Penetrating thoracic trauma
Penetrating thoracic trauma, namely gunshot and stab injuries, vary widely in incidence globally but nevertheless result in high mortality and serious morbidity. CT is the modality of choice in imaging these patients and can reduce the need for surgical exploration.
Penetrating thoracic trauma most commonly affects the chest wall, pleura and lungs (up to 97%) with precordial and periclavicular injuries less common 1. Accurate identification of the entry site(s) is important, although it should be noted that the wound tract can appear remote due to respiratory motion.
In the typical trauma setting a supine AP radiograph is acquired. Despite the inherent limitations of this technique, many pathologies can be easily identified 2:
- pneumothorax, pneumomediastinum, hemothorax, subcutaneous emphysema
- pulmonary opacities representing contusion, laceration, etc
- abnormal cardiomediastinal contour representing hematoma from cardiac or mediastinal injury
- rib fractures
- foreign bodies, e.g. bullets/bullet fragments, knife blade
In the stable patient, contrast-enhanced CT is the modality of choice to assess for thoracic injuries. CT can be used to delineate the wound track and identify any foreign bodies (e.g. bullets).
In addition to injuries seen on plain radiography, CT is more sensitive in assessing for 1,3:
- mediastinal injuries
- detecting small pneumothorax/hemothorax not seen on plain radiographs
- subclavian artery injury
- diaphragmatic injury
- 1. Dreizin D, Munera F. Multidetector CT for Penetrating Torso Trauma: State of the Art. Radiology. 2015;277 (2): 338-55. doi:10.1148/radiol.2015142282 - Pubmed citation
- 2. Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol. 2009;192 (3): 599-612. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.07.3324 - Pubmed citation
- 3. Co SJ, Yong-Hing CJ, Galea-Soler S et-al. Role of imaging in penetrating and blunt traumatic injury to the heart. Radiographics. 2011;31 (4): E101-15. doi:10.1148/rg.314095177 - Pubmed citation