentalboundaries affected [21]. In our study, contusions were found in 71patients (56.8%). Thirty-two cases presented with consolidation, 27cases presented with ground glass opacifications and 12 cases showedboth types of lesions. Six cases showed only centrally distributed le-sions, and the remaining cases showed mainly peripheral lesions.

Parenchymal lung lacerations were found in seven patients (5.6%).This low percentage is due to possible missed lacerations in the acutestage, as reported by Miele et al., as blood accumulation at the site oflaceration in the acute stage shows well-defined homogenous opacityand the density of soft tissue can be masked by associated pulmonarycontusions, which become clearly detectable on serial follow-up ex-amination [21].

In this study, haemothorax was detected in fifty-three patients(42.4%). These results coincided with those of Sangster et al. whostated that haemothorax occurs in 30–50% of patients with blunt chesttrauma [22].

Pneumothorax was detected in forty-two patients (33.6%), simplepneumothorax was found in 16 patients (12.8%), tension pneu-mothorax was found in 5 patients (4%), and hydropneumothorax wasfound in 21 patients (16.8%). Farooq et al. confirmed that pneu-mothorax occurs in 30–40% of trauma patients [23].

In this study, rib fracture was the most common skeletal injurydetected. It was detected in twenty-eight patients (22.4%), corre-sponding to 68% of all fractures observed, with 53.6% of cases ex-hibiting right-sided fractures, 39.3% of cases exhibiting left-sidedfractures and 7.1% of cases exhibiting bilateral fractures. Kaewali et al.stated that rib fractures are the most common type of injury after bluntchest trauma and occur in approximately 50% of patients [7]. Ribfracture detection on CT is a challenging task. Missed fractures on CTare typically located at the anterior arc, and more than 50% of missedrib fractures have a buckled shape. They appear equally on both sides ofthe thoracic cage. Frequently, missed fractures are on the same rib orthe neighbouring rib [24]. Multi-planar reformatting (MPR) supple-mented by the 3D volume-rendering technique (VRT) is best for iden-tifying fractures in coronal and sagittal views [25].

Scapular fractures were found in five patients (4%), including onewith severe chest trauma due to a road traffic accident and one whoexperienced a fall from height. These fractures are associated with otherinjuries, including pneumothorax, haemothorax, pulmonary injuries,and spinal injuries. These results are consistent with those of Weeninget al., who reported that fractures of the scapula are uncommon, ac-counting for only 3–5% of all shoulder girdle fractures and occurring in3.7% of patients with multiple injuries [26], and Veysi et al. reportedthat scapular fractures indicate high-force trauma because the scapulais enveloped and protected by the large muscle masses of the posteriorthorax; therefore, isolated fractures are rare [27].

Clavicular fractures were found in three patients (2.4%);Scheurecker reported that clavicular fractures from blunt chest trauma

account for 2.6–5% of all fractures [28]. Sternal fractures are also re-latively rare, appearing in only 3–8% of patients after severe blunt chesttrauma [29]. Sternal fractures were detected in two patients (1.6%) inthis study. These fractures are typically associated with anterior med-iastinal or retrosternal haematomas [6].

Soft tissue haematomas may occur during direct compressiontrauma when rib fractures cause laceration of veins or arteries [30]. All13 cases of soft tissue chest wall haematoma in this study were relatedto rib fractures.

Subcutaneous emphysema was found in thirty-four patients(27.2%). Trkulja et al. reported that subcutaneous emphysema is pre-sent in up to 34% of patients after blunt chest trauma [31].

In this study, eight patients showed pneumo-mediastinum (6.4%),which is similar to the findings of Oikonomou and Prassopoulos, whoreported that pneumo-mediastinum occurs in up to 10% of patientswith blunt chest trauma [30]. Pneumo-mediastinum is attributed to theMacklin effect caused by alveolar rupture, leading to air dissectionalong bronchovascular bundles and diffusion of pulmonary interstitialemphysema into the mediastinum. Other sources of air are derived fromlung parenchymal, oesophageal, chest wall, neck, and retroperitonealinjuries [15]. In this study, the Macklin effect was observed in fourpatients with pneumo-mediastinum and in two patients with oesopha-geal injury.

Pneumo-pericardium is a rare finding in blunt chest trauma [31],and it was detected in only 1 patient (0.8%) in our study.

Oesophageal injury detection by MDCT mainly depends on indirectfindings of oesophageal rupture, such as localized oesophageal wallthickening, oesophageal haematoma, peri-oesophageal air, oedema,pneumo-mediastinum, mediastinitis, hydropneumothorax, or leakageof intraluminal fluid or orally administered contrast medium [32].Oesophageal injury is very common in penetrating or iatrogenic in-juries, but it occurs in only 1% of cases of blunt chest trauma [30]. Inthis study, oesophageal injury was identified in two patients (1.6%)who presented with pneumo-mediastinum and peri-oesophageal fluidand oedema.

In this study, tracheo-bronchial injuries were detected in two pa-tients (1.6%). Tracheo-bronchial injuries are rare in clinical practice.Kaewali et al. verified that blunt tracheo-bronchial trauma accounts foronly 0.2–8% of all cases of blunt chest trauma [7].

Diaphragmatic rupture occurs in 0.8–7% of blunt trauma patients.MDCT can identify herniated fat or viscera and can detect small dia-phragmatic defects; 77–90% of diaphragmatic ruptures originate on theleft side, as the liver protects the right hemidiaphragm [33]. In thisstudy, diaphragmatic injury was detected in six patients (4.8%), with50% of injuries on the left side.

5. Conclusion

Chest trauma may cause significant morbidity, and MDCT couldlead to critical changes in a patient’s management. Therefore, cliniciansand radiologists should be familiar with the most frequent MDCTfindings and their various aspects in this group of patients.

6. Conflict of interest

We have no conflict of interest to declare.

References

[1] Euathrongchit J, Thoongsuwan N, Stern EJ. Nonvascular mediastinal trauma.Radiol Clin North Am 2006;44:251–8.

[2] Maier D, Jaeger M, Izadpanah K, Bornebusch L, Südkamp NP. Traumatic injuries ofthe sternoclavicular joint. Unfallchirurg 2011;114:611–21.

[3] Schulz-Drost S, Oppel P, Grupp S, Krinner S, Langenbach A, Lefering R, Mauerer A.Bony injuries of the thoracic cage in multiple trauma: Incidence, concomitant in-juries, course and outcome. Unfallchirurg 2015;119:1023–30.

[4] Daffner RH, Hackney DB. ACR Appropriateness Criteria on suspected spine trauma.

Y.Y. Sabri et al. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

643

http://refhub.elsevier.com/S0378-603X(18)30079-2/h0005http://refhub.elsevier.com/S0378-603X(18)30079-2/h0005http://refhub.elsevier.com/S0378-603X(18)30079-2/h0010http://refhub.elsevier.com/S0378-603X(18)30079-2/h0010http://refhub.elsevier.com/S0378-603X(18)30079-2/h0015http://refhub.elsevier.com/S0378-603X(18)30079-2/h0015http://refhub.elsevier.com/S0378-603X(18)30079-2/h0015http://refhub.elsevier.com/S0378-603X(18)30079-2/h0020

J Am Coll Radiol 2007;4:762–75.[5] Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J

Roentgenol. 2009 Mar;192(3):599–612.[6] Wirth S, Jansen S. Bony and thoracic chest wall injuries. In: Scaglione M,

Linsenmaier U, Schueller G, Berger F, Wirth S, editors. Emergency radiology of thechest and cardiovascular system. Switzerland: Springer; 2016. p. 25–60.

[7] Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracictrauma. Radiographics 2008;28:1555–70.

[8] Nelson D, Porta C, Satterly S, Blair K, Johnson E, Inaba K, Martin M. Physiology andcardiovascular effect of severe tension pneumothorax in a porcine model. J Surg Res2013;184:450–7.

[9] Laberge JM, Kerlan RK, Ponrartana S. Large asymptomatic hydropneumothoraxafter thoracentesis. J Vasc Interv Radiol 2004;15:1047–9.

[10] Strumwasser A, Chu E, Yeung L, Miraflor E, Sadjadi J, Victorino G. A novel CTvolume index score correlates with outcomes in polytrauma patients with pul-monary contusion. J Surg Res 2011;170:280–5.

[11] Gilkeson RC, Lange P, Kirby TJ. Lung torsion after lung transplantation evaluationwith helical CT. Am J Roentgenol 2000;174(5):1341–3.

[12] Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: areview on epidemiology, mechanisms of injury, diagnosis and treatment. JCardiothorac Surg 2014;9:117.

[13] Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics2012;32:477–98.

[14] Magu S, Agarwal S, Singla S. Computed tomography in the evaluation of dia-phragmatic hernia following blunt trauma. Indian J Surg 2012;74:288–93.

[15] Schnyder P, Wintermark M. Trauma of the chest wall. In: Schnyder P, WintermarkM, editors. Radiology of blunt trauma of the chest. 1st ed.Berlin/Heidelberg:Springer; 2000. p. 9–27.

[16] Chung JH, Carr RB, Stern EJ. Extrapleural hematomas: imaging appearance, clas-sification, and clinical significance. J Thorac Imaging 2010;26:218–23.

[17] Restrepo CS, Lemos DF, Lemos JA. Imaging findings in cardiac tamponade withemphasis on CT. Radiographics 2007;27:1595–610.

[18] Mirka H, Ferda J, Baxa J. Multidetector computed tomography of chest trauma:indications, technique and interpretation. Nsights into Imaging 2012;3:433–49.

[19] Mancini MC, Talavera F, Karwande SV, Geibel J, Roe BB, Sawyer MAJ, et al. Blunt

chest trauma: overview, relevant anatomy, workup. [Online] Available: < http://emedicine.medscape Com/article/428723-Overview> ; 2014.

[20] Dabees NL, Salama AL, Abd Elhamid SSM. Multi-detector computed tomographyimaging of blunt chest trauma. Egypt J Radiol Nucl Med 2014;45(4):1105–13.

[21] Miele V, Giampietro I, Ianniello S, Pinto F, Trinci M. Diagnostic imaging in pediatricpolytrauma management. Radiol Med 2015 Jan;120(1):33–49.

[22] Sangster P, Gonzalez-Beicos A, Carbo AI. Blunt traumatic injuries of the lung par-enchyma, pleura, thoracicwall, and intrathoracic airways: multidetector computertomography imaging findings. Emerg Radiol 2007;14:297–310.

[23] Farooq UW, Zia RN, Hanif M, Kha MM. Classification and management of chesttrauma. J Coll Physicians Surg Pakistan 2006;16:101–3.

[24] Ringl H, Lazar M, Topker M, Woitek R, Prosch H, Asenbaum U, Balassy C, Toth D,Weber M, Hajdu S, Soza G, Wimmer A, Mang T. The ribs unfolded – a CT visuali-zation algorithm for fast detection of rib fractures: effect on sensitivity and specificity in trauma patients. Eur Radiol 2015;25:1865–74.

[25] Geyer Lucas L, Linsenmaier U. MDCT of chest trauma. In: Schoepf UJ, Reiser MF,editors. Multidetector-Row CT Thorax. 2nd ed.Springer; 2016. p. 525–44.

[26] Weening B, Walton C, Cole PA, Alanezi K, Hanson BP, Bhandari M. Lower mortalityin patients with scapular fractures. J Trauma 2010;59:1477–81.

[27] Veysi VT, Mittal R, Agarwal S. Multiple trauma and scapular fractures: so what? JTrauma 2009;55(6):1145–7.

[28] Scheurecker G. Traumatic bone and cartilage injuries of the shoulder. Radiologe2015;55:188–94.

[29] Mirvis SE, Kubal WS, Shanmuganathan K, Soto JA, Yu J. Problem solving inemergency radiology. 1st ed. Elsevier; 2014.

[30] Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging2011;2:281–95.

[31] Turkalj I, Petrović K, Stojanović S, Petrović D, Brakus A, Ristić J. Blunt chesttrauma: an audit of injuries diagnosed by the MDCT examination. Vojnosanitetskipregled 2014;71(2):161–6.

[32] Young CA. Menias CO Bhalla S and Prasad SR. CT features of esophageal emer-gencies. Radiographics 2008;28:1541–53.

[33] João P, Matos AP, Mascarenhas V, Herédia V, Ramalho M. Multidetector computertomography: evaluation of blunt chest trauma in adults. Radiol Res Practice2014:1–12.

Y.Y. Sabri et al. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 638–644

644

http://refhub.elsevier.com/S0378-603X(18)30079-2/h0020http://refhub.elsevier.com/S0378-603X(18)30079-2/h0025http://refhub.elsevier.com/S0378-603X(18)30079-2/h0025http://refhub.elsevier.com/S0378-603X(18)30079-2/h0030http://refhub.elsevier.com/S0378-603X(18)30079-2/h0030http://refhub.elsevier.com/S0378-603X(18)30079-2/h0030http://refhub.elsevier.com/S0378-603X(18)30079-2/h0035http://refhub.elsevier.com/S0378-603X(18)30079-2/h0035http://refhub.elsevier.com/S0378-603X(18)30079-2/h0040http://refhub.elsevier.com/S0378-603X(18)30079-2/h0040http://refhub.elsevier.com/S0378-603X(18)30079-2/h0040http://refhub.elsevier.com/S0378-603X(18)30079-2/h0045http://refhub.elsevier.com/S0378-603X(18)30079-2/h0045http://refhub.elsevier.com/S0378-603X(18)30079-2/h0050http://refhub.elsevier.com/S0378-603X(18)30079-2/h0050http://refhub.elsevier.com/S0378-603X(18)30079-2/h0050http://refhub.elsevier.com/S0378-603X(18)30079-2/h0055http://refhub.elsevier.com/S0378-603X(18)30079-2/h0055http://refhub.elsevier.com/S0378-603X(18)30079-2/h0060http://refhub.elsevier.com/S0378-603X(18)30079-2/h0060http://refhub.elsevier.com/S0378-603X(18)30079-2/h0060http://refhub.elsevier.com/S0378-603X(18)30079-2/h0065http://refhub.elsevier.com/S0378-603X(18)30079-2/h0065http://refhub.elsevier.com/S0378-603X(18)30079-2/h0070http://refhub.elsevier.com/S0378-603X(18)30079-2/h0070http://refhub.elsevier.com/S0378-603X(18)30079-2/h0075http://refhub.elsevier.com/S0378-603X(18)30079-2/h0075http://refhub.elsevier.com/S0378-603X(18)30079-2/h0075http://refhub.elsevier.com/S0378-603X(18)30079-2/h0080http://refhub.elsevier.com/S0378-603X(18)30079-2/h0080http://refhub.elsevier.com/S0378-603X(18)30079-2/h0085http://refhub.elsevier.com/S0378-603X(18)30079-2/h0085http://refhub.elsevier.com/S0378-603X(18)30079-2/h0090http://refhub.elsevier.com/S0378-603X(18)30079-2/h0090http://emedicine.medscape%20Com/article/428723-Overviewhttp://emedicine.medscape%20Com/article/428723-Overviewhttp://refhub.elsevier.com/S0378-603X(18)30079-2/h0100http://refhub.elsevier.com/S0378-603X(18)30079-2/h0100http://refhub.elsevier.com/S0378-603X(18)30079-2/h0105http://refhub.elsevier.com/S0378-603X(18)30079-2/h0105http://refhub.elsevier.com/S0378-603X(18)30079-2/h0110http://refhub.elsevier.com/S0378-603X(18)30079-2/h0110http://refhub.elsevier.com/S0378-603X(18)30079-2/h0110http://refhub.elsevier.com/S0378-603X(18)30079-2/h0115http://refhub.elsevier.com/S0378-603X(18)30079-2/h0115http://refhub.elsevier.com/S0378-603X(18)30079-2/h0120http://refhub.elsevier.com/S0378-603X(18)30079-2/h0120http://refhub.elsevier.com/S0378-603X(18)30079-2/h0120http://refhub.elsevier.com/S0378-603X(18)30079-2/h0120http://refhub.elsevier.com/S0378-603X(18)30079-2/h0125http://refhub.elsevier.com/S0378-603X(18)30079-2/h0125http://refhub.elsevier.com/S0378-603X(18)30079-2/h0130http://refhub.elsevier.com/S0378-603X(18)30079-2/h0130http://refhub.elsevier.com/S0378-603X(18)30079-2/h0135http://refhub.elsevier.com/S0378-603X(18)30079-2/h0135http://refhub.elsevier.com/S0378-603X(18)30079-2/h0140http://refhub.elsevier.com/S0378-603X(18)30079-2/h0140http://refhub.elsevier.com/S0378-603X(18)30079-2/h0145http://refhub.elsevier.com/S0378-603X(18)30079-2/h0145http://refhub.elsevier.com/S0378-603X(18)30079-2/h0150http://refhub.elsevier.com/S0378-603X(18)30079-2/h0150http://refhub.elsevier.com/S0378-603X(18)30079-2/h0155http://refhub.elsevier.com/S0378-603X(18)30079-2/h0155http://refhub.elsevier.com/S0378-603X(18)30079-2/h0155http://refhub.elsevier.com/S0378-603X(18)30079-2/h0160http://refhub.elsevier.com/S0378-603X(18)30079-2/h0160http://refhub.elsevier.com/S0378-603X(18)30079-2/h0165http://refhub.elsevier.com/S0378-603X(18)30079-2/h0165http://refhub.elsevier.com/S0378-603X(18)30079-2/h0165

Spectrum of MDCT findings in blunt chest trauma patients at a tertiary health care University Hospital: A single-centre experienceIntroductionPatients and methodsInclusion criteriaExclusion criteriaMethods

ResultsChest wall injuries were detected in 51/125 (40.8%) patientsBony chest wall injuriesSoft tissue chest wall injuries

Pleural space injuries were detected in 90/125 (72%) patientsLung parenchymal injuries were detected in 71/125 (56.8%) patientsMediastinal injuries were detected in 14/125 (11.2%) patientsDiaphragmatic injuries (Fig. 5) were detected in 6 (4.8%) patientsTracheo-bronchial injuries (Fig. 6) were detected in 6 (4.8%) patients were suspected in 2 (1.6%) patients

DiscussionConclusionConflict of interestReferences