WorldWideScience

Sample records for paediatric chest trauma

  1. Paediatric chest wall trauma causing delayed presentation of ventricular arrhythmia.

    Science.gov (United States)

    Tegethoff, Angela M; Raney, Emerald; Mendelson, Jenny; Minckler, Michael R

    2017-07-24

    This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

  3. Paediatric trauma

    African Journals Online (AJOL)

    Trauma Unit, Red Cross War Memorial Children's Hospital, Cape Town ... projects, educational initiatives and advocacy roles on child safety initiatives regarding child injuries as well as child abuse. ... The development of the total body digital.

  4. CT of chest trauma

    International Nuclear Information System (INIS)

    Goodman, P.C.

    1986-01-01

    There appears to be a limited role for computed tomography in the evaluation of chest trauma. The literature contains few papers specifically addressing the use of CT in the setting of chest trauma. Another series of articles relates anecdotal experiences in this regard. This paucity of reports attests to the remarkable amount of information present on conventional chest radiographs as well as the lack of clear indications for CT in the setting of chest trauma. In this chapter traumatic lesions of various areas of the thorax are discussed. The conventional radiographic findings are briefly described and the potential or proven application of CT is addressed

  5. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

    Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

  6. Radiology in chest trauma

    International Nuclear Information System (INIS)

    Wenz, W.; Kloehn, I.; Wolfart, W.; Freiburg Univ.

    1979-01-01

    In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20-30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology. (orig.) [de

  7. Chest radiography after minor chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Rossen, B.; Laursen, N.O.; Just, S.

    The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.

  8. Chest radiography after minor chest trauma

    International Nuclear Information System (INIS)

    Rossen, B.; Laursen, N.O.; Just, S.

    1987-01-01

    The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma. (orig.)

  9. Trauma of the chest

    International Nuclear Information System (INIS)

    Reuter, M.

    1996-01-01

    This paper describes the typical radiologic findings in chest trauma, and the value of conventional radiography, CT, MRI, and aortography is discussed. Conventional radiography rather than cross-sectional imaging is the mainstay in diagnosing thoracic trauma. During the critical phase with often concomitant shock, pelvic and spinal injuries tailored raiographic views or even upright chest radiographs are impractical. The severely traumatized patient is usually radiographed in the supine position and suboptimal roentgenograms may have to be accepted for several reasons. It is well documented that many abnormalities detected on CT were not apparent on conventional radiographs, but CT is reserved for hemodynamical stable patients. Nevertheless certain situations like aortic rupture require further evaluation by CT and aortography. (orig./MG)

  10. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Prosch, H.; Negrin, L.

    2014-01-01

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

  11. The imaging of paediatric thoracic trauma

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael A.; Westra, Sjirk J. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Wallace, E.C. [UMass Memorial Medical Center and University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States)

    2009-05-15

    Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity. (orig.)

  12. The imaging of paediatric thoracic trauma

    International Nuclear Information System (INIS)

    Moore, Michael A.; Westra, Sjirk J.; Wallace, E.C.

    2009-01-01

    Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity. (orig.)

  13. CT findings of chest trauma

    International Nuclear Information System (INIS)

    Kim, Young Tong; Kim Young Il

    1998-01-01

    Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 persons under 40 years of age. Most pleural, pulmonary, mediastinal, and diaphragmatic injuries are not seen on conventional chest radiographs, or are underestimated. In patients with chest trauma, CT scanning is an effective and sensitive method of detecting thoracic injuries and provides accurate information regarding their pattern and extent. (author). 5 refs., 17 figs

  14. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A.

    2000-01-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  15. Algorithm for optimisation of paediatric chest radiography

    International Nuclear Information System (INIS)

    Kostova-Lefterova, D.

    2016-01-01

    The purpose of this work is to assess the current practice and patient doses in paediatric chest radiography in a large university hospital. The X-ray unit is used in the paediatric department for respiratory diseases. Another purpose was to recommend and apply optimized protocols to reduce patient dose while maintaining diagnostic image quality for the x-ray images. The practice of two different radiographers was studied. The results were compared with the existing practice in paediatric chest radiography and the opportunities for optimization were identified in order to reduce patient doses. A methodology was developed for optimization of the x-ray examinations by grouping children in age groups or according to other appropriate indication and creating an algorithm for proper selection of the exposure parameters for each group. The algorithm for the optimisation of paediatric chest radiography reduced patient doses (PKA, organ dose, effective dose) between 1.5 and 6 times for the different age groups, the average glandular dose up to 10 times and the dose for the lung between 2 and 5 times. The resulting X-ray images were of good diagnostic quality. The subjectivity in the choice of exposure parameters was reduced and standardization has been achieved in the work of the radiographers. The role of the radiologist, the medical physicist and radiographer in the process of optimization was shown. It was proven the effect of teamwork in reducing patient doses at keeping adequate image quality. Key words: Chest Radiography. Paediatric Radiography. Optimization. Radiation Exposure. Radiation Protection

  16. Radiology of blunt chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Shulman, H.S.; Samuels, T.H. (Sunnybrook Medical Centre, Toronto, Ontario (Canada))

    1983-09-01

    Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronhcial rupture and diaphragmatic rupture.

  17. Computed tomography of chest trauma

    International Nuclear Information System (INIS)

    Dinkel, E.; Uhl, H.; Reinbold, W.D.; Wimmer, B.; Wenz, W.

    1987-01-01

    Chest CT scans were obtained in 86 patients suffering from serious blunt or penetrating chest trauma. The finding of mediastinal widening was by far the most common CT indication. CT proved to be a more sensitive method for detection of parenchymal lung lesions and occult pneumothorax than bedside radiographs. CT contributed substantially in differentiation of lung abscess and empyema, exclusion of mediastinal pathology and spinal injuries. Aortography is still indicated, even when CT findings are normal, if aortic laceration is clinically suspected. Despite all technical problems combined with CT examinations in the critically ill patient, we consider CT a valuable diagnostic tool for selected problems in the traumatized patient. (orig.) [de

  18. Computed tomography of chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Dinkel, E.; Uhl, H.; Reinbold, W.D.; Wimmer, B.; Wenz, W.

    1987-09-01

    Chest CT scans were obtained in 86 patients suffering from serious blunt or penetrating chest trauma. The finding of mediastinal widening was by far the most common CT indication. CT proved to be a more sensitive method for detection of parenchymal lung lesions and occult pneumothorax than bedside radiographs. CT contributed substantially in differentiation of lung abscess and empyema, exclusion of mediastinal pathology and spinal injuries. Aortography is still indicated, even when CT findings are normal, if aortic laceration is clinically suspected. Despite all technical problems combined with CT examinations in the critically ill patient, we consider CT a valuable diagnostic tool for selected problems in the traumatized patient.

  19. Transfusion therapy in paediatric trauma patients

    DEFF Research Database (Denmark)

    Nystrup, Kristin Brønnum; Stensballe, Jakob; Bøttger, Morten

    2015-01-01

    Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid...... in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma...... patients.MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.Considering the high...

  20. Paediatric horse-related trauma.

    Science.gov (United States)

    Theodore, Jane E; Theodore, Sigrid G; Stockton, Kellie A; Kimble, Roy M

    2017-06-01

    This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded. Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed. Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  1. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  2. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  3. THE DEADLY DOZEN OF CHEST TRAUMA

    African Journals Online (AJOL)

    Enrique

    specialised surgical intervention; probably the most common presentation is related .... failure. Operation is another treatment option for flail chest, after having been discarded in the ... physiologically unstable due to trauma in other anatomical ...

  4. Determinants of Mortality in Chest Trauma Patients

    African Journals Online (AJOL)

    10% of trauma admissions.[1,2] In the United States it is estimated at 12 out of 1 million population per day.[3] Furthermore chest injury is still directly responsible for about 25% of trauma‑related deaths and contribute to death in another 25% of trauma‑related deaths.[1,2,4] Therefore, chest injury directly and indirectly ...

  5. Chest trauma in children: A local experience

    International Nuclear Information System (INIS)

    Al-Saigh, A.; Fazili, Fiaz M.; Allam, Abdulla R.

    1999-01-01

    Chest trauma in childhood is relatively uncommon in clinical practice andhas been the subject of few reports in literature. This study was undertakento examine our experience in dealing with chest trauma in children. This wasa retrospective study of 74 children who sustained chest trauma and werereferred to King Fahd Hospital in Medina over a two-year period. The age,cause of injury, severity of injury, associated extrathoracic injuries,treatment and outcome were analyzed. The median age of patients was nineyears. Fifty-nine of them (80%) sustained blunt trauma in 62% of thechildren, gun shot wounds were seen in five and stab wounds in 10 children.Head injury was the most common injury associated with thoracic trauma andwas seen in 14 patients (19%) and associated intra-abdominal injuries wereseen in nine patients. Chest x-ray of the blunt trauma patients revealedfractured ribs in 24 children, pneumothorax in six, hemothorax in four,hemoneumothorax in three, and pulmonary contusions in 22 patients. Fifty onepercent of children were managed conservatively, 37% required tubethoracostomy, 8% were mechanically ventilated and 4% underwent thoractomy.The prevalence of chest trauma in children due to road traffic accidents ishigh in Saudi Arabia. Head injury is thought to be the most common associatedextrathoracic injuries, however, most of these patients can be managedconservatively. (author)

  6. CT of blunt chest trauma in children

    International Nuclear Information System (INIS)

    Manson, D.; Babyn, P.S.; Palder, S.; Bergmann, K.

    1993-01-01

    While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy. (orig.)

  7. Classification and management of chest trauma

    International Nuclear Information System (INIS)

    Farooq, U.; Raza, W.; Zia, N.; Hanif, M.; Khan, M.M.

    2006-01-01

    Objective: To classify the predominant pattern of injuries following blunt and penetrating chest trauma and to assess the adequacy of treatment strategies, complications and mortality associated with such injuries. Design: Descriptive study. Place and Duration of Study: Surgical Unit I, Holy Family Hospital, Rawalpindi, from December 2000 to December 2003. Patients and Methods: One hundred consecutive patients with thoracic trauma either blunt or penetrating, admitted in the ward were evaluated. Their injuries were classified, treatment strategies outlined and complications and mortality were documented on a specially-designed proforma. Results: Out of the 100 patients presenting in emergency, 44% presented with blunt and 56% with penetrating trauma. Pneumothorax was detected in 39% of the patients, hemopneumothorax in 29%, hemothorax in 12%, flail chest in 9%. Two had involvement of the heart and major vessels, 4% had injury to the diaphragm and 5% had multiple trauma. During treatment, 3% of all the patients were managed conservatively, 83% of patients required chest intubations, 6% needed ventilatory support and 8 % required thoracotomy. Complications were experienced in 28% of the patients of which 9% had pneumonias, 14% empyema and 5% suffered from wound infections. The overall mortality was 7%. Conclusion: This series showed the pattern of injuries following blunt and penetrating chest trauma. Furthermore, it was found that chest incubation and simple resuscitation was adequate for majority of the cases. (author)

  8. Possibilities of CT examinations by chest trauma

    International Nuclear Information System (INIS)

    Ftacnikova, B.

    1994-01-01

    Chest trauma represents the most frequent associated injury in multiply injured patients. The success of treatment depends also on prompt and effective diagnosis and extent of the injuries, on quality interdisciplinary approach. Author presents contributions of computed tomography (CT) in the management of 77 critically injured patients. Attention is focused on the efficacy of CT examination routinely employed in the setting of thoracic trauma and its relationship to following rationalization of treatment. CT scans of thorax is modality of choice for evaluating patients with occult pneumothorax, chest wall deformity of rib fractures, early diagnosis of lung contusion and laceration. (author). 13 figs., 1 tab., 7 refs

  9. Chest Trauma in Athletic Medicine.

    Science.gov (United States)

    Phillips, Nicholas R; Kunz, Derek E

    2018-03-01

    While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax. Basic field-side management should be rapid and focused, using the standardized approach of Advanced Traumatic Life Support protocol. Early and appropriate diagnosis and management can help allow safe and enjoyable sports participation.

  10. Chest trauma in children, single center experience.

    Science.gov (United States)

    Ismail, Mohamed Fouad; al-Refaie, Reda Ibrahim

    2012-10-01

    Trauma is the leading cause of mortality in children over one year of age in industrialized countries. In this retrospective study we reviewed all chest trauma in pediatric patients admitted to Mansoura University Emergency Hospital from January 1997 to January 2007. Our hospital received 472 patients under the age of 18. Male patients were 374 with a mean age of 9.2±4.9 years. Causes were penetrating trauma (2.1%) and blunt trauma (97.9%). The trauma was pedestrian injuries (38.3%), motor vehicle (28.1%), motorcycle crash (19.9%), falling from height (6.7%), animal trauma (2.9%), and sports injury (1.2%). Type of injury was pulmonary contusions (27.1%) and lacerations (6.9%), rib fractures (23.9%), flail chest (2.5%), hemothorax (18%), hemopneumothorax (11.8%), pneumothorax (23.7%), surgical emphysema (6.1%), tracheobronchial injury (5.3%), and diaphragm injury (2.1%). Associated lesions were head injuries (38.9%), bone fractures (33.5%), and abdominal injuries (16.7%). Management was conservative (29.9%), tube thoracostomy (58.1%), and thoracotomy (12.1%). Mortality rate was 7.2% and multiple trauma was the main cause of death (82.3%) (Ptrauma is the most common cause of pediatric chest trauma and often due to pedestrian injuries. Rib fractures and pulmonary contusions are the most frequent injuries. Delay in diagnosis and multiple trauma are associated with high incidence of mortality. Copyright © 2011 SEPAR. Published by Elsevier España, S.L. All rights reserved.

  11. ACR appropriateness criteria blunt chest trauma.

    Science.gov (United States)

    Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

    2014-04-01

    Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. The radiology of blunt chest trauma

    International Nuclear Information System (INIS)

    Shulman, H.S.; Samuels, T.H.

    1983-01-01

    Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronhcial rupture and diaphragmatic rupture

  13. Spiral CT for evaluation of chest trauma

    International Nuclear Information System (INIS)

    Roehnert, W.; Weise, R.

    1997-01-01

    After implementation of spiral CT in our department, we carried out an analysis for determining anew the value of CT as a modality of chest trauma diagnosis in the emergency department. The retrospective study covers a period of 10 months and all emergency patients with chest trauma exmined by spiral CT. The major lesions of varying seriousness covered by this study are: pneumothorax, hematothorax, pulmonary contusion or laceration, mediastinal hematoma, rupture of a vessel, injury of the heart and pericardium. The various fractures are not included in this study. In many cases, spiral CT within relatively short time yields significant diagnostic findings, frequently saving additional angiography. A rigid diagnostic procedure cannot be formulated. Plain-film chest radiography still remains a diagnostic modality of high value. (Orig.) [de

  14. Cardiogenic shock following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  15. Does hemopericardium after chest trauma mandate sternotomy?

    Science.gov (United States)

    Thorson, Chad M; Namias, Nicholas; Van Haren, Robert M; Guarch, Gerardo A; Ginzburg, Enrique; Salerno, Tomas A; Schulman, Carl I; Livingstone, Alan S; Proctor, Kenneth G

    2012-06-01

    Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110). Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy. Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases. Therapeutic study, level III. Copyright © 2012 by Lippincott Williams & Wilkins.

  16. Ventricular septal necrosis after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Alireza Ahmadi

    2012-07-01

    Full Text Available Ventricular Septal Defect (VSD after blunt chest trauma is a very rare traumatic affection.We report here a case of blunt chest injury-related VSD and pseudoaneurysm.A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edemaand echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely theintracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue somehidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinicalsequelae.

  17. Quality of outpatient paediatric chest radiography - a pilot study

    International Nuclear Information System (INIS)

    Engelmann, D.; Duetting, T.; Wunsch, R.; Troeger, J.

    2001-01-01

    A quality control of outpatient paediatric chest X-rays was conducted in a sample of patients of one paediatric practice. During a period of eight months the technical image quality was analysed considering both diagnostic aspects and radiation protection. The quality of the 139 examined chest X-rays was inadequate concerning the collimation and focussing of the X-rays and the positioning of the patients. Exposure was estimated as average, sharpness was rated as good. In total 14% of the X-rays were not suitable for medical diagnosis. Image quality of the X-rays of infants (children younger than 6 years) was significantly lower compared to the total sample. Radiation protection standards were not fulfilled. As a conclusion from our results, improvements in outpatient paediatric radiography are urgently necessary. Quality control committees should pay particular attention in radiographs of infants. (orig.) [de

  18. Pattern of Paediatric Trauma in North Western Nigeria | Mungadi ...

    African Journals Online (AJOL)

    Socio-economic emancipation, intra-city traffic considerations, abrogation of child labour and provision of adequate water supply should reduce these accidents. Trauma prevention and care programme in developing countries should always address paediatric injuries. KEY Words: Paediatric, Trauma, North Western, ...

  19. Myocardial contusion following nonfatal blunt chest trauma

    International Nuclear Information System (INIS)

    Kumar, S.A.; Puri, V.K.; Mittal, V.K.; Cortez, J.

    1983-01-01

    Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma

  20. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  1. Hepatic hydrothorax after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Shang-Chiung Wang

    2012-08-01

    Full Text Available We report a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. This was a female patient with liver cirrhosis, Child–Turcotte–Pugh class A, without ascites before injury. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually. We inserted a chest tube to relieve the patient's symptoms, and the daily drainage amount remained consistent. Hepatic hydrothorax was confirmed by the intraperitoneal injection of radioisotope 99mTc-sulfur colloid that demonstrated one-way transdiaphragmatic flow of fluid from the peritoneal cavity to pleural cavities. Finally, the hydrothorax was treated successfully by minocycline-induced pleural symphysis. To the best of our knowledge, this is the first case of hepatic hydrothorax developed after thoracoabdominal trauma.

  2. Chest tube placement in thorax trauma - comparison chest X-ray and computed tomography (CT)

    International Nuclear Information System (INIS)

    Heim, P.; Maas, R.; Buecheler, E.; Tesch, C.

    1998-01-01

    Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. Material and methods: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. Results: In chest radiography in the supine position there were no chest tube malpositions (n=40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. Conclusion: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube. (orig.) [de

  3. Atrioventricular Dissociation following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Salim Surani

    2014-01-01

    Full Text Available Blunt chest trauma (BCT is a common clinical presentation seen in emergency departments. Few cases of cardiac conduction abnormalities due to BCT have been reported in the medical literature. This dysrhythmias may present as permanent conduction defects requiring permanent pacemaker or may have temporary conduction abnormalities requiring temporary pacemaker or supportive care. We present the case of a young woman who suffered from BCT after being kicked by a horse with the development of a significant substernal hematoma. She developed temporary atrioventricular block, which was completely resolved with the decrease in the size of the substernal hematoma suffered.

  4. Determinants of Mortality in Chest Trauma Patients | Ekpe | Nigerian ...

    African Journals Online (AJOL)

    Background: Chest trauma is an important trauma globally accounting for about 10% of trauma admission and 25‑50% of trauma death. Different types and severity of ... Data were collected and were analyzed using WINPEPI Stone Mountain, Georgia: USD Inc; 1995 statistical software. Results: A total 149 patients with ...

  5. PAEDIATRIC OCULAR TRAUMA IN KUCHING, SARAWAK, MALAYSIA

    Directory of Open Access Journals (Sweden)

    INTAN G

    2011-01-01

    Full Text Available Purpose: To evaluate the demography, aetiology, type and outcome of paediatric ocular trauma in tertiary centre in Malaysia. Method: We retrospectively studied 118 eyes from 117 patients over a period of 36 months (January 2006 to December 2008. All ocular injuries in patients aged 12 and below seen in the Ophthalmology Department for the first time were included in thisstudy. Results: Mean age of patients was 6.1±3.0 years. 68 cases (58.2% occurred in pre-school children, whereas 49 (41.9% in school-aged children. Boys accounted for 65.8% of cases. There was no predilection for either right or the left eye. 47% of cases (56 patients occurred in Malay. Most of the injuries took place at home when the children were alone (p<0.05. Sharp objects were the commonest cause (45 cases, 38.1%. The majority of cases (103, 87.3% were considered preventable. The frequency of open and closed globe injury was similar. Hyphema was more common in closed globe injury compared to open globe injury (p<0.05. Other associated injuries such as cataract, vitreous hemorrhage and retinal hemorrhage are similar between the two groups. Visual outcome is generally poor with only 34 eyes (28.8% had no visual impairment. Conclusion: Ocular trauma in children is an important cause of visual loss. Most cases occurred at home and were preventable. Prevention through education is the best approach.

  6. Paediatric Blunt Liver Trauma in a Dutch Level 1 Trauma Center

    NARCIS (Netherlands)

    Nellensteijn, D.; Porte, R. J.; van Zuuren, W.; ten Duis, H. J.; Hulscher, J. B. F.

    2009-01-01

    Introduction: Paediatric blunt hepatic trauma treatment is changing from operative treatment (OT) to non-operative treatment (NOT). In 2000 the American Pediatric Surgical Association has published guidelines for NOT of these injuries. Little is known about the treatment of paediatric liver trauma

  7. Chest trauma in children: current imaging guidelines and techniques.

    LENUS (Irish Health Repository)

    Moore, Michael A

    2011-09-01

    Given the heterogeneous nature of pediatric chest trauma, the optimal imaging approach is tailored to the specific patient. Chest radiography remains the most important imaging modality for initial triage. The decision to perform a chest computed tomography scan should be based on the nature of the trauma, the child\\'s clinical condition, and the initial radiographic findings, taking the age-related pretest probabilities of serious injury into account. The principles of as low as reasonably achievable and Image Gently should be followed. The epidemiology and pathophysiology, imaging techniques, characteristic findings, and evidence-based algorithms for pediatric chest trauma are discussed.

  8. Multi-detector row computed tomography and blunt chest trauma

    International Nuclear Information System (INIS)

    Scaglione, Mariano; Pinto, Antonio; Pedrosa, Ivan; Sparano, Amelia; Romano, Luigia

    2008-01-01

    Blunt chest trauma is a significant source of morbidity and mortality in industrialized countries. The clinical presentation of trauma patients varies widely from one individual to another and ranges from minor reports of pain to shock. Knowledge of the mechanism of injury, the time of injury, estimates of motor vehicle accident velocity and deceleration, and evidence of associated injury to other systems are all salient features to provide for an adequate assessment of chest trauma. Multi-detector row computed tomography (MDCT) scanning and MDCT-angiography are being used more frequently in the diagnosis of patients with chest trauma. The high sensitivity of MDCT has increased the recognized spectrum of injuries. This new technology can be regarded as an extremely valuable adjunct to physical examination to recognize suspected and unsuspected blunt chest trauma

  9. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    International Nuclear Information System (INIS)

    Palas, J.; Matos, A.P.; Ramalho, M.; Mascarenhas, V.; Heredia, V.

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  10. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  11. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    OpenAIRE

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-01-01

    Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a tru...

  12. Blunt chest trauma: bony injury in the thorax.

    Science.gov (United States)

    Zreik, Nasri H; Francis, Irene; Ray, Arun; Rogers, Benedict A; Ricketts, David M

    2016-02-01

    The management of blunt chest trauma is an evolving concept with no clear current guidelines. This article explores the bony injuries associated with this, focusing on rib fractures and flail segments and the themes around investigation and best management.

  13. Paediatric trauma imaging: Why do we need separate guidance?

    International Nuclear Information System (INIS)

    Negus, S.; Danin, J.; Fisher, R.; Johnson, K.; Landes, C.; Somers, J.; Fitzsimmons, C.; Ashford, N.; Foster, J.

    2014-01-01

    It is often assumed that the pattern of injury in children mirrors that of the adult population, but children have different anatomical proportions and the relative elasticity of their tissues results in different injury patterns. The authors of this review are members of the British Society of Paediatric Radiologists subgroup and developed the recently published 47 paediatric trauma protocols for imaging children involved in major blunt trauma. The following article has been written to bring these guidelines to the attention of the wider community of UK radiologists, and explain the rationale behind the recommendations

  14. Role of computed tomography in blunt chest trauma

    International Nuclear Information System (INIS)

    Cho, Jae Hyun; Kim, Sang Jin; Lee, Chan Wha; Kim, Hae Kyoon

    1994-01-01

    In patient with blunt trauma of chest, supine AP x-ray cannot differentiate the lung contusion, laceration, atelectasis, and hemothorax definitely. Therefore, computed tomographic evaluation is needed for accurate evaluation of the injuries. In our knowledge, there are few reports about CT findings of blunt chest trauma, in our country, therefore we tried to fluid the characteristic CT findings in patients with blunt trauma. We analyzed the plain x-ray and CT image of 4 patients with blunt chest trauma. Location and morphology of lung parenchymal contusion and laceration, hemopneumothorax, chest wall injuries and location of chest tube. Lung parenchymal contusion was noted in 53 segments., of 16 patients infiltration(n=27 segment), and multiple nodular pattern was noted in 15 segment, pattern of consolidation along the lung periphery was seen in 11 segment. Laceration was noted in 18 lesion and most commonly located in paravertebral area(b=8). CT scan of chest in patient with blunt chest trauma, provides accurate information of the pattern of injuries, and localization, therefore, should be performed as possible

  15. Radiodiagnosis of pulmonary lesions in a severe closed chest trauma

    International Nuclear Information System (INIS)

    Kishkovskij, A.N.; Tyutin, L.A.; Savchenko, B.K.

    1986-01-01

    The results of X-ray examination of 548 persons with a severe closed chest trauma were summed up. Urgent chest X-ray examination included panoramic roentgenography or electroroentgenography of the chest in two projections performed mostly in a special wheelchair without resetting and turning the patients. Dynamic X-ray control was used afterwards. Pulmonary lesions developed most frequently in a closed chest trauma. Roentgenosemiotics of lung contusion was characterized by a variety of symptoms and determined by the nature of a contusion syndrome. Infiltrate like, cavitary, miliary and peribronchial forms of lung contusion should be distinguished by an X-ray picture. In lung rupture, pneumothorax was detected in 33%, pneumohemothorax in 56%, emphysema of the chest soft tissues in 28%, mediastinal emphysema in 4% of the cases

  16. Factors Associated with ICU Admission following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Andrea Bellone

    2016-01-01

    Full Text Available Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1% were admitted to intensive care unit (ICU within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p=0.0018 and the severity of trauma score (p<0.0002 were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

  17. Penetrating cardiac injuries in blunt chest wall trauma.

    Science.gov (United States)

    Kanchan, Tanuj; Menezes, Ritesh G; Sirohi, Parmendra

    2012-08-01

    The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  18. Failure rate of prehospital chest decompression after severe thoracic trauma.

    Science.gov (United States)

    Kaserer, Alexander; Stein, Philipp; Simmen, Hans-Peter; Spahn, Donat R; Neuhaus, Valentin

    2017-03-01

    Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied. In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization. Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission. Copyright © 2016. Published by Elsevier Inc.

  19. Occult pneumomediastinum in blunt chest trauma: clinical significance.

    Science.gov (United States)

    Rezende-Neto, J B; Hoffmann, J; Al Mahroos, M; Tien, H; Hsee, L C; Spencer Netto, F; Speers, V; Rizoli, S B

    2010-01-01

    Thoracic injuries are potentially responsible for 25% of all trauma deaths. Chest X-ray is commonly used to screen patients with chest injury. However, the use of computed tomography (CT) scan for primary screening is increasing, particularly for blunt trauma. CT scans are more sensitive than chest X-ray in detecting intra-thoracic abnormalities such as pneumothoraces and pneumomediastinums. Pneumomediastinum detected by chest X-ray or "overt pneumomediastinum", raises the concern of possible aerodigestive tract injuries. In contrast, there is scarce information on the clinical significance of pneumomediastinum diagnosed by CT scan only or "occult pneumomediastinum". Therefore we investigated the clinical consequences of occult pneumomediastinum in our blunt trauma population. A 2-year retrospective chart review of all blunt chest trauma patients with initial chest CT scan admitted to a level I trauma centre. Data extracted from the medical records include; demographics, occult, overt, or no pneumomediastinum, the presence of intra-thoracic aerodigestive tract injuries (trachea, bronchus, and/or esophagus), mechanism and severity of injury, endotracheal intubation, chest thoracostomy, operations and radiological reports by an attending radiologist. All patients with intra-thoracic aerodigestive tract injuries from 1994 to 2004 were also investigated. Of 897 patients who met the inclusion criteria 839 (93.5%) had no pneumomediastinum. Five patients (0.6%) had overt pneumomediastinum and 53 patients (5.9%) had occult pneumomediastinum. Patients with occult pneumomediastinum had significantly higher ISS and AIS chest (pchest thoracostomy tube was more common (ppneumothorax. None of the patients with occult pneumomediastinum had aerodigestive tract injuries (95%CI 0-0.06). Follow up CT scan of patients with occult pneumomediastinum showed complete resolution in all cases, in average 3 h after the initial exam. Occult pneumomediastinum occurred in approximately 6% of

  20. The application of MDCT in the diagnosis of chest trauma.

    Science.gov (United States)

    Błasińska-Przerwa, Katarzyna; Pacho, Ryszard; Bestry, Iwona

    2013-01-01

    Traumas are the third most common cause of death worldwide, after cardiovascular diseases and neoplasms, and the main cause of death of patients under 40 years of age. Contemporary image diagnosis of chest trauma uses chest X-ray (CXR), multidetector computed tomography (MDCT), transthoracic and transoesophageal ultrasound (USG), X-ray angiography and magnetic resonance. The aim of the present study was to evaluate MDCT results in the examination of posttraumatic chest injuries and to compare the results of CXR and MDCT in chosen chest traumatic injuries. The sixty patients with chest trauma included in the study were diagnosed at the Department of Radiology of the Institute of Tuberculosis and Lung Diseases between May 2004 and October 2007. MDCT was performed in all patients. Two groups with different types of injury (blunt or penetrating chest trauma) were distinguished. The analysis of injuries in both groups was conducted depending on the mechanism of trauma. The detection of 20 selected injuries at CXR and MDCT was compared. Moreover, the compatibility of MDCT with the results of intraoperative assessment and bronchoscopy was analysed. The influence of MDCT on the treatment modality was also assessed. History of blunt chest trauma was found in 51 patients (group 1) and of penetrating trauma in 9 patients (group 2). The most frequent injuries among group 1 were lung contusion and rib fractures, and among group 2 it was pericardial hematoma. Compared to MDCT, the sensitivity and specificity of CXR were 66.7 and 58%, respectively. Change of treatment modality was observed after MDCT in 83% of patients. The sensitivity and specificity of MDCT in diagnosing tracheobronchial injury, compared to bronchoscopy, were 72.7% and 100%, respectively. Compatibility of MDCT results and intraoperative assessment was observed in 43% of patients, and the main reason for discrepancy was underdiagnosis of diaphragm injury in MDCT. MDCT was a valuable diagnostic method in

  1. Pectus excavatum in blunt chest trauma: a case report

    Directory of Open Access Journals (Sweden)

    Liodakis Emmanouil

    2013-01-01

    Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

  2. Compliance with barrier precautions during paediatric trauma resuscitations.

    Science.gov (United States)

    Kelleher, Deirdre C; Carter, Elizabeth A; Waterhouse, Lauren J; Burd, Randall S

    2013-03-01

    Barrier precautions protect patients and providers from blood-borne pathogens. Although barrier precaution compliance has been shown to be low among adult trauma teams, it has not been evaluated during paediatric resuscitations in which perceived risk of disease transmission may be low. The purpose of this study was to identify factors associated with compliance with barrier precautions during paediatric trauma resuscitations. Video recordings of resuscitations performed on injured children (compliance with an established policy requiring gowns and gloves. Depending on activation level, trauma team members included up to six physicians, four nurses, and a respiratory therapist. Multivariate logistic regression was used to determine the effect of team role, resuscitation factors, and injury mechanism on barrier precaution compliance. Over twelve weeks, 1138 trauma team members participated in 128 resuscitations (4.7% penetrating injuries, 9.4% highest level activations). Compliance with barrier precautions was 81.3%, with higher compliance seen among roles primarily at the bedside compared to positions not primarily at the bedside (90.7% vs. 65.1%, pcompliance, while surgical attendings (20.8%) had the lowest (prole, increased compliance was observed during resuscitations of patients with penetrating injuries (OR=3.97 [95% CI: 1.35-11.70], p=0.01), during resuscitations triaged to the highest activation level (OR=2.61 [95% CI: 1.34-5.10], p=0.005), and among team members present before patient arrival (OR=4.14 [95% CI: 2.29-7.39], pCompliance with barrier precautions varies by trauma team role. Team members have higher compliance when treating children with penetrating and high acuity injuries and when arriving before the patient. Interventions integrating barrier precautions into the workflow of team members are needed to reduce this variability and improve compliance with universal precautions during paediatric trauma resuscitations. Copyright © 2012 Elsevier

  3. Predictors of chest drainage complications in trauma patients

    Directory of Open Access Journals (Sweden)

    CECÍLIA ARAÚJO MENDES

    2018-04-01

    Full Text Available ABSTRACT Objective: to identify predictors of chest drainage complications in trauma patients attended at a University Hospital. Methods: we conducted a retrospective study of 68 patients submitted to thoracic drainage after trauma, in a one-year period. We analyzed gender, age, trauma mechanism, trauma indices, thoracic and associated lesions, environment in which the procedure was performed, drainage time, experience of the performer, complications and evolution. Results: the mean age of the patients was 35 years and the male gender was the most prevalent (89%. Blunt trauma was the most frequent, with 67% of cases, and of these, 50% were due to traffic accidents. The mean TRISS (Trauma and Injury Severity Score was 98, with a mortality rate of 1.4%. The most frequent thoracic and associated lesions were, respectively, rib fractures (51% and abdominal trauma (32%. The mean drainage time was 6.93 days, being higher in patients under mechanical ventilation (p=0.0163. The complication rate was 26.5%, mainly poor drain positioning (11.77%. Hospital drainage was performed in 89% of cases by doctors in the first year of specialization. Thoracic drainage performed in prehospital care presented nine times more chances of complications (p=0.0015. Conclusion: the predictors of post-trauma complications for chest drainage were a procedure performed in an adverse site and mechanical ventilation. The high rate of complications demonstrates the importance of protocols of care with the thoracic drainage.

  4. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2011-09-01

    Full Text Available Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  5. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

    Science.gov (United States)

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-09-27

    Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  6. Common tasks and problems in paediatric trauma radiology

    International Nuclear Information System (INIS)

    Paertan, Gerald; Pamberger, Petra; Blab, Edmund; Hruby, Walter

    2003-01-01

    Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology

  7. Common tasks and problems in paediatric trauma radiology

    Energy Technology Data Exchange (ETDEWEB)

    Paertan, Gerald E-mail: gerald.paertan@smz.magwien.gv.at; Pamberger, Petra; Blab, Edmund; Hruby, Walter

    2003-10-01

    Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology.

  8. Transient electrocardiographic abnormalities following blunt chest trauma in a child

    NARCIS (Netherlands)

    Udink ten Cate, Floris; Heerde, van Marc; Rammeloo, Lukas; Hruda, Jaroslav

    2008-01-01

    Blunt cardiac injury may occur in patients after suffering nonpenetrating trauma of the chest. It encompasses a wide spectrum of cardiac injury with varied severity and clinical presentation. Electrocardiographic abnormalities are frequently encountered. This article presents a case of a child

  9. Imaging of blunt chest trauma; Bildgebung des stumpfen Thoraxtraumas

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, H. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Negrin, L. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Unfallchirurgie, Wien (Austria)

    2014-09-15

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [German] Stumpfe Thoraxtraumen gehen mit einer hohen Morbiditaet und Mortalitaet einher. Daher sollten Patienten mit Verdacht auf ein stumpfes Thoraxtrauma rasch radiologisch untersucht werden, damit die entsprechenden therapeutischen Schritte zeitgerecht eingeleitet werden koennen. Zur Abklaerung von Patienten nach einem stumpfen Thoraxtrauma sind seit Jahren das konventionelle Lungenroentgen und die Computertomographie bewaehrte Verfahren. In den letzten Jahren hat die fokussierte Ultraschalluntersuchung (eFAST, Extended Focused Assessment with Sonography for Trauma) von schwerverletzten Patienten vermehrt an Bedeutung gewonnen. Durch eine eFAST-Untersuchung kann in der Akutphase rasch geklaert werden, ob bei dem Patienten ein therapiebeduerftiger Pneumothorax, Haematoperikard oder Haematothorax vorliegen. Auch das Lungenroentgen wird zur Diagnose eines Pneumothorax oder Haematothorax eingesetzt, wenngleich seine Sensitivitaet deutlich eingeschraenkt ist. Die CT ist das diagnostische Verfahren der Wahl, um v. a. Patienten mit einem schweren Thoraxtrauma abzuklaeren. (orig.)

  10. Mitral valve plasty for mitral regurgitation after blunt chest trauma.

    Science.gov (United States)

    Kumagai, H; Hamanaka, Y; Hirai, S; Mitsui, N; Kobayashi, T

    2001-06-01

    A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

  11. Thoracic Trauma: Which Chest Tube When and Where?

    Science.gov (United States)

    Molnar, Tamas F

    2017-02-01

    Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Tracheobronchial injuries in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    vahid Montazeri

    2004-01-01

    Full Text Available Introduction: Tracheobronchial injuries are uncommon but potentially fatal complication of blunt thoracic trauma harboring a high morbidity and mortality if not diagnosed early . A recent series gleaning cases from four major Trauma Center in Los Angeles nine cases in a seven- year period , but the incidence of these injuries has been increasing recently. This has been attributed to improvement in hospital care and advanced Trauma Centers and earlier diagnosis of such injuries. Disruption of tight main bronchus is more common, such injuries are often associated with rib or clavicular fractures. Findings: Clinical and paraclinical data gathered from records of three patients referred with tracheobronchial injuries during the recent ten years have been reviewed .These include clinical manifestations, diagnostic findings, treatment modality and clinical course. The outcome has been satisfactory in all three patients who have undergone operation 2-5 hours after sustaining the injury. We have not had any mortality. Conclusion: These results are similar to those of other series emphasizing over early diagnosis and treatment of such injuries .

  13. Non-Invasive Mechanic Ventilation Using in Flail Chest, Caused By Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2008-01-01

    Full Text Available A 75-year-old woman admitted our faculty emergency room with shortness of breath, and chest pain after traffic accident’s second hour. She was diagnosed as bilateral multipl rib fractures, left clavicula fracture, and left flail chest by phsical and radiological examinations. She was transfered to Chest Surgery Depatment’s intensive care unit. The patient was undergone non-invasive mask mechanic ventilation support, because of the decreasing of blood oxygen saturation and increasing of arteriel blood partial carbondioxide pressure. The treatment of non-invasive mechanic ventilation was succesfull for ventilation support. With this report, we would like to attentioned that non-invasive mechanic ventilation for blunt chest trauma patients could be used succesfully and could be used instead of endotracheal invasive mechanic ventilation.

  14. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

    DEFF Research Database (Denmark)

    Bartels, Mette Damkjær; Nielsen, PE; Sleight, P

    2006-01-01

    Prompted by a case where a patient (with no risk factors, and single vessel disease) developed angina pectoris after previous blunt chest trauma, we searched Medline for blunt chest trauma and myocardial ischaemia. We found 77 cases describing AMI after blunt chest trauma, but only one reporting...... angina pectoris. We focused on the age and sex distribution, type of trauma, the angiography findings and the time interval between the trauma and the angiography. The age distribution was atypical, compared to AMI in general; 82% of the patients with AMI after blunt chest trauma were less than 45 years......, which strongly suggested a causal relation between the trauma and subsequent occlusion. AMI should therefore be considered in patients suffering from chest pain after blunt chest trauma. Because traumatic AMI might often be the result of an intimal tear or dissection, thrombolytic therapy might worsen...

  15. Delayed pneumothorax complicating minor rib fracture after chest trauma.

    Science.gov (United States)

    Lu, Ming-Shian; Huang, Yao-Kuang; Liu, Yun-Hen; Liu, Hui-Ping; Kao, Chiung-Lun

    2008-06-01

    Pneumothorax (PTX) after trauma is a preventable cause of death. Drainage procedures such as chest tube insertion have been traditionally advocated to prevent fatal tension PTX. We evaluated the safety of close observation in patients with delayed PTX complicating rib fracture after minor chest trauma. Adult patients (>18 years) with a diagnosis of chest trauma and 3 or fewer fractured ribs were reviewed. Case patients were divided according to age, location and number of fractured ribs, mechanism of trauma, and initial pulmonary complication after thoracic trauma for comparative analysis. There were 207 male (70.2%) and 88 female (29.8%) patients whose ages ranged from 18 to 93 years (median, 55 years). The mechanisms of trauma were a motor vehicle accident in 207 patients, falls in 66, pedestrian injury in 10, and assaults in 14. Ninety-five patients sustained 1 rib fracture, 95 had 2 rib fractures, and 105 suffered 3 rib fractures. Right-sided injury occurred in 164 cases, left-sided injury did in 127, and bilateral injury did in 4. The most frequent location of rib fractures was from the fourth rib to the ninth rib. The initial pulmonary complications after trauma were PTX in 16 patients, hemothorax in 43, pneumohemothorax in 14, lung contusion in 75, and isolated subcutaneous emphysema (SubcEmph) in 33. Thirty percent of the patients (n = 5/16) who presented with traumatic PTX were observed safely without drainage. Delayed PTX was recorded in 16 patients, occurring mostly during the first 2 days of their admission. Associated extrathoracic injury was recorded in 189 patients. The mean hospital stay of the patients was 7.66 days. Longer hospital stay was related to increasing number of fractured ribs, need for thoracic drainage, and the presence of associated extrathoracic injury. The mortality rate for the entire group was 2%. The presence of SubcEmph was the only risk factor associated with the development of delayed PTX. Patients sustaining blunt chest

  16. Impacted thoracic foreign bodies after penetrating chest trauma.

    Science.gov (United States)

    Sersar, Sameh I; Albohiri, Khalid A; Abdelmohty, Hysam

    2016-10-01

    Retained foreign bodies in the chest may include shell fragments, bullets, shrapnel, pieces of clothing, bones, and rib fragments. The risks of removal of foreign bodies must be weighed against the complications of leaving them inside the chest. We treated 90 cases of retained intrathoracic foreign bodies in patients admitted to 3 tertiary centers in Saudi Arabia between March 2015 and March 2016. Sixty patients were injured by shrapnel, 26 had one or more bullets, 3 had broken rib fragments, and one had a metal screw. The chest wall was site of impaction in 48 cases, the lungs in 24, pleura in 14, and mediastinum in 4. Removal of the retained foreign body was carried out in 12 patients only: bullets in 9 cases, bone fragments in 2, and a metal screw in one. The predictors for removal were bullets, female sex, and mediastinal position with bilateral chest injury, especially with fracture ribs. Retained intrathoracic foreign bodies due to penetrating chest trauma are treated mainly conservatively unless there is another indication for chest exploration. © The Author(s) 2016.

  17. Rib fractures in blunt chest trauma - associated thoracic injuries

    Directory of Open Access Journals (Sweden)

    Iv. Dimitrov

    2017-09-01

    Full Text Available PURPOSE. The aim of our retrospective study was to analyze the patterns of associated thoracic injuries in patients underwent blunt chest trauma and rib fractures. METHODS. The study included 212 patients with rib fractures due to blunt thoracic trauma. The mechanism of trauma, the type of rib fracture and the type of associated injuries were analyzed. RESULTS. The patients were divided in two groups according to the number of fractured ribs-group I included the patients with up to two fractured ribs (72 patients-33,9%, and group II – with ≥3 fractured ribs (140 patients-66,1%. Associated chest injuries were present in 36 of the patients from group I (50%, and in 133 patients from group II (95%. Pulmonary contusion was the most common intrathoracicinjurie-65,6% of the cases. The mean hospital stay was 8, 7 days. The lethality rate was 16,9% -all of them due to the associated chest injuries. CONCLUSIONS. The mortality related to rib fractures is affected by the associated thoracic injuries, the advanced age, and the number of fractured ribs.

  18. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience.

    Science.gov (United States)

    Veysi, Veysi T; Nikolaou, Vassilios S; Paliobeis, Christos; Efstathopoulos, Nicolas; Giannoudis, Peter V

    2009-10-01

    A review of prospectively collected data in our trauma unit for the years 1998-2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of >/=16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AIS(chest) = 1) were associated with mortality comparable to injuries involving an AIS(chest) = 3. Additionally, the vast majority of polytraumatised patients with an AIS(chest) = 1 died in ICU sooner than patients of groups 2-5.

  19. Chest Traumas due to Bicycle accident in Childhood

    Directory of Open Access Journals (Sweden)

    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Aim:Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Trauma is the second most common cause of mortality in children aged 1-4 years and leading cause of death in children older than 4 years. Thoracic injury is the second most leading cause of death in traumatized children. Multisystemic injury is found in more than 50% of children with thoracic injuries most of which are secondary to blunt traumas. We planned this study to evaluate thorax trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers.Material and Methods:  A retrospective evaluation was performed in 17 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2010 with a diagnosis of chest trauma due to bicycle driving. For every patient, a pediatric trauma score (PTS was calculated. Descriptive statistics were performed for PTS. Results; Eleven (64.70% cases were injured due to the tricycle accidents and six cases 6 (35.29% were injured due to the two-wheeled bicycle accidents. The most frequent thoracic pathologies included pulmonary contusion (41.2% and chest wall contusion (29.41%. Extrathoracic injuries were seen in 35.29%, the extremities (17.64% and abdomino pelvic (11.76% being the most commonly involved. Treatment consisted of symptomatic treatment in 12 patients (70.58%, tube thoracostomy in 2 patients (11.76%, and thoracotomy in 1 patient (5.9%. The morbidity was seen in 3 patients (17.64%. The mortality rate was 5.9% (n:1. The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas Conclusions: The pediatric thorax has a greater cartilage content and incomplete ossification of the ribs. Due to the pliability of the pediatric rib cage and mediastinal mobility, significant intrathoracic injury may exist in the

  20. Experimental article – Maintaining image quality for paediatric chest CTs while lowering dose : FBP versus SAFIRE

    NARCIS (Netherlands)

    Borgea, Synnøve; Campbell, Nina; Gomes, Ana; Raszkowskia, Aysha M.; Rook, Jan Willem; Sanderud, Audun; Vallinga, Anique; Buissink, Carst; Vouillamoze, Audrey

    2015-01-01

    Objectives: Children have a greater risk from radiation, per unit dose, due to increased radiosensitivity and longer life expectancies. It is of paramount importance to reduce the radiation dose received by children. This research concerns chest CT examinations on paediatric patients. The purpose of

  1. Meet TOM - the world's first open chest paediatric/adult manikin.

    Science.gov (United States)

    Dix, Ann

    2016-07-20

    Aged 15, TOM is a model patient. He has suffered more than his fair share of life-threatening events and never complains. But then TOM is not your average sick teenager - he is the world's first open chest paediatric/adult manikin.

  2. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

    OpenAIRE

    Idris, Baig M.; Hefny, Ashraf F.

    2016-01-01

    Introduction: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. Presentation of case: A 63- year- old man presented...

  3. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

    Science.gov (United States)

    Masuda, Norikazu; Yasojima, Hiroyuki; Mizutani, Makiko; Nakamori, Shoji; Kanazawa, Toru; Kuriyama, Keiko; Mano, Masayuki; Sekimoto, Mitsugu

    2014-01-01

    Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient's chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery. PMID:24660001

  4. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Yusuke Yamaoka

    2014-01-01

    Full Text Available Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient’s chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery.

  5. CT analysis of pulmonary injuries from blunt chest trauma

    International Nuclear Information System (INIS)

    Konno, Shoko

    1996-01-01

    The purpose of this paper is to analyze the CT findings of pulmonary parenchymal injuries due to blunt chest trauma and to categorize CT findings on the basis of their outcome. The materials of this study consist of 62 patients who had pulmonary injuries on CT obtained within 6 hours after blunt chest trauma. CT findings were analysed with regards to the shape, size, and distribution of the lesions. Follow-up CT scans were obtained in 35 patients at intervals from 1 day to 1 month after the initial CT study. CT showed ill-defined opacities in 59 patients (64 lesions in the peripheral area and 95 in the non-peripheral area) and pulmonary nodules with or without cavitary lesions in 30 patients (7 lesions in the peripheral area and 31 in the non-peripheral area). Follow-up CT allowed the classification of these pulmonary injuries into 3 types; the non-peripheral, ill-defined opacities showing immediate clearing, nodules with or without cavitary lesions over 1 cm in diameter showing prolongation, and the peripheral ill-defined opacities adjacent to the thoracic cage, and small nodules with or without cavitary lesions within 1 cm in diameter, showing various courses. CT has marked advantage over plain chest radiographs not only in the detection rate but in accurate estimation of the prognosis of the lesions. (author)

  6. Chest wall stabilization in trauma patients: why, when, and how?

    Science.gov (United States)

    White, Thomas W.

    2018-01-01

    Blunt trauma to the chest wall and rib fractures are remarkably frequent and are the basis of considerable morbidity and possible mortality. Surgical remedies for highly displaced rib fractures, especially in cases of flail chest, have been undertaken intermittently for more than 50 years. Rib-specific plating systems have started to be used in the last 10 years. These have ushered in the modern era of rib repair with chest wall stabilization (CWS) techniques that are safer, easier to perform, and more efficient. Recent consensus statements have sought to define the indications and contraindications, as well as the when, the how, and the technical details of CWS. Repair should be considered for patients who have three or more displaced rib fractures or a flail chest, whether or not mechanical ventilation is required. Additional candidates include patients who fail non-operative management irrespective of fracture pattern and those with rib fractures who need thoracic procedures for other reasons. Traditionally, unstable spine fracture and severe traumatic brain injury are definite contraindications. Pulmonary contusion’s role in the decision to perform CWS remains controversial. A range of rib-specific plating systems are now commercially available. PMID:29744222

  7. Estimated risk of radiation-induced cancer from paediatric chest CT: two-year cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Niemann, Tilo [Cantonal Hospital Baden, Department of Radiology, Baden (Switzerland); University Lille Nord de France, Department of Thoracic Imaging, Hospital Calmette, Lille (France); Colas, Lucie; Santangelo, Teresa; Faivre, Jean Baptiste; Remy, Jacques; Remy-Jardin, Martine [University Lille Nord de France, Department of Thoracic Imaging, Hospital Calmette, Lille (France); Roser, Hans W.; Bremerich, Jens [University of Basel Hospital, Clinic of Radiology and Nuclear Medicine, Medical Physics, Basel (Switzerland)

    2015-03-01

    The increasing absolute number of paediatric CT scans raises concern about the safety and efficacy and the effects of consecutive diagnostic ionising radiation. To demonstrate a method to evaluate the lifetime attributable risk of cancer incidence/mortality due to a single low-dose helical chest CT in a two-year patient cohort. A two-year cohort of 522 paediatric helical chest CT scans acquired using a dedicated low-dose protocol were analysed retrospectively. Patient-specific estimations of radiation doses were modelled using three different mathematical phantoms. Per-organ attributable cancer risk was then estimated using epidemiological models. Additional comparison was provided for naturally occurring risks. Total lifetime attributable risk of cancer incidence remains low for all age and sex categories, being highest in female neonates (0.34%). Summation of all cancer sites analysed raised the relative lifetime attributable risk of organ cancer incidence up to 3.6% in female neonates and 2.1% in male neonates. Using dedicated scan protocols, total lifetime attributable risk of cancer incidence and mortality for chest CT is estimated low for paediatric chest CT, being highest for female neonates. (orig.)

  8. Isolated right atrial appendage rupture following blunt chest trauma.

    Science.gov (United States)

    Hegde, Rakesh; Lafayette, Nathan; Sywak, Michael; Ricketts, Gregory; Otero, Jorge; Kurtzman, Scott; Zhang, Zhongqiu

    2018-02-01

    Right sided tears or rupture are the most common injury to the heart after blunt chest trauma. The majority of these injuries are to the thin walled atrium. Reports of localized right atrial appendage rupture are rare. The classical features of Beck's triad are unreliable in the trauma bay. With the advent of EFAST (Focused assessment with sonography for trauma extended to thorax), Beck's triad should be considered but not used as the primary clinical tool for diagnosis of cardiac tamponade [1]. EFAST aids in rapid diagnosis and definitive care [3]. Our patient was a 17 year old male who presented with hypotension after a rollover motor vehicle accident. He presented with a grossly negative physical exam and positive EFAST for pericardial effusion with tamponade physiology. We performed an emergency pericardiocentesis and expedited transportation for operative exploration. A Right atrial appendage injury was identified and repaired and patient recovered uneventfully. EFAST examination aids in rapid diagnosis of cardiac tamponade in the trauma setting. Pericardiocentesis facilitates temporizing the hemodynamics in preparation for operative exploration.

  9. Profile of thoracic trauma victims submitted to chest drainage

    Directory of Open Access Journals (Sweden)

    CESAR AUGUSTO BROSKA JÚNIOR

    Full Text Available ABSTRACT Objective: to describe and compare the variables involved in trauma victims undergoing thoracic drainage. Methods: we conducted a retrospective, analytical, descriptive, cross-sectional study, with medical records of patients attended at the Trauma Service of the Curitiba Evangelical University Hospital between February 2011 and January 2014. Results: there were 488 patients undergoing chest drainage, 84.7% men and 15.3% women, with an average age of 38.2 years. Attendances usually occurred at night, without predominance between open or closed mechanism, gender or age group. The majority of patients with thoracic trauma requiring drainage were diagnosed by anamnesis and physical examination (41.1% and drained in the emergency room (80.8%. Most of the patients (66.2% had another associated lesion, mostly some abdominal viscera. Complications were present in 16.6% (81 patients, most of them due to drainage positioning error (9.2%. The mean hospital stay was 15 days and drainage lasted for an average of 8.1 days, with no statistical difference between open and closed trauma. The clinical outcome was discharge in most cases. Conclusion: the profile of patients with thoracic trauma is that of young men, attended at night, with some other associated lesion. Although diagnosis and treatment were rapid and most often without the need for complex examinations, the time of drainage, hospitalization and complications were higher than in the literature, which can be explained by the drainage being made at the Emergency Room and the presence of associated injuries.

  10. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem?

    Science.gov (United States)

    Chrysou, Konstantina; Halat, Gabriel; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

    2017-04-20

    Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included. A total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AIS thorax 3), 19.1% a severe chest injury (AIS thorax 4) and 15.5% a moderate chest injury (AIS thorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AIS thorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AIS thorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality. Although 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AIS

  11. The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period.

    Science.gov (United States)

    Naidoo, Natasha; Muckart, David J J

    2015-09-19

    Injury in childhood is a major cause of potentially preventable morbidity and mortality. In order to implement effective preventive strategies, epidemiological data on mechanisms of injury and outcome are essential. To assess the causation, severity of injury, morbidity and mortality of paediatric trauma admitted to a level 1 trauma intensive care unit (TICU). Children were defined as being 25 in 98 patients (54.1%), 16-25 in 51 (28.2%), 9-15 in 9 (4.9%) and 25. Of the 26 patients who died, 88.4% had a head injury, 46.2% an extremity injury, 38.5% an external injury, 34.6% abdominal or chest injuries, 19.2% neck injury and 11.5% facial injury. Motor vehicle-related injuries, especially PMVCs, dominate severe paediatric trauma and there is an urgent need for more road traffic education and stringent measures to decrease the incidence and associated morbidity and mortality.

  12. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

    Directory of Open Access Journals (Sweden)

    Tabet A. Al-Sadek

    2016-11-01

    CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries, but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.

  13. Initial assessment of chest X-ray in thoracic trauma patients: Awareness of specific injuries

    NARCIS (Netherlands)

    Aukema, Tjeerd S.; Beenen, Ludo F. M.; Hietbrink, Falco; Leenen, Luke Ph

    2012-01-01

    To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical

  14. Delayed cardiac tamponade in a patient with previous minor blunt chest trauma

    NARCIS (Netherlands)

    Hermens, Jeannine A.J.M.; Wajon, Elly M.C.J.; Grandjean, Jan G; Grandjean, Jan G.; Haalebos, Max M.P.; von Birgelen, Clemens

    2009-01-01

    Hemopericardium with cardiac tamponade after non-penetrating chest trauma is a very rare but life-threatening condition. If this complication develops after an interval of several weeks following the non-penetrating chest trauma, the causal relation with the traumatic event is less evident, which

  15. Profile of chest trauma in Zaria Nigeria: A prelminary report

    Directory of Open Access Journals (Sweden)

    S A Edaigbini

    2011-01-01

    Materials and Methods A prospective study of trauma patients admitted to Ahmadu Bello University Teaching Hospital through the Accident and Emergency units was commenced in January 2008.This preliminary report is for the period of 27months.The clinical history, physical examination and outcome of management recorded in a predesigned proforma, were analysed with SPSS 15 and the patients were followed up in the surgical outpatient department. Results A total of 4784 patients (3143 men and 1641 women were admitted during this period for trauma. There were a total of 628(13.13% deaths. Of the 42 consecutive patients identified with chest trauma35 (83.3% were males and 7(16.7% were females. The age range was from 5-75years and the mean age was 35.4years, while the most affected ages were in the range of 20 to 49years. Blunt injury constituted 71.4% and penetrating injury constituted 28.6%. Road traffic accident was responsible for 61.9%, stab injury 21.4%, falls 7.1%, gunshot injury 4.8%, impalement 2.4% and animal attack also 2.4%. The average time taken between accident and admission was 31hours,40minutes and 12seconds while the average duration of hospital stay was 16.10 days. The injury pattern included rib fracture(s (23.8%, hemopneumothorax (14.3%, hemothorax (7.1%, pneumothorax (4.8%, combinations of chest injuries (7.1%, chest laceration 7.1%, bruises 11.9%, lung contusion 4.8%, subcutaneous empyema 2.4%, flail chest 4.8% and no specific injury (11.9%. Associated injuries included head injury (63.6%, orthopaedic injury (27.3% and combinations (abdominal, head, orthopaedic (9.1%. The fatality of road traffic accident was 36.8%. No patient was attended to by paramedics at the scene of accident while 21.9% of the patients had pre-hospital resuscitation in peripheral clinics before admission. The transfusion requirement was 14.3%. One patient (2.4% required a median sternotomy and cardiopulmonary bypass, 54.8% required tube thoracostomy while 42.9% had general

  16. Profile of thoracic trauma victims submitted to chest drainage.

    Science.gov (United States)

    Broska, Cesar Augusto; Botelho, Adriane Barbosa; Linhares, André DE Castro; DE-Oliveria, Mariana Santos; Veronese, Gabriela; Naufel, Carlos Roberto; Batista, Lislaine Cruz; Diogo, Maria Angélica Kurpel

    2017-01-01

    to describe and compare the variables involved in trauma victims undergoing thoracic drainage. we conducted a retrospective, analytical, descriptive, cross-sectional study, with medical records of patients attended at the Trauma Service of the Curitiba Evangelical University Hospital between February 2011 and January 2014. there were 488 patients undergoing chest drainage, 84.7% men and 15.3% women, with an average age of 38.2 years. Attendances usually occurred at night, without predominance between open or closed mechanism, gender or age group. The majority of patients with thoracic trauma requiring drainage were diagnosed by anamnesis and physical examination (41.1%) and drained in the emergency room (80.8%). Most of the patients (66.2%) had another associated lesion, mostly some abdominal viscera. Complications were present in 16.6% (81 patients), most of them due to drainage positioning error (9.2%). The mean hospital stay was 15 days and drainage lasted for an average of 8.1 days, with no statistical difference between open and closed trauma. The clinical outcome was discharge in most cases. the profile of patients with thoracic trauma is that of young men, attended at night, with some other associated lesion. Although diagnosis and treatment were rapid and most often without the need for complex examinations, the time of drainage, hospitalization and complications were higher than in the literature, which can be explained by the drainage being made at the Emergency Room and the presence of associated injuries. descrever e comparar as variáveis envolvidas nos pacientes vítimas de trauma torácico submetidos à drenagem de tórax. estudo transversal descritivo analítico retrospectivo realizado com prontuários de pacientes atendidos no Serviço de Trauma do Hospital Universitário Evangélico de Curitiba entre fevereiro de 2011 e janeiro de 2014. neste período foram atendidos 488 pacientes, 84,7% homens e 15,3% mulheres, com média de idade de 38,2 anos

  17. Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma

    International Nuclear Information System (INIS)

    Faruque, A. V.; Qazi, S. H.; Khan, M. A. M.

    2013-01-01

    Objective: To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive. Methods: The retrospective study covered 10 years, from January 1, 2000 to December 31, 2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis. Results: Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonography had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p>0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up. Conclusions: Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be

  18. Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma.

    Science.gov (United States)

    Faruque, Ahmad Vaqas; Qazi, Saqib Hamid; Khan, Muhammad Arif Mateen; Akhtar, Wassem; Majeed, Amina

    2013-03-01

    To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive. The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis. Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p>0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up. Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed

  19. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    Energy Technology Data Exchange (ETDEWEB)

    Nahum, E.; Ben-Ari, J.; Schonfeld, T. [Pediatric Intensive Care Unit, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Horev, G. [Dept. of Diagnostic Radiology, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2001-06-01

    A 3{sup 1}/{sub 2}-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  20. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    International Nuclear Information System (INIS)

    Nahum, E.; Ben-Ari, J.; Schonfeld, T.; Horev, G.

    2001-01-01

    A 3 1 / 2 -year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  1. Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre.

    Science.gov (United States)

    Buckland, Aaron J; Bressan, Silvia; Jowett, Helen; Johnson, Michael B; Teague, Warwick J

    2016-10-01

    Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma. © 2016 Australasian

  2. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

    Science.gov (United States)

    Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

    2017-01-01

    Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Pediatric chest CT after trauma: impact on surgical and clinical management

    International Nuclear Information System (INIS)

    Patel, Rina P.; Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H.; Yu, Chang; Ray, Jackie

    2010-01-01

    Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. To assess the impact of chest CT compared with chest radiography on pediatric trauma management. Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients. (orig.)

  4. Pediatric chest CT after trauma: impact on surgical and clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rina P. [Vanderbilt University School of Medicine, Nashville, TN (United States); Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H. [Vanderbilt University, Department of Radiology and Radiological Sciences, Vanderbilt Children' s Hospital, Nashville, TN (United States); Yu, Chang [Vanderbilt University, Department of Biostatistics, Nashville, TN (United States); Ray, Jackie [Vanderbilt University, Department of Pediatric Surgery, Vanderbilt Children' s Hospital, Nashville, TN (United States)

    2010-07-15

    Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. To assess the impact of chest CT compared with chest radiography on pediatric trauma management. Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients. (orig.)

  5. Aetiological patterns and management outcome of paediatric head trauma: one-year prospective study.

    Science.gov (United States)

    Emejulu, J K C; Shokunbi, M T

    2010-09-01

    Trauma is the most common cause ofpaediatric deaths. In 75% ofpaediatric trauma deaths, head injury is responsible, and most are from falls. Recent reports from Nigeria, however, appear to indicate a predominance of road traffic accidents, instead of falls. To evaluate the aetiology of paediatric head trauma, management protocols and outcome from our Centre, in order to acquire a baseline data base and recommend measures to reduce childhood trauma. A prospective study of all paediatric head trauma cases presenting to Nnamdi Azikiwe University Teaching Hospital, Nnewi, for 12months from April 21, 2006 to April 20, 2007, was done and collated data subsequently analyzed. The paediatric age group was taken as = 15 years, and grading of head injury was with the Glasgow Coma Scale (3-15) and the modified scale for non-verbal children; while outcome was measured with the Glasgow Outcome Scale (1-5). Out of 334 patients treated within the period of study, 210 were head trauma cases. Of these, 52 were paediatric head trauma, representing 24.8% of all head trauma cases; and 19.2% (10 of 52) of them were aged 0-2 years. About 62% (32 of 52) were males. Falls and RTA were each responsible in 25 (48.1%) cases. Mild head injury occurred in 31 (59.6%), and 49 (94.2%) patients were evaluated by plain radiography. Treatment was conservative in 39 (75%) cases; with satisfactory outcome in 36 (69.2%), and a mortality rate of 15.4%. Road traffic injury, mostly from motorcycles, has become the major cause of morbidity and mortality amongst the paediatric age group, especially the male gender, and outcome from management is mostly satisfactory.

  6. Limiting chest computed tomography in the evaluation of pediatric thoracic trauma.

    Science.gov (United States)

    Golden, Jamie; Isani, Mubina; Bowling, Jordan; Zagory, Jessica; Goodhue, Catherine J; Burke, Rita V; Upperman, Jeffrey S; Gayer, Christopher P

    2016-08-01

    Computed tomography (CT) of the chest (chest CT) is overused in blunt pediatric thoracic trauma. Chest CT adds to the diagnosis of thoracic injury but rarely changes patient management. We sought to identify a subset of blunt pediatric trauma patients who would benefit from a screening chest CT based on their admission chest x-ray (CXR) findings. We hypothesize that limiting chest CT to patients with an abnormal mediastinal silhouette identifies intrathoracic vascular injuries not otherwise seen on CXR. All blunt trauma activations that underwent an admission CXR at our Level 1 pediatric trauma center from 2005 to 2013 were retrospectively reviewed. Patients who had a chest CT were evaluated for added diagnoses and change in management after CT. An admission CXR was performed in 1,035 patients. One hundred thirty-nine patients had a CT, and the diagnosis of intra-thoracic injury was added in 42% of patients. Chest CT significantly increased the diagnosis of contusion or atelectasis (30.3% vs 60.4%; p pneumothorax (7.2% vs 18.7%; p chest CT. Chest CT changed the management of only 4 patients (2.9%). Two patients underwent further radiologic evaluation that was negative for injury, one had a chest tube placed for an occult pneumothorax before exploratory laparotomy, and one patient had a thoracotomy for repair of aortic injury. Chest CT for select patients with an abnormal mediastinal silhouette on CXR would have decreased CT scans by 80% yet still identified patients with an intrathoracic vascular injury. The use of chest CT should be limited to the identification of intrathoracic vascular injuries in the setting of an abnormal mediastinal silhouette on CXR. Therapeutic study, level IV; diagnostic study, level III.

  7. Analysis the findings of chest radiograph and CT scan in 217 acute thoracic trauma

    International Nuclear Information System (INIS)

    Huang Shaoying

    2005-01-01

    Objective: To evaluate chest radiograph and CT scan in assessing acute thoracic trauma. Methods: Retrospectively analyzed the findings of chest radiograph and CT scan in 217 cases of acute thoracic trauma and positive rate of each modality was compared. Results: The positive rate of rib and clavicle fracture was higher in chest radiograph than these in CT scan. But the positive rate of chest wall hematoma, mediastinum and subcutaneous emphysema, pneumothorax, hydropneumothorax, damage of lung parenchyma and traumatic pulmonary atelectasis was higher in CT scan than those in chest radiograph. Conclusion: The application of the combined imaging modalities improves assessing of acute thoracic trauma, because the imaging manifestation of the lesion is various. (authors)

  8. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report.

    Science.gov (United States)

    Idris, Baig M; Hefny, Ashraf F

    2016-01-01

    Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Evaluation of the efficiency of bismuth breast shield in CT chest paediatric examinations

    International Nuclear Information System (INIS)

    Sevillano, D.; Espana, M. L.; Castro, P.; Minguez, C.; Albi, G.; Garcia, E.; Lopez Franco, P.

    2006-01-01

    The aim of this study is to evaluate the efficiency of bismuth breast shield in CT chest paediatric examinations when automatic exposure control techniques are used. The influence in the radiation dose and the image quality has been evaluated with and without the breast shield in the scoutview. In addition the radiation dose in shielded and non-shielded areas has been compared. Measurements were made in a 16 cm diameter cylindrical PMMA phantom simulating a newborn, and older children were simulated controlling the maximum intensities allowed by the automatic exposure control system AutomA. The highest dose reduction (59%) was obtained with AutomA system and when the breast shield is not used in the scoutview. This reduction in the radiation dose does not mean a significant increase of noise level. The use of the breast shield in the scoutview yielded an increase in the radiation dose in non-shielded areas. The use of bismuth breast shield is recommended only after the scoutview in order to optimise the radiation dose in CT chest paediatric examination when using automatic exposure control AutomA. (Author)

  10. The value of routine chest radiographs in a paediatric intensive care unit: a prospective study

    International Nuclear Information System (INIS)

    Valk, J.W.; Ploetz, F.B.; Schuerman, F.A.B.A.; Vught, H. van; Kramer, P.P.G.; Beek, E.J.A.

    2001-01-01

    Background. In many paediatric intensive care units (PICUs) chest X-ray films (CXRs) are required as part of the daily examination or after completion of invasive procedures. Objective. First, to evaluate if the American College of Radiology (ACR) guidelines for adult patients are appropriate for paediatric pa- tients. Second, to assess the diagnostic efficacy of the CXRs. Materials and methods. One-hundred-seventy-four CXRs acquired in 74 patients, either routinely or after invasive procedures, were analysed. The indication of the obtained CXRs, or the absence of indication in patients in whom no CXRs was taken, was compared with ACR guidelines. The position of medical devices was evaluated. Changes in cardiopulmonary status were noted. Results. Sixty-seven percent of the CXRs were in accordance with the ACR guidelines, and in 74 % of pa- tients in whom no CXRs were taken this was also in accordance with these guidelines. Sixteen percent of the endotracheal tubes, 23 % of central venous lines and 15 % of nasogastric tubes were malpositioned. Changes in cardiopulmonary status, after the initial film, were noted in 63 %. Conclusions. The indications for the majority of CXRs in our PICU appeared to be in accordance with ACR guidelines. The high percentage of malpositioned tubes and lines and the number of cardiopulmonary changes on CXRs in a PICU underline the value of these films. Adjustments of the ACR guidelines for particular groups of paediatric patients may limit the number of CXRs taken and may further increase diagnostic efficacy. (orig.)

  11. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature.

    NARCIS (Netherlands)

    Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

    2009-01-01

    AIM: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. METHODS: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers

  12. Computed tomography of the chest in blunt thoracic trauma: results of a prospective study

    International Nuclear Information System (INIS)

    Blostein, P.; Hodgman, C.

    1998-01-01

    Blunt thoracic injuries detected by computed tomography of the chest infrequently require immediate therapy. If immediate therapy is needed, findings will be visible on plain roentgenograms or on clinical exam. Routine Computed Tomography of the chest in blunt trauma is not recommended but may be helpful in selected cases. (N.C.)

  13. Are routine repeat chest x-rays before leaving the trauma room useful?

    NARCIS (Netherlands)

    Lemmers, M.; Saltzherr, T. P.; Beenen, L. F. M.; Ponsen, K. J.; Goslings, J. C.

    2010-01-01

    Several guidelines advocate multiple chest x-rays during primary resuscitation of trauma patients. Some local hospital protocols include a repeat x-ray before leaving the trauma resuscitation room (TR). The purpose of this study was to determine the value of routine repeat x-rays. One-year data of

  14. Concomitant aortic valve and internal mammary artery injuries in blunt chest trauma: report of a case.

    Science.gov (United States)

    Yeh, Chun-Chieh; Hsieh, Chi-Hsun; Wang, Yu-Chun; Chung, Ping-Kuei; Chen, Ray-Jade

    2009-01-01

    We report a case of concomitant injury to the aortic valve and internal mammary artery (IMA) from nonpenetrating chest trauma. To our knowledge, this is the first such case to be reported. Transcatheter arterial embolization (TAE) following diagnostic angiography offers an effective and minimally invasive treatment for traumatic IMA injuries. Because there might be an asymptomatic interval after traumatic aortic valve injuries, serial physical examinations and repeated echocardiography should be mandatory for patients with de novo heart failure after blunt chest trauma. Transesophageal echocardiography can provide a clearer image of cardiac injuries than transthoracic echocardiography, particularly if there is extensive anterior mediastinal hematoma resulting from IMA trauma.

  15. Specific Radiological Findings of Traumatic Gastrointestinal Tract Injuries in Patients With Blunt Chest and Abdominal Trauma.

    Science.gov (United States)

    Kokabi, Nima; Harmouche, Elie; Xing, Minzhi; Shuaib, Waqas; Mittal, Pardeep K; Wilson, Kenneth; Johnson, Jamlik-Omari; Nicolaou, Savvas; Khosa, Faisal

    2015-05-01

    Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such injuries significantly decreases morbidity and mortality. Since physical examination is not accurate in detecting such injuries, contrast-enhanced computed tomography has been the mainstay for diagnosis in many emergency departments. This pictorial essay aims to review the incidence, mechanisms, and signs of gastrointestinal hollow viscus injuries in the setting of blunt chest and abdominal trauma. Copyright © 2015 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  16. Paediatric trauma and safety in the media: An audit of its coverage in ...

    African Journals Online (AJOL)

    Objectives. In view of the high rate of paediatric trauma in South Africa, we investigated how much attention – and of what nature – was given in printed media to these incidents, and to the broader subject of child safety. Methods. Over 4 months, every article in the Cape Argus and Weekend Argus that pertained to either: (i) ...

  17. Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma.

    Science.gov (United States)

    Haraguchi, Yumiko; Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Nakashima, Ikue; Wada, Hiroshi; Sanui, Masamitsu; Momomura, Shin-Ichi; Fujita, Hideo

    2018-03-30

    Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.

  18. Criteria for the selective use of chest computed tomography in blunt trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G. [Radboud University Nijmegen, Medical Centre, Department of Radiology, Nijmegen (Netherlands); Deunk, Jaap; Edwards, Michael J.R. [Radboud University Nijmegen, Medical Centre, Department of Surgery, Nijmegen (Netherlands); Vugt, Arie B. van [Radboud University Nijmegen, Medical Centre Nijmegen, Department of Emergency Medicine, Nijmegen (Netherlands); Kuijk, Cornelis van [VU (Vrije Universiteit) University, Medical Center Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2010-04-15

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients ({>=}16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age {>=}55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with {>=}1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  19. Criteria for the selective use of chest computed tomography in blunt trauma patients

    International Nuclear Information System (INIS)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G.; Deunk, Jaap; Edwards, Michael J.R.; Vugt, Arie B. van; Kuijk, Cornelis van

    2010-01-01

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  20. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

    Science.gov (United States)

    Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

    2017-02-10

    Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

  1. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms

    International Nuclear Information System (INIS)

    Lomoschitz, Fritz M.; Eisenhuber, Edith; Linnau, Ken F.; Peloschek, Philipp; Schoder, Maria; Bankier, Alexander A.

    2003-01-01

    In patients after chest trauma, imaging plays a key role for both, the primary diagnostic work-up, and the secondary assessment of potential treatment. Despite its well-known limitations, the anteroposterior chest radiograph remains the starting point of the imaging work-up. Adjunctive imaging with computed tomography, that recently is increasingly often performed on multidetector computed tomography units, adds essential information not readily available on the conventional radiograph. This allows better definition of trauma-associated thoracic injuries not only in acute traumatic aortic injury, but also in pulmonary, tracheobronchial, cardiac, diaphragmal, and thoracic skeletal injuries. This article reviews common radiographic findings in patients after chest trauma, shows typical imaging features resulting from thoracic injury, presents imaging algorithms, and recalls to the reader less common but clinically relevant entities encountered in patients after thoracic trauma

  2. Emergency management of blunt chest trauma in children: an evidence-based approach.

    Science.gov (United States)

    Pauzé, Denis R; Pauzé, Daniel K

    2013-11-01

    Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

  3. Cardiac and great vessel injuries after chest trauma: our 10-year experience.

    Science.gov (United States)

    Onan, Burak; Demirhan, Recep; Öz, Kürşad; Onan, Ismihan Selen

    2011-09-01

    Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.

  4. CT dose reduction using Automatic Exposure Control and iterative reconstruction: A chest paediatric phantoms study.

    Science.gov (United States)

    Greffier, Joël; Pereira, Fabricio; Macri, Francesco; Beregi, Jean-Paul; Larbi, Ahmed

    2016-04-01

    To evaluate the impact of Automatic Exposure Control (AEC) on radiation dose and image quality in paediatric chest scans (MDCT), with or without iterative reconstruction (IR). Three anthropomorphic phantoms representing children aged one, five and 10-year-old were explored using AEC system (CARE Dose 4D) with five modulation strength options. For each phantom, six acquisitions were carried out: one with fixed mAs (without AEC) and five each with different modulation strength. Raw data were reconstructed with Filtered Back Projection (FBP) and with two distinct levels of IR using soft and strong kernels. Dose reduction and image quality indices (Noise, SNR, CNR) were measured in lung and soft tissues. Noise Power Spectrum (NPS) was evaluated with a Catphan 600 phantom. The use of AEC produced a significant dose reduction (p<0.01) for all anthropomorphic sizes employed. According to the modulation strength applied, dose delivered was reduced from 43% to 91%. This pattern led to significantly increased noise (p<0.01) and reduced SNR and CNR (p<0.01). However, IR was able to improve these indices. The use of AEC/IR preserved image quality indices with a lower dose delivered. Doses were reduced from 39% to 58% for the one-year-old phantom, from 46% to 63% for the five-year-old phantom, and from 58% to 74% for the 10-year-old phantom. In addition, AEC/IR changed the patterns of NPS curves in amplitude and in spatial frequency. In chest paediatric MDCT, the use of AEC with IR allows one to obtain a significant dose reduction while maintaining constant image quality indices. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. Studying morbidity and predicting mortality in patients with blunt chest trauma using a novel clinical score

    Directory of Open Access Journals (Sweden)

    Priyadarshini Manay

    2017-01-01

    Full Text Available Background: A departmental audit in March 2015 revealed significant mortality rate of 40% in blunt chest trauma patients (much greater than the global 25%. A study was thus planned to study morbidity and predictors of mortality in blunt chest trauma patients admitted to our hospital. Methods: This study was a prospective observational study of 139 patients with a history of blunt chest trauma between June 2015 and November 2015 after the Institutional Ethics Committee approval in April 2015. The sample size was calculated from the prevalence rate in our institute from the past medical records. Results: The morbidity factors following blunt chest injuries apart from pain were need for Intensive Care Unit stay, mechanical ventilation, and pneumonia/acute respiratory distress syndrome. Significant predictors of mortality in our study were SpO2 16, and need for mechanical ventilation. By calculating the likelihood ratios of each respiratory sign, a clinical score was devised. Conclusion: The modifiable factors affecting morbidity and mortality were identified. Mild to moderate chest injury due to blunt trauma is difficult to diagnose. The restoration of respiratory physiology has not only significant implications on recovery from chest injury but also all other injuries. It is our sincere hope that the score we have formulated will help reduce mortality and morbidity after further trials.

  6. Dose evaluation in paediatric patients undergoing chest X-ray examinations

    Science.gov (United States)

    Piantini, F.; Schelin, H. R.; Denyak, V.; Bunick, A. P.; Legnani, A.; Ledesma, J. A.; Filipov, D.; Paschuk, S. A.

    2017-11-01

    This study aimed to estimate the incident air kerma in chest X-ray examinations, for lateral (LAT) and anterior-posterior (AP) (together with posterior-anterior (PA)) projections, in one of the largest paediatric hospitals in Brazil, and to compare these with the results obtained in a general hospital of the same city. The dosimetric results were analysed along with the patient characteristics and radiographer strategies. The examinations of 225 (119 male and 106 female) patients were studied and 389 X-ray scans (200 AP/PA projections and 189 LAT projections) of paediatric patients were acquired. For analysis of the results, the patients were divided into the following age groups: 0-1 y, 1-5 y, 5-10 y, and 10-15 y. Patient's thickness can be determined from age, height or weight with an uncertainty of 20-30%. In different hospitals, the difference in patient's thicknesses between the same age groups can reach 25-55%. A minimal correlation between the patient dose and thickness was observed, with a 4-fold difference in the dose for patients of the same thickness. By standardizing radiological protocols, it should be possible to keep the dose within intervals of 50-100 μGy for LAT projection and 40-80 μGy for AP/PA projection.

  7. Blunt chest trauma in a non-specialist centre: Right treatment, right place?

    Science.gov (United States)

    Maher, Lesley; Jayathissa, Sisira

    2016-12-01

    To compare patient characteristics, management and outcomes for patients admitted with isolated blunt chest trauma, managed by medical or surgical teams. We reviewed adult patients admitted with blunt chest trauma between 1 September 2006 and 31 August 2011 to a secondary hospital in New Zealand. Inclusion criteria were: blunt chest trauma, with at least one radiologically demonstrated rib fracture. The primary outcome was in-hospital mortality, and secondary outcomes were development of pneumonia, and use of analgesia. Seventy-two patients were included. Thirty-three patients were managed by medical teams and 39 by surgical teams. In-hospital mortality was greater amongst medical patients 5/33 (15%) versus surgical 0/39 (0%); P = 0.012. Pneumonia occurred in 15/33 (45%); medical patients versus surgical 2/39 (5%), P trauma fall compared to surgically managed patients (28/33 [85%] vs 9/39 [27%]; P chest trauma, those managed by medical teams were older, had more comorbidities and were more likely to have become injured with a low trauma fall than those managed by surgical teams. They had less access to analgesic options, developed pneumonia more often and had higher mortality. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  8. Chest and spine radiography abnormality in blunt chest trauma correlated with major vessel injury in an unselected patient population

    International Nuclear Information System (INIS)

    Fernandez, G.; Kadir, S.; Encarnacion, C.

    1989-01-01

    To assess the true incidence of major vessel injury, the authors retrospectively reviewed all arch aortograms obtained for blunt chest trauma (BCT) during a 24-month period beginning December 1986. Aortograms were correlated with preangiographic chest radiographic and operative findings. The goals of this review were to examine the usefulness of commonly employed screening criteria for aortography and determine whether thoracic spine fractures imply a decreased likelihood of aortic injury. One hundred twenty aortograms were obtained during this period. The incidence of aortic laceration was 6.7%, and 7.5% had brachiocerebral vascular injury. Only 51% of chest radiographs were suggestive of vascular injury. Two patients with subtle radiographic findings had aortic laceration. One patient with a burst fracture of T-4 had aortic laceration. The results of this review indicate the incidence of great vessel injury is as high as that of injury to the aorta itself and that the presence of spine fractures does not exclude vascular injury

  9. Alveolar macrophage phagocytosis is enhanced after blunt chest trauma and alters the posttraumatic mediator release.

    Science.gov (United States)

    Seitz, Daniel H; Palmer, Annette; Niesler, Ulrike; Fröba, Janine S; Heidemann, Vera; Rittlinger, Anne; Braumüller, Sonja T; Zhou, Shaoxia; Gebhard, Florian; Knöferl, Markus W

    2011-12-01

    Blunt chest trauma is known to induce a pulmonary invasion of short-lived polymorphonuclear neutrophils and apoptosis of alveolar epithelial type 2 (AT2) cells. Apoptotic cells are removed by alveolar macrophages (AMΦ). We hypothesized that chest trauma alters the phagocytic response of AMΦ as well as the mediator release of AMΦ during phagocytosis. To study this, male Sprague-Dawley rats were subjected to blunt chest trauma. Phagocytosis assays were performed in AMΦ isolated 2 or 24 h after trauma with apoptotic cells or opsonized beads. Phagocytosis of apoptotic AT2 cells by unstimulated AMΦ was significantly increased 2 h after trauma. At 24 h, AMΦ from traumatized animals, stimulated with phorbol-12-myristate-13-acetate, ingested significantly more apoptotic polymorphonuclear neutrophils than AMΦ from sham animals. Alveolar macrophages after trauma released significantly higher levels of tumor necrosis factor α, macrophage inflammatory protein 1α, and cytokine-induced neutrophil chemoattractant 1 when they incorporated latex beads, but significantly lower levels of interleukin 1β and macrophage inflammatory protein 1α when they ingested apoptotic cells. In vivo, phagocytosis of intratracheally instilled latex beads was decreased in traumatized rats. The bronchoalveolar lavage concentrations of the phagocytosis-supporting surfactant proteins A and D after blunt chest trauma were slightly decreased, whereas surfactant protein D mRNA expression in AT2 cells was significantly increased after 2 h. These findings indicate that chest trauma augments the phagocytosis of apoptotic cells by AMΦ. Phagocytosis of opsonized beads enhances and ingestion of apoptotic cells downregulates the immunologic response following lung contusion. Our data emphasize the important role of phagocytosis during posttraumatic inflammation after lung contusion.

  10. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

    International Nuclear Information System (INIS)

    Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

    2009-01-01

    Aim: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. Methods: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2 x 2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Results: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). Conclusion: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients

  11. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.R.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all

  12. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center.

    Science.gov (United States)

    Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, Cemal

    2011-09-01

    Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 9.33 (range, 15–54) years. The mean LOS was 10.65 8.30 (range, 5–65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 9.92 days; stab wound, 8.76 6.42 days, p chest AIS score (p chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury.

  13. The importance of plain radiographic signs for emergency aortography in blunt chest trauma

    International Nuclear Information System (INIS)

    Schumacher, K.A.; Trost, K.; Bargon, G.

    1983-01-01

    A retrospective study of plain radiographic findings in 11 patients with traumatic rupture of the aorta was conducted, and the results compared with the incidence of numerous chest x-rays signs previously described in 294 cases of angiographically proven thoracic aorta dissection. It is concluded that positive plain radiographic signs obtained from patients with blunt chest trauma reveal high sensitivity and may thus be used as an indication for emergency aortography. However, since this procedure lacks 100% specificity even those patients with normal x-ray findings but clinically and/or anamnestically adequate thoracic trauma should be submitted to aortography. (orig.) [de

  14. Mitral Perivalvular Leak after Blunt Chest Trauma: A Rare Cause of Severe Subacute Mitral Regurgitation.

    Science.gov (United States)

    Marchese, Nicola; Facciorusso, Antonio; Vigna, Carlo

    2015-12-01

    Blunt chest trauma is a very rare cause of valve disorder. Moreover, mitral valve involvement is less frequent than is aortic or tricuspid valve involvement, and the clinical course is usually acute. In the present report, we describe the case of a 49-year-old man with a perivalvular mitral injury that became clinically manifest one year after a violent, nonpenetrating chest injury. This case is atypical in regard to the valve involved (isolated mitral damage), the injury type (perivalvular leak in the absence of subvalvular abnormalities), and the clinical course (interval of one year between trauma and symptoms).

  15. Traumatic pulmonary pseudocysts after blunt chest trauma: Prevalence, mechanisms of injury, and computed tomography findings.

    Science.gov (United States)

    Cho, Hyun Jin; Jeon, Yang Bin; Ma, Dae Sung; Lee, Jung Nam; Chung, Min

    2015-09-01

    Traumatic pulmonary pseudocyst (TPP) is a rare complication of blunt chest trauma and closely related with severe injury. However, it has been poorly documented. We present a retrospective review of TPP cases treated at our hospital. The medical records and chest computed tomography scans of patients with TPP treated from January 2010 to December 2013 were retrospectively studied. A total of 978 patients underwent chest computed tomography for blunt chest trauma during the study period, and 81 (8.3%) had a total of 150 TPPs. The most common mechanism of injury was being struck by a motorized vehicle (n = 25, 30.9%). The mean (SD) Injury Severity Score (ISS) of the 81 patients was 33.2 (11.4). The prevalence of TPP was higher in younger patients (p = 0.011), but the total number of fractured ribs was significantly lower (p = 0.001). In a subgroup analysis performed according to pseudocyst location, the intraparenchymal group had more severe injuries than the subpleural group (ISS, 23.3 vs. 32.4, p chest Abbreviated Injury Scale [AIS] score, 3.4 vs. 4.0, p chest trauma was 8.3% and was higher in those struck by a vehicle and younger patients. Intraparenchymal pseudocyst was found to be related to more severe injuries. TPP was a self-limiting condition that does not require specific treatment. Prognostic/epidemiologic study, level IV.

  16. Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Gregory Mansella

    2014-01-01

    Full Text Available Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

  17. Significance of X-ray examination in the diagnosis of contralateral pneumonia in closed chest trauma

    International Nuclear Information System (INIS)

    Anan'ina, G.V.; Parizhskij, Z.M.; Abramova, T.T.

    1986-01-01

    It is shown that after unilateral closed chest traumas X-ray examination of both lungs should be conducted to except traumatic pneumonia as at the side of the trauma as in contralateral lung and to exclude pneumonia complications. Special attention must be paid to the patients with traumatic rib fractures and to those who has chromic nonspecific diseases of lungs and abused with alcochol

  18. The Use of Chest Computed Tomographic Angiography in Blunt Trauma Pediatric Population.

    Science.gov (United States)

    Hasadia, Rabea; DuBose, Joseph; Peleg, Kobi; Stephenson, Jacob; Givon, Adi; Kessel, Boris

    2018-02-05

    Blunt chest trauma in children is common. Although rare, associated major thoracic vascular injuries (TVIs) are lethal potential sequelae of these mechanisms. The preferred study for definitive diagnosis of TVI in stable patients is computed tomographic angiography imaging of the chest. This imaging modality is, however, associated with high doses of ionizing radiation that represent significant carcinogenic risk for pediatric patients. The aim of the present investigation was to define the incidence of TVI among blunt pediatric trauma patients in an effort to better elucidate the usefulness of computed tomographic angiography use in this population. A retrospective cohort study was conducted including all blunt pediatric (age blunt trauma victims, 119,821patients were younger than 14 years. Twelve (0.0001%, 12/119821) of these children were diagnosed with TVI. The most common mechanism in this group was pedestrian hit by a car. Mortality was 41.7% (5/12). Thoracic vascular injury is exceptionally rare among pediatric blunt trauma victims but does contribute to the high morbidity and mortality seen with blunt chest trauma. Computed tomographic angiography, with its associated radiation exposure risk, should not be used as a standard tool after trauma in injured children. Clinical protocols are needed in this population to minimize radiation risk while allowing prompt identification of life-threatening injuries.

  19. Developing risk factors for post traumatic empyema in patients with chest trauma

    Institute of Scientific and Technical Information of China (English)

    Mara del Pilar Quiroga; Jos Daniel Charry; Nicols Becerra; Juan Camilo Garcia; Eliana Karina Muoz; Rodrigo Lara

    2015-01-01

    Objective:To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68%(17) and 84%coagulated hemothorax trauma. Empyema management thoracoscopy was in 100%of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

  20. Tube thorocostomy: management and outcome in patients with penetrating chest trauma.

    Science.gov (United States)

    Muslim, Muhammad; Bilal, Amer; Salim, Muhammad; Khan, Muhammad Abid; Baseer, Abdul; Ahmed, Manzoor

    2008-01-01

    Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lung

  1. European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division?

    Science.gov (United States)

    Tschauner, Sebastian; Marterer, Robert; Gübitz, Michael; Kalmar, Peter I; Talakic, Emina; Weissensteiner, Sabine; Sorantin, Erich

    2016-02-01

    Accurate collimation helps to reduce unnecessary irradiation and improves radiographic image quality, which is especially important in the radiosensitive paediatric population. For AP/PA chest radiographs in children, a minimal field size (MinFS) from "just above the lung apices" to "T12/L1" with age-dependent tolerance is suggested by the 1996 European Commission (EC) guidelines, which were examined qualitatively and quantitatively at a paediatric radiology division. Five hundred ninety-eight unprocessed chest X-rays (45% boys, 55% girls; mean age 3.9 years, range 0-18 years) were analysed with a self-developed tool. Qualitative standards were assessed based on the EC guidelines, as well as the overexposed field size and needlessly irradiated tissue compared to the MinFS. While qualitative guideline recommendations were satisfied, mean overexposure of +45.1 ± 18.9% (range +10.2% to +107.9%) and tissue overexposure of +33.3 ± 13.3% were found. Only 4% (26/598) of the examined X-rays completely fulfilled the EC guidelines. This study presents a new chest radiography quality control tool which allows assessment of field sizes, distances, overexposures and quality parameters based on the EC guidelines. Utilising this tool, we detected inadequate field sizes, inspiration depths, and patient positioning. Furthermore, some debatable EC guideline aspects were revealed. • European Guidelines on X-ray quality recommend exposed field sizes for common examinations. • The major failing in paediatric radiographic imaging techniques is inappropriate field size. • Optimal handling of radiographic units can reduce radiation exposure to paediatric patients. • Constant quality control helps ensure optimal chest radiographic image acquisition in children.

  2. Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Somsekhar Ganti

    2006-03-01

    Full Text Available Abstract Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon.

  3. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

    Science.gov (United States)

    Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed; Al-Sadek, Lina

    2016-01-01

    AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries. MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed. RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema. CONCLUSIONS: The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients. PMID:28028415

  4. Criteria for the selective use of chest computed tomography in blunt trauma patients.

    NARCIS (Netherlands)

    Brink, M.; Deunk, J.; Dekker, H.M.; Edwards, M.J.R.; Kool, D.R.; Vugt, A.B. van; Kuijk, C. van; Blickman, J.G.

    2010-01-01

    PURPOSE: The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. METHODS: This observational study prospectively included consecutive patients (>or=16 years old) who underwent

  5. Measurement of hemothorax amount in patients with non-penetrating chest trauma by supine chest AP radiograph

    International Nuclear Information System (INIS)

    Han, Heon; Yang, Joo Hyun; Na, Myung Hoon; Baik, Hee Jong

    1994-01-01

    To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coeffcient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax

  6. Measurement of hemothorax amount in patients with non-penetrating chest trauma by supine chest AP radiograph

    Energy Technology Data Exchange (ETDEWEB)

    Han, Heon; Yang, Joo Hyun; Na, Myung Hoon; Baik, Hee Jong [Chung-Ang Gil Hospital, Incheon (Korea, Republic of)

    1994-10-15

    To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coeffcient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax.

  7. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

    Directory of Open Access Journals (Sweden)

    Fogarassy Peter

    2009-10-01

    Full Text Available Abstract Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior infarction, as well as multiple small septal lesions which were presumed to have resulted from embolization. The culprit lesion was a proximal 75% LAD stenosis with a prominent plaque-rupture and thrombus-formation, and the distal LAD was occluded by thromboembolic material.

  8. Challenges in management of pediatric life-threatening neck and chest trauma

    Directory of Open Access Journals (Sweden)

    Shilpa Sharma

    2018-01-01

    Full Text Available Introduction: Neck and thoracic trauma in children pose unforeseen challenges requiring variable management strategies. Here, we describe some unusual cases. Patients and Methods: Pediatric cases of unusual neck and thoracic trauma prospectively managed from April 2012 to March 2014 at a Level 1 trauma center were studied for management strategies, outcome, and follow-up. Results: Six children with a median age of 5.5 (range 2–10 years were managed. Mechanism of injury was road traffic accident, fall from height and other accidental injury in 2, 3 and 1 patient respectively. The presentation was respiratory distress and quadriplegia, exposed heart, penetrating injury in neck, dysphagia and dyspnea, and swelling over the chest wall in 1, 1, 1, 2 and 1 cases respectively. Injuries included lung laceration, open chest wall, vascular injury of the neck, tracheoesophageal fistula (2, and chest wall posttraumatic pyomyositis. One patient had a flare of miliary tuberculosis. Immediate management included chest wall repair; neck exploration and repair, esophagostomy, gastroesophageal stapling, and feeding jejunostomy (followed by gastric pull-up 8 months later. Chest tube insertion and total parenteral nutrition was required in one each. 2 and 4 patients required tracheostomy and mechanical ventilation. The patient with gastric pull-up developed a stricture of the esophagogastric anastomosis that was revised at 26-month follow-up. At follow-up of 40–61 months, five patients are well. One patient with penetrating neck injury suffered from blindness due to massive hemorrhage from the vascular injury in the neck and brain ischemia with only peripheral vision recovery. Conclusion: Successful management of neck and chest wall trauma requires timely appropriate decisions with a team effort.

  9. Dose measurements in chest diagnostic X rays: Adult and paediatric patients

    International Nuclear Information System (INIS)

    Freitas, M. B.; Yoshimura, E. M.

    2004-01-01

    This survey was carried out in the state of Sao Paulo (Brazil)). The health services located in the state perform approximately 321 radiological examinations per 1000 inhabitants. A representative sample of 200 health services was selected using sampling techniques, and a postal dosimetric kit was sent to each one who agreed to participate. The kit evaluates entrance surface dose (ESD), making use of thermoluminescence dosemeters attached to the skin of patients. The radiographic technique employed and some physical data of patients were also gathered. In this stage of the survey, only chest examinations, projections AP, PA and LAT, were evaluated. A total of 917 ESD values were measured, which correspond to 588 patients and 74 examination rooms. The ESD to patients were analysed according to weight and age. Groups of standard patients (children and adults) were selected, and reference doses were determined. Large variations of ESD were observed, indicating that much can be done in order to reduce the patient doses by changing the technical parameters. Moreover, the results of ESD in paediatric radiology point to the necessity of special attention in the practice of radiological examinations in this age group. (authors)

  10. Radiation doses to paediatric patients and comforters undergoing chest x rays

    International Nuclear Information System (INIS)

    Sulieman, A.; Vlychou, M.; Tsougos, I.; Theodorou, K.

    2011-01-01

    Pneumonia is an important cause of hospital admission among children in the developed world and it is estimated to be responsible for 3-18 % of all paediatric admissions. Chest X ray is an important examination for pneumonia diagnosis and for evaluation of complications. This study aims to determine the entrance surface dose (ESD), organ, effective doses and propose a local diagnostic reference level. The study was carried out at the university hospital of Larissa (Greece). Patients were divided into three groups: organ and effective doses were estimated using National Radiological Protection Board software. The ESD was determined by thermoluminescent dosemeters for 132 children and 76 comforters. The average ESD value was 55±8 μGy. The effective dose for patients was 11.2±5 μSv. The mean radiation dose for comforter is 22±3 mGy. The radiation dose to the patients is well within dose constraint, in the light of the current practice. (authors)

  11. Myocardial contusion in patients with blunt chest trauma as evaluated by thallium 201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Bodin, L.; Rouby, J.J.; Viars, P.

    1988-01-01

    Fifty five patients suffering from blunt chest trauma were studied to assess the diagnosis of myocardial contusion using thallium 201 myocardial scintigraphy. Thirty-eight patients had consistent scintigraphic defects and were considered to have a myocardial contusion. All patients with scintigraphic defects had paroxysmal arrhythmias and/or ECG abnormalities. Of 38 patients, 32 had localized ST-T segment abnormalities; 29, ST-T segment abnormalities suggesting involvement of the same cardiac area as scintigraphic defects; 21, echocardiographic abnormalities. Sixteen patients had segmental hypokinesia involving the same cardiac area as the scintigraphic defects. Fifteen patients had clinical signs suggestive of myocardial contusion and scintigraphic defects. Almost 70 percent of patients with blunt chest trauma had scintigraphic defects related to areas of myocardial contusion. When thallium 201 myocardial scintigraphy directly showed myocardial lesion, two-dimensional echocardiography and standard ECG detected related functional consequences of cardiac trauma

  12. Delayed chest wall hematoma caused by progressive displacement of rib fractures after blunt trauma

    Directory of Open Access Journals (Sweden)

    Nobuhiro Sato

    2016-06-01

    Full Text Available Rib fracture is a common injury resulting from blunt thoracic trauma. Although hemothorax and pneumothorax are known delayed complications of rib fracture, delayed chest wall hematoma has rarely been reported. We discuss the case of an 81-year-old woman who was not undergoing antiplatelet or anticoagulant therapy who presented to our emergency department after a traffic injury. This patient had a nondisplaced rib fracture that went undetected on the initial computed tomography scan; the development of progressive displacement led to hemorrhagic shock due to delayed chest wall hematoma. The chest wall hematoma was effectively diagnosed and treated via contrast-enhanced computed tomography and angiographic embolization. This case highlights the possibility of this potential delayed complication from a common injury such as a rib fracture. Keywords: Angiography, Chest wall, Delayed complication, Rib fracture, Thoracic injury

  13. The number of displaced rib fractures is more predictive for complications in chest trauma patients.

    Science.gov (United States)

    Chien, Chih-Ying; Chen, Yu-Hsien; Han, Shih-Tsung; Blaney, Gerald N; Huang, Ting-Shuo; Chen, Kuan-Fu

    2017-02-28

    Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications. We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia. In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture. In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore

  14. Can routine trauma bay chest x-ray be bypassed with an extended focused assessment with sonography for trauma examination?

    Science.gov (United States)

    Soult, Michael C; Weireter, Leonard J; Britt, Rebecca C; Collins, Jay N; Novosel, Timothy J; Reed, Scott F; Britt, L D

    2015-04-01

    The objective of this study was to investigate the feasibility of using ultrasound (US) in place of portable chest x-ray (CXR) for the rapid detection of a traumatic pneumothorax (PTX) requiring urgent decompression in the trauma bay. All patients who presented as a trauma alert to a single institution from August 2011 to May 2012 underwent an extended focused assessment with sonography for trauma (FAST). The thoracic cavity was examined using four-view US imaging and were interpreted by a chief resident (Postgraduate Year 4) or attending staff. US results were compared with CXR and chest computed tomography (CT) scans, when obtained. The average age was 37.8 years and 68 per cent of the patients were male. Blunt injury occurred in 87 per cent and penetrating injury in 12 per cent of activations. US was able to predict the absence of PTX on CXR with a sensitivity of 93.8 per cent, specificity of 98 per cent, and a negative predictive value of 99.9 per cent compared with CXR. The only missed PTX seen on CXR was a small, low anterior, loculated PTX that was stable for transport to CT. The use of thoracic US during the FAST can rapidly and safely detect the absence of a clinically significant PTX. US can replace routine CXR obtained in the trauma bay and allow more rapid initiation of definitive imaging studies.

  15. Hemorrhagic lesion on the chest wall after trauma.

    LENUS (Irish Health Repository)

    Roche, Lisa

    2018-01-01

    A 59-year-old woman presented with a burning, rapidly progressive mass on the midchest, occurring after a fall, 4 months prior. Examination found a large well-circumscribed mass over the lower xiphisternum (Figs 1 and 2). Results of baseline investigations were normal apart from mildly elevated liver function values. A computerized tomography scan confirmed a 6.4- x 4.9-cm lobulated soft tissue heterogeneous-density mass located in the subcutaneous fat with ill-defined borders and no obvious infiltration of the chest wall. A single focal abnormality\\r\

  16. Average chest wall thickness at two anatomic locations in trauma patients.

    Science.gov (United States)

    Schroeder, Elizabeth; Valdez, Carrie; Krauthamer, Andres; Khati, Nadia; Rasmus, Jessica; Amdur, Richard; Brindle, Kathleen; Sarani, Babak

    2013-09-01

    Needle thoracostomy is the emergent treatment for tension pneumothorax. This procedure is commonly done using a 4.5cm catheter, and the optimal site for chest wall puncture is controversial. We hypothesize that needle thoracostomy cannot be performed using this catheter length irrespective of the site chosen in either gender. A retrospective review of all chest computed tomography (CT) scans obtained on trauma patients from January 1, 2011 to December 31, 2011 was performed. Patients aged 18 and 80 years were included and patients whose chest wall thickness exceeded the boundary of the images acquired were excluded. Chest wall thickness was measured at the 2nd intercostal (ICS), midclavicular line (MCL) and the 5th ICS, anterior axillary line (AAL). Injury severity score (ISS), chest wall thickness, and body mass index (BMI) were analyzed. 201 patients were included, 54% male. Average (SD) BMI was 26 (7)kg/m(2). The average chest wall thickness in the overall cohort was 4.08 (1.4)cm at the 2nd ICS/MCL and 4.55 (1.7)cm at the 5th ICS/AAL. 29% of the overall cohort (27 male and 32 female) had a chest wall thickness greater than 4.5cm at the 2nd ICS/MCL and 45% (54 male and 36 female) had a chest wall thickness greater than 4.5cm at the 5th ICS/AAL. There was no significant interaction between gender and chest wall thickness at either site. BMI was positively associated with chest wall thickness at both the 2nd and 5th ICS/AAL. A 4.5cm catheter is inadequate for needle thoracostomy in most patients regardless of puncture site or gender. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Radiation protection. Factors influencing compliance to referral guidelines in minor chest trauma

    International Nuclear Information System (INIS)

    Tack, Denis; Louage, Fabian; Muylem, Alain van; Howarth, Nigel; Gevenois, Pierre Alain

    2018-01-01

    To test the hypothesis that referral guidelines are not sufficiently known by prescribers and that medico-legal concerns could influence the prescription of radiographs in minor chest trauma. We submitted a questionnaire including a typical clinical history and questions on reasons for prescribing radiographs of the ribs in minor chest trauma to 112 prescriptors (33 residents, 18 surgeons, 7 internists, 24 general practitioners and 30 ER physicians). All accepted to participate. Comparisons were performed by Fisher's exact test followed by a post-hoc analysis and by a McNemar test. Fifty-eight percent of prescriptors proposed rib radiographs, most (89%) being unaware of the guidelines. Only 11% of them changed their intention to order radiographs after information on referral guidelines and radiation dose (P=0.057). The mean dose delivered by rib radiographs was 38 times higher than that of a chest X-ray. Legal and medico-legal concerns (requirements from insurance policies and avoidance of lawsuits) were the main reasons for requesting radiographs. Unsharpness of guidelines in addition to social and medico-legal issues, rather than medical reasons or the lack of knowledge of the guidelines, strongly influence the prescription of radiographs of the ribs in minor chest trauma. (orig.)

  18. Acute paediatric ankle trauma: MRI versus plain radiography

    Energy Technology Data Exchange (ETDEWEB)

    Lohman, M. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Radiological Dept., Helsinki University Central Hospital (Finland); Kivisaari, A.; Kivisaari, L. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Kallio, P.; Puntila, J. [Dept. of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki Univ. Central Hospital, Helsinki (Finland); Vehmas, T. [Finnish Institute of Occupational Health, Helsinki (Finland)

    2001-09-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  19. Acute paediatric ankle trauma: MRI versus plain radiography

    International Nuclear Information System (INIS)

    Lohman, M.; Kivisaari, A.; Kivisaari, L.; Vehmas, T.

    2001-01-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  20. How early should VATS be performed for retained haemothorax in blunt chest trauma?

    Science.gov (United States)

    Lin, Hsing-Lin; Huang, Wen-Yen; Yang, Chyan; Chou, Shih-Min; Chiang, Hsin-I; Kuo, Liang-Chi; Lin, Tsung-Ying; Chou, Yi-Pin

    2014-09-01

    Blunt chest injury is not uncommon in trauma patients. Haemothorax and pneumothorax may occur in these patients, and some of them will develop retained pleural collections. Video-assisted thoracoscopic surgery (VATS) has become an appropriate method for treating these complications, but the optimal timing for performing the surgery and its effects on outcome are not clearly understood. In this study, a total of 136 patients who received VATS for the management of retained haemothorax from January 2003 to December 2011 were retrospectively enrolled. All patients had blunt chest injuries and 90% had associated injuries in more than two sites. The time from trauma to operation was recorded and the patients were divided into three groups: 2-3 days (Group 1), 4-6 days (Group 2), and 7 or more days (Group 3). Clinical outcomes such as the length of stay (LOS) at the hospital and intensive care unit (ICU), and duration of ventilator and chest tube use were all recorded and compared between groups. The mean duration from trauma to operation was 5.9 days. All demographic characteristics showed no statistical differences between groups. Compared with other groups, Group 3 had higher rates of positive microbial cultures in pleural collections and sputum, longer duration of chest tube insertion and ventilator use. Lengths of hospital and ICU stay in Groups 1 and 2 showed no statistical difference, but were longer in Group 3. The frequency of repeated VATS was lower in Group 1 but without statistically significant difference. This study indicated that an early VATS intervention would decrease chest infection. It also reduced the duration of ventilator dependency. The clinical outcomes were significantly better for patients receiving VATS within 3 days under intensive care. In this study, we suggested that VATS might be delayed by associated injuries, but should not exceed 6 days after trauma. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Tracheal rupture caused by blunt chest trauma: radiological and clinical features

    Energy Technology Data Exchange (ETDEWEB)

    Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S. [Dept. of Diagnostic Radiology, Justus Liebig Univ., Giessen (Germany); Hoppe, M. [Dept. of Diagnostic Radiology, University Hospital, Philipps University, Marburg (Germany); Popella, C. [Dept. of ENT, Justus Liebig University, Giessen (Germany)

    2000-03-01

    The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

  2. Tracheal rupture caused by blunt chest trauma: radiological and clinical features

    International Nuclear Information System (INIS)

    Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S.; Hoppe, M.; Popella, C.

    2000-01-01

    The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

  3. Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Daniel H. Wolbrom

    2016-01-01

    Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

  4. Pneumopericardium and Deep Sulcus Sign After Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Taner Tarladacalisir

    2014-12-01

    Full Text Available Pneumopericardium is defined as air between the leaves of the pericardium, which is usually self-limited. In tension pneumopericardium, however, rapid fluid resuscitation and haemodynamic monitoring followed by pericardial fenestration and drainage should be performed. A 49-year-old male falling from height was brought to the emergency room. On chest X-ray in supine position, a deep sulcus sign and subcutaneous emphysema with multiple rib fractures were detected. At computerized tomography, pericardial free air, right pneumothorax and subcutaneous emphysema were detected. A tube thoracostomy was applied to the patient. During follow-up with cardiac enzymes in the intensive care unit, no tension pneumopericardium developed, and subcutaneous emphysema regressed. A control computerized tomography scan showed a complete regression in the pneumopericardium on the tenth day.

  5. Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management.

    Science.gov (United States)

    Lee, Ka L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

    2010-05-01

    Occult pneumothorax (OP) is a pneumothorax not visualised on a supine chest X-ray (CXR) but detected on computed tomography (CT) scanning. With increasing CT use for trauma, more OP may be detected. Management of OP remains controversial, especially for patients undergoing mechanical ventilation. This study aimed to identify the incidence of OP using thoracic CT as the gold standard and describe its management amongst Hong Kong Chinese trauma patients. Analysis of prospectively collected trauma registry data. Consecutive significantly injured trauma patients admitted through the emergency department (ED) suffering from blunt chest trauma who underwent thoracic computed tomography (TCT) between in calendar years 2007 and 2008 were included. An OP was defined as the identification (by a specialist radiologist) of a pneumothorax on TCT that had not been previously detected on supine CXR. 119 significantly injured patients were included. 56 patients had a pneumothorax on CXR and a further 36 patients had at least one OP [OP incidence 30% (36/119)]. Bilateral OP was present in 8/36 patients, so total OP numbers were 44. Tube thoracostomy was performed for 8/44 OP, all were mechanically ventilated in the ED. The remaining 36 OP were managed expectantly. No patients in the expectant group had pneumothorax progression, even though 8 patients required subsequent ventilation in the operating room for extrathoracic surgery. The incidence of OP (seen on TCT) in Chinese patients in Hong Kong after blunt chest trauma is higher than that typically reported in Caucasians. Most OP were managed expectantly without significant complications; no pneumothorax progressed even though some patients were mechanically ventilated. (c) 2010 Elsevier Ltd. All rights reserved.

  6. European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division?

    Energy Technology Data Exchange (ETDEWEB)

    Tschauner, Sebastian; Marterer, Robert; Guebitz, Michael; Weissensteiner, Sabine; Sorantin, Erich [Medical University of Graz, Division of Paediatric Radiology, Department of Radiology, Graz (Austria); Kalmar, Peter I. [Medical University of Graz, Division of Vascular and Interventional Radiology, Department of Radiology, Graz (Austria); Talakic, Emina [Medical University of Graz, Division of General Radiological Diagnostics, Department of Radiology, Graz (Austria)

    2016-02-15

    Accurate collimation helps to reduce unnecessary irradiation and improves radiographic image quality, which is especially important in the radiosensitive paediatric population. For AP/PA chest radiographs in children, a minimal field size (MinFS) from ''just above the lung apices'' to ''T12/L1'' with age-dependent tolerance is suggested by the 1996 European Commission (EC) guidelines, which were examined qualitatively and quantitatively at a paediatric radiology division. Five hundred ninety-eight unprocessed chest X-rays (45 % boys, 55 % girls; mean age 3.9 years, range 0-18 years) were analysed with a self-developed tool. Qualitative standards were assessed based on the EC guidelines, as well as the overexposed field size and needlessly irradiated tissue compared to the MinFS. While qualitative guideline recommendations were satisfied, mean overexposure of +45.1 ± 18.9 % (range +10.2 % to +107.9 %) and tissue overexposure of +33.3 ± 13.3 % were found. Only 4 % (26/598) of the examined X-rays completely fulfilled the EC guidelines. This study presents a new chest radiography quality control tool which allows assessment of field sizes, distances, overexposures and quality parameters based on the EC guidelines. Utilising this tool, we detected inadequate field sizes, inspiration depths, and patient positioning. Furthermore, some debatable EC guideline aspects were revealed. (orig.)

  7. Dose reduction with adaptive statistical iterative reconstruction for paediatric CT: phantom study and clinical experience on chest and abdomen CT

    Energy Technology Data Exchange (ETDEWEB)

    Gay, F.; Lasalle, S.; Neuenschwander, S.; Brisse, H.J. [Institut Curie, Imaging Department, Paris (France); Pavia, Y.; Pierrat, N. [Institut Curie, Medical Physics Department, Paris (France)

    2014-01-15

    To assess the benefit and limits of iterative reconstruction of paediatric chest and abdominal computed tomography (CT). The study compared adaptive statistical iterative reconstruction (ASIR) with filtered back projection (FBP) on 64-channel MDCT. A phantom study was first performed using variable tube potential, tube current and ASIR settings. The assessed image quality indices were the signal-to-noise ratio (SNR), the noise power spectrum, low contrast detectability (LCD) and spatial resolution. A clinical retrospective study of 26 children (M:F = 14/12, mean age: 4 years, range: 1-9 years) was secondarily performed allowing comparison of 18 chest and 14 abdominal CT pairs, one with a routine CT dose and FBP reconstruction, and the other with 30 % lower dose and 40 % ASIR reconstruction. Two radiologists independently compared the images for overall image quality, noise, sharpness and artefacts, and measured image noise. The phantom study demonstrated a significant increase in SNR without impairment of the LCD or spatial resolution, except for tube current values below 30-50 mA. On clinical images, no significant difference was observed between FBP and reduced dose ASIR images. Iterative reconstruction allows at least 30 % dose reduction in paediatric chest and abdominal CT, without impairment of image quality. (orig.)

  8. Dose reduction with adaptive statistical iterative reconstruction for paediatric CT: phantom study and clinical experience on chest and abdomen CT

    International Nuclear Information System (INIS)

    Gay, F.; Lasalle, S.; Neuenschwander, S.; Brisse, H.J.; Pavia, Y.; Pierrat, N.

    2014-01-01

    To assess the benefit and limits of iterative reconstruction of paediatric chest and abdominal computed tomography (CT). The study compared adaptive statistical iterative reconstruction (ASIR) with filtered back projection (FBP) on 64-channel MDCT. A phantom study was first performed using variable tube potential, tube current and ASIR settings. The assessed image quality indices were the signal-to-noise ratio (SNR), the noise power spectrum, low contrast detectability (LCD) and spatial resolution. A clinical retrospective study of 26 children (M:F = 14/12, mean age: 4 years, range: 1-9 years) was secondarily performed allowing comparison of 18 chest and 14 abdominal CT pairs, one with a routine CT dose and FBP reconstruction, and the other with 30 % lower dose and 40 % ASIR reconstruction. Two radiologists independently compared the images for overall image quality, noise, sharpness and artefacts, and measured image noise. The phantom study demonstrated a significant increase in SNR without impairment of the LCD or spatial resolution, except for tube current values below 30-50 mA. On clinical images, no significant difference was observed between FBP and reduced dose ASIR images. Iterative reconstruction allows at least 30 % dose reduction in paediatric chest and abdominal CT, without impairment of image quality. (orig.)

  9. Can ultrasound extended emergency (EFAST) replace the chest radiograph in the initial approach to trauma?

    International Nuclear Information System (INIS)

    Aguirre Jimenez, Marcela

    2010-01-01

    The sensitivity diagnosed between ultrasound Extended emergency (EFAST) and portable radiography was compared. Life-threatening pathologies are detected in the initial approach to trauma, through an analysis comparative between EFAST and portable chest radiography. So, the need or not both studies or if the use of EFAST as the only diagnostic method in primary evaluation of trauma can be limited. The study has concluded that the EFAST can be used as the only tool for polytrauma patients, although in this analysis the sample has been very small [es

  10. Thorax computed tomography findings in patients victims of chest trauma

    Directory of Open Access Journals (Sweden)

    Francisco Jose Rodrigues de Moura Filho

    2015-12-01

    Full Text Available Objective: To describe thorax computed tomography findings in patients assisted in the emergency unit of Institute Dr Jose Frota (IJF. Materials and Methods: Descriptive study analyzing 160 consecutive contrast-enhanced thorax computed tomography of patients victims of thoracic trauma admitted to the emergency unit of IJF, between November 1st, 2014 and January 31st, 2015. Results: Abnormal findings were observed in 91,2 % of the patients. Among them, the following findings were most frequently observed: fractures (48%, hemothorax (43%, atelectasis (37%, pneumothorax (26% and lung contusions (17% Rupture of the esophagus was seen in three patients. Conclusion: We recognize that the findings encountered in our study are of similar prevalence to the ones reported in the literature and that CT scan is essencial to quickly diagnose these findings.

  11. The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective.

    Science.gov (United States)

    Cowley, Alan; Durge, Neal

    2014-05-13

    Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout the western world. Both the physical and psychological consequences of trauma are well documented and it is shown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed, parental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital accompaniment, and where research has been done on parental presence it often focuses primarily on the parents or staff, rather than the child themselves. Whilst acknowledging the impact on parents and staff, the importance of the emotional wellbeing of the child should be reinforced, to reduce the likelihood of developing symptoms in keeping with post-traumatic stress disorder. This non-systematic literature review, aims to examine the impact of parental accompaniment to hospital, following paediatric trauma, and to help pre-hospital clinicians decide whether accompaniment would be of benefit to their patient population. The lack of published data does not enable a formal recommendation of parental accompaniment in the helicopter to be mandated, though it should be the preference in land based conveyance. Future research is needed into the emotional recovery of children after trauma, as well as the experiences of patient, parent and staff during conveyance.

  12. Provider perceptions concerning use of chest x-ray studies in adult blunt trauma assessments.

    Science.gov (United States)

    Calderon, Georgina; Perez, Daniel; Fortman, Jonathan; Kea, Bory; Rodriguez, Robert M

    2012-10-01

    Although they infrequently lead to management changing diagnoses, chest x-rays (CXRs) are the most commonly ordered imaging study in blunt trauma evaluation. To determine: 1) the reasons physicians order chest X-ray studies (CXRs) in blunt trauma assessments; 2) what injuries they expect CXRs to reveal; and 3) whether physicians can accurately predict low likelihood of injury on CXR. At a Level I Trauma Center, we asked resident and attending physicians treating adult blunt trauma patients: 1) the primary reason(s) for getting CXRs; 2) what, if any, significant intrathoracic injuries (SITI) they expected CXRs to reveal; and 3) the likelihood of these injuries. An expert panel defined SITI as two or more rib fractures, sternal fracture, pulmonary contusion, pneumothorax, hemothorax, or aortic injury on official CXR readings. There were 484 patient encounters analyzed--65% of participating physicians were residents and 35% were attendings; 16 (3.3%) patients had SITI. The most common reasons for ordering CXRs were: "enough concern for significant injury" (62.9%) and belief that CXR is a "standard part of trauma work-up" (24.8%). Residents were more likely than attendings to cite "standard trauma work-up" (mean difference = 13.5%, p = 0.003). When physicians estimated a 25% likelihood, 9.1% (95% CI 3.0-20.0%) had SITI. Physicians order CXRs in blunt trauma patients because they expect to find injuries and believe that CXRs are part of a "standard" work-up. Providers commonly do not expect CXRs to reveal SITI. When providers estimated low likelihood of SITI, the rate of SITI was very low. Published by Elsevier Inc.

  13. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review.

    Science.gov (United States)

    Sawa, Jake; Green, Robert S; Thoma, Brent; Erdogan, Mete; Davis, Philip J

    2017-08-11

    The objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma. EMBASE and MEDLINE were searched from inception until March 2017 for prognostic factors associated with adverse outcomes in older adults sustaining blunt chest trauma using a pre-specified search strategy. References were independently screened for inclusion by two reviewers. Study quality was assessed using the Quality in Prognostic Studies tool. Where appropriate, descriptive statistics were used to evaluate study characteristics and predictors of adverse outcomes. Thirteen cohort studies representing 79,313 patients satisfied our selection criteria. Overall, 26 prognostic factors were examined across studies and were reported for morbidity (8 studies), length of stay (7 studies), mortality (6 studies), and loss of independence (1 study). No studies examined patient quality of life or emergency department recidivism. Prognostic factors associated with morbidity and mortality included age, number of rib fractures, and injury severity score. Although age and rib fractures were found to be associated with adverse outcomes in more than 3 studies, meta-analysis was not performed due to heterogeneity amongst included studies in how these variables were measured. While blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.

  14. Blunt chest trauma--an audit of injuries diagnosed by the MDCT examination.

    Science.gov (United States)

    Turkalj, Ivan; Petrović, Kosta; Stojanović, Sanja; Petrović, Djordje; Brakus, Alma; Ristić, Jelena

    2014-02-01

    Multidetector computed tomography (MDCT) characterised by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

  15. Our Experiences with Chest Trauma Patients in Syrian Civil War

    Directory of Open Access Journals (Sweden)

    Samil Gunay

    2014-03-01

    Full Text Available Aim: Thoracic surgery is a branch, the efficiency of which is unquestionable for war. And during the civil war in Syria, thoracic surgery specialists have been feeling this efficiency so closely. So we want to share our experiences on patients sent from this region. Material and Method: The cases comprised of 41 patients in total, 33 men and 8 women, between the ages of 16-75, who were brought from Syria between the dates of August 2012 %u2013 November 2013. The files of the patients were received from archive. Results: Except 11 isolated thorax trauma patients, it was determined thorax and abdomen injuries at 9 patients (21.9%, thorax and extremity injuries at 8 patients (19.5%, thorax and vertebra injuries at 3 patients (7.3%, thorax, abdomen and cranium injuries at 5 patients (12.1%, thorax, abdomen and eye injuries at one patient (2.4%, thorax, abdomen and vertebra injuries at 3 patients (7.3%, thorax, abdomen and extremity injuries at one patient (2.4%. Discussion: Thoracic surgery is a lifesaving branch in case of fast and effectual medical intervention to injuries during war.

  16. Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre.

    Science.gov (United States)

    Naqvi, G; Johansson, G; Yip, G; Rehm, A; Carrothers, A; Stöhr, K

    2017-01-01

    Introduction Paediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK. Methods This retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region. Results A total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4-10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0-2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson's correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001). Conclusions There is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

  17. Paediatric dose measurements for chest X-ray examinations at Maternity and Children Hospital in Najran - Saudi Arabia

    International Nuclear Information System (INIS)

    Saeed, M.K.; Al-Qahtani, J.M.

    2012-01-01

    The entrance skin dose (ESD) of chest X-ray examinations for AP and PA projections of paediatric patients at Maternity and Children Hospital in Najran, Saudi Arabia have been obtained using DoseCal software. The majority of the results obtained show low measured ESD for chest X-ray examinations. The mean of ESD for the AP projection was found to be 37.5, 40.5, 41.3, and 52.3μGy for age groups 0−1, >1−5, >5−10, and >10−15 years respectively. However, the ESD for PA projection was found to be 50.7 and 56.7μGy for age groups >5−10, and >10−15 years respectively.

  18. What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma?

    Science.gov (United States)

    Kea, Bory; Gamarallage, Ruwan; Vairamuthu, Hemamalini; Fortman, Jonathan; Lunney, Kevin; Hendey, Gregory W; Rodriguez, Robert M

    2013-08-01

    Computed tomography (CT) has been shown to detect more injuries than plain radiography in patients with blunt trauma, but it is unclear whether these injuries are clinically significant. This study aimed to determine the proportion of patients with normal chest x-ray (CXR) result and injury seen on CT and abnormal initial CXR result and no injury on CT and to characterize the clinical significance of injuries seen on CT as determined by a trauma expert panel. Patients with blunt trauma older than 14 years who received emergency department chest imaging as part of their evaluation at 2 urban level I trauma centers were enrolled. An expert trauma panel a priori classified thoracic injuries and subsequent interventions as major, minor, or no clinical significance. Of 3639 participants, 2848 (78.3%) had CXR alone and 791 (21.7%) had CXR and chest CT. Of 589 patients who had chest CT after a normal CXR result, 483 (82.0% [95% confidence interval [CI], 78.7-84.9%]) had normal CT results, and 106 (18.0% [95% CI, 15.1%-21.3%]) had CTs diagnosing injuries-primarily rib fractures, pulmonary contusion, and incidental pneumothorax. Twelve patients had injuries classified as clinically major (2.0% [95% CI, 1.2%-3.5%]), 78 were clinically minor (13.2% [95% CI, 10.7%-16.2%]), and 16 were clinically insignificant (2.7% (95% CI, 1.7%-4.4%]). Of 202 patients with CXRs suggesting injury, 177 (87.6% [95% CI, 82.4%-91.5%]) had chest CTs confirming injury and 25 (12.4% [95% CI, 8.5%-17.6%]) had no injury on CT. Chest CT after a normal CXR result in patients with blunt trauma detects injuries, but most do not lead to changes in patient management. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Dose reduction with adaptive statistical iterative reconstruction for paediatric CT: phantom study and clinical experience on chest and abdomen CT.

    Science.gov (United States)

    Gay, F; Pavia, Y; Pierrat, N; Lasalle, S; Neuenschwander, S; Brisse, H J

    2014-01-01

    To assess the benefit and limits of iterative reconstruction of paediatric chest and abdominal computed tomography (CT). The study compared adaptive statistical iterative reconstruction (ASIR) with filtered back projection (FBP) on 64-channel MDCT. A phantom study was first performed using variable tube potential, tube current and ASIR settings. The assessed image quality indices were the signal-to-noise ratio (SNR), the noise power spectrum, low contrast detectability (LCD) and spatial resolution. A clinical retrospective study of 26 children (M:F = 14/12, mean age: 4 years, range: 1-9 years) was secondarily performed allowing comparison of 18 chest and 14 abdominal CT pairs, one with a routine CT dose and FBP reconstruction, and the other with 30 % lower dose and 40 % ASIR reconstruction. Two radiologists independently compared the images for overall image quality, noise, sharpness and artefacts, and measured image noise. The phantom study demonstrated a significant increase in SNR without impairment of the LCD or spatial resolution, except for tube current values below 30-50 mA. On clinical images, no significant difference was observed between FBP and reduced dose ASIR images. Iterative reconstruction allows at least 30 % dose reduction in paediatric chest and abdominal CT, without impairment of image quality. • Iterative reconstruction helps lower radiation exposure levels in children undergoing CT. • Adaptive statistical iterative reconstruction (ASIR) significantly increases SNR without impairing spatial resolution. • For abdomen and chest CT, ASIR allows at least a 30 % dose reduction.

  20. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy.

    Science.gov (United States)

    Helling, T S; Gyles, N R; Eisenstein, C L; Soracco, C A

    1989-10-01

    Tube thoracostomy (TT) is required in the treatment of many blunt and penetrating injuries of the chest. In addition to complications from the injuries, TT may contribute to morbidity by introducing microorganisms into the pleural space or by incomplete lung expansion and evacuation of pleural blood. We have attempted to assess the impact of TT following penetrating and blunt thoracic trauma by examining a consecutive series of 216 patients seen at two urban trauma centers with such injuries who required TT over a 30-month period. Ninety-four patients suffered blunt chest trauma; 122 patients were victims of penetrating wounds. Patients with blunt injuries had longer ventilator requirements (12.6 +/- 14 days vs. 3.7 +/- 7.1 days, p = 0.003), longer intensive care stays (12.2 +/- 12.5 days vs. 4.1 +/- 7.5 days, p = 0.001), and longer periods of TT, (6.5 +/- 4.9 days vs. 5.2 +/- 4.5 days, p = 0.018). Empyema occurred in six patients (3%). Residual hemothorax was found in 39 patients (18%), seven of whom required decortication. Recurrent pneumothorax developed in 51 patients (24%) and ten required repeat TT. Complications occurred in 78 patients (36%). Patients with blunt trauma experienced more complications (44%) than those with penetrating wounds (30%) (p = 0.04). However, only seven of 13 patients developing empyema or requiring decortication had blunt trauma. Despite longer requirements for mechanical ventilation, intensive care, and intubation, victims of blunt trauma seemed to have effective drainage of their pleural space by TT without increased risk of infectious complications.

  1. Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands.

    Science.gov (United States)

    Heus, C; Mellema, J J; Giannakopoulos, G F; Zuidema, W P

    2015-04-25

    Most patients with penetrating chest injuries benefit from early treatment with chest tube drainage or surgery. Although penetrating chest injury is not uncommon, few descriptive studies are published, especially in Europe. The aim of this study was to review our experience and further improve our management of penetrating chest injuries in a level I trauma center in the Netherlands. All patients with penetrating chest injury between August 2004 and December 2012 were included. Demographics, mechanism of injury, physiological parameters, Injury Severity Scores (ISS), surgical and non-surgical treatment, length of intensive care unit (ICU) stay, length of hospital stay (LOS), complications and rate of mortality were collected. A total of 159 patients were analyzed. Patients included 116 (73 %) stab wounds and 34 (21 %) gunshot wounds. In 27 patients (17 %), cardiac injury was seen. The mean ISS was 12. Almost half of all patients (49 %) were treated with only chest tube drainage. Alternatively, surgical treatment was performed in 24 % of all cases. Anterolateral incision was most frequently used to gain access to the thoracic cavity. The mean LOS was 9 days. Among all patients, 17 % were admitted to the ICU with a mean stay of 3 days. In 18 (11 %) patients, one or more complications occurred. The 30-day mortality was 7.5 %. Patients presenting with penetrating chest injury are not uncommon in the Netherlands and can mostly be treated conservatively. In one-fourth of the patients, surgical treatment is performed. A structural and vigorous approach is needed for good clinical outcome.

  2. Early detection of thoracic spine fracture in the multiple-trauma patient: Findings on the initial anteroposterior chest radiograph

    International Nuclear Information System (INIS)

    Lawrason, J.N.; Novelline, R.A.; Rhea, J.T.; DeLuca, S.A.; Sacknoff, R.

    1987-01-01

    In the unconscious, multiple-trauma patient, thoracic spine fractures may be initially overlooked due to a combination of immediate concern given to more obvious injuries and a failure to carefully scrutinize the initial, often anteroposterior (AP) and portable chest radiograph. In a recent review of their cases the authors retrospectively identified primary or secondary signs of thoracic spine fracture in 80% of the initial chest radiographs of multiple-trauma patients with this injury. This paper reviews these obvious and subtle, bony and soft-tissue AP chest radiograph signs of thoracic spine fracture and compare them with matching spine radiographs, tomography, and CT

  3. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®).

    Science.gov (United States)

    Huber, Stephan; Biberthaler, Peter; Delhey, Patrick; Trentzsch, Heiko; Winter, Hauke; van Griensven, Martijn; Lefering, Rolf; Huber-Wagner, Stefan

    2014-09-03

    Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002-2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt

  4. Surgical repair of right atrial wall rupture after blunt chest trauma.

    Science.gov (United States)

    Telich-Tarriba, Jose E; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.

  5. Spiral CT for evaluation of chest trauma; Spiral-CT beim Thoraxtrauma

    Energy Technology Data Exchange (ETDEWEB)

    Roehnert, W. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Weise, R. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik

    1997-07-01

    After implementation of spiral CT in our department, we carried out an analysis for determining anew the value of CT as a modality of chest trauma diagnosis in the emergency department. The retrospective study covers a period of 10 months and all emergency patients with chest trauma exmined by spiral CT. The major lesions of varying seriousness covered by this study are: pneumothorax, hematothorax, pulmonary contusion or laceration, mediastinal hematoma, rupture of a vessel, injury of the heart and pericardium. The various fractures are not included in this study. In many cases, spiral CT within relatively short time yields significant diagnostic findings, frequently saving additional angiography. A rigid diagnostic procedure cannot be formulated. Plain-film chest radiography still remains a diagnostic modality of high value. (Orig.) [Deutsch] Nach Einfuehrung der Spiral-CT in unserer Einrichtung versuchten wir, den Stellenwert der Computertomographie in der Notfalldiagnostik des Thoraxtraumas neu zu bestimmen. Dazu wurden retrospektiv ueber einen Zeitraum von 10 Monaten alle mittels Spiral-CT untersuchten Notfallpatienten mit Thoraxverletzungen ausgewertet. Im Vordergrund standen folgende Befunde unterschiedlichen Schweregrades: Pneumothorax, Haematothorax, Lungenkontusion/-lazeration, Mediastinalhaematom, Gefaessruptur, Herz- und Herzbeutelverletzung. Auf die unterschiedlichen Frakturen wird bewusst nicht naeher eingegangen. In vielen Faellen liefert die Spiral-CT mit relativ geringem Zeitaufwand wesentliche diagnostische Aussagen. Haeufig kann auf eine Angiographie verzichtet werden. Ein starres diagnostisches Stufenschema laesst sich nicht definieren. Die Thoraxuebersichtsaufnahme besitzt einen unveraendert hohen Stellenwert. (orig.)

  6. "Anterior convergent" chest probing in rapid ultrasound transducer positioning versus formal chest ultrasonography to detect pneumothorax during the primary survey of hospital trauma patients: a diagnostic accuracy study.

    Science.gov (United States)

    Ziapour, Behrad; Haji, Houman Seyedjavady

    2015-01-01

    Occult pneumothorax represents a diagnostic pitfall during the primary survey of trauma patients, particularly if these patients require early positive pressure ventilation. This study investigated the accuracy of our proposed rapid model of ultrasound transducer positioning during the primary survey of trauma patients after their arrival at the hospital. This diagnostic trial was conducted over 12 months and was based on the results of 84 ultrasound (US) exams performed on patients with severe multiple trauma. Our index test (US) was used to detect pneumothorax in four pre-defined locations on the anterior of each hemi-thorax using the "Anterior Convergent" approach, and its performance was limited to the primary survey. Consecutively, patients underwent chest-computed tomography (CT) with or without chest radiography. The diagnostic findings of both chest radiography and chest ultrasounds were compared to the gold-standard test (CT). The diagnostic sensitivity was 78 % for US and 36.4 % for chest radiography (p chest radiography (not significant); the positive predictive values were 74 % for US and 80 % for chest radiography (not significant); the negative predictive values were 94 % for US and 87 % for chest radiography (not significant); the positive likelihood ratio was 10 for US and 18 for chest radiography (p = 0.007); and the negative likelihood ratio was 0.25 for US and 0.65 for chest radiography (p = 0.001). The mean required time for performing the new method was 64 ± 10 s. An absence of the expected diffused dynamic view among ultrasound images obtained from patients with pneumothorax was also observed. We designated this phenomenon "Gestalt Lung Recession." "Anterior convergent" chest US probing represents a brief but efficient model that provides clinicians a safe and accurate exam and adequate resuscitation during critical minutes of the primary survey without interrupting other medical staff activities taking place around the

  7. CIVILIAN GUNSHOT WOUNDS TO THE CHEST: A CLINICOPATHOLOGICAL ANALYSIS OF AN ANNUAL CASELOAD AT A LEVEL 1 TRAUMA CENTRE.

    Science.gov (United States)

    Meijering, V M; Hattam, A T; Navsaria, P H; Nicol, A J; Edu, S

    2017-06-01

    Gunshot wounds (GSW) to the chest are common presentations to trauma centres in South Africa. The clinical management and outcome of GSW to the chest are significantly altered by missile trajectory and the associated anatomical structures injured making them challenging injuries to treat. Currently, the management of GSW chest is based on scant evidence and treatment is typically according to algorithms based largely on the anecdotal experience of high volume institutions and experienced clinicians. Ethical approval was obtained for this study. The Electronic Trauma Health Registry (eTHR) Application of the Trauma Centre at Groote Schuur Hospital in Cape Town was interrogated for the year 2015 for all patients with GSW chest. The data was then analysed using descriptive statistics. A total of 141 patients with GSW to the chest were admitted to the Trauma Centre with a median age of 26 years. More than half of the patients, 53. 2% (n = 75) sustained an isolated GSW to the chest. Overall, 29.1% (n = 41) patients sustained a thoracoabdominal injury, which accounts for a significant higher amount of emergency surgeries compared to patients with non thoracoabdominal injuries (54% vs 15%, p = chest surgery of which 5 patients survived. Overall mortality was 7.1% (n = 10) of which 5 patients died from a thoracic cause. Civilian GSW to the chest are common injuries seen in Cape Town, often with concomitant injuries leading to increased morbidity. Significantly more emergency surgeries were done in patients with thoracoabdominal injury. Overall few patients needed chest-related emergency operative intervention (9.2%) with a survival rate of 38.5%. Overall mortality of patients with GSW chest who reached the hospital was 7.1% of whom 50% died from a thoracic cause.

  8. An analysis of the efficacy of bag-valve-mask ventilation and chest compression during different compression-ventilation ratios in manikin-simulated paediatric resuscitation.

    Science.gov (United States)

    Kinney, S B; Tibballs, J

    2000-01-01

    The ideal chest compression and ventilation ratio for children during performance of cardiopulmonary resuscitation (CPR) has not been determined. The efficacy of chest compression and ventilation during compression ventilation ratios of 5:1, 10:2 and 15:2 was examined. Eighteen nurses, working in pairs, were instructed to provide chest compression and bag-valve-mask ventilation for 1 min with each ratio in random on a child-sized manikin. The subjects had been previously taught paediatric CPR within the last 3 or 5 months. The efficacy of ventilation was assessed by measurement of the expired tidal volume and the number of breaths provided. The rate of chest compression was guided by a metronome set at 100/min. The efficacy of chest compressions was assessed by measurement of the rate and depth of compression. There was no significant difference in the mean tidal volume or the percentage of effective chest compressions delivered for each compression-ventilation ratio. The number of breaths delivered was greatest with the ratio of 5:1. The percentage of effective chest compressions was equal with all three methods but the number of effective chest compressions was greatest with a ratio of 5:1. This study supports the use of a compression-ventilation ratio of 5:1 during two-rescuer paediatric cardiopulmonary resuscitation.

  9. Chest radiographic pulmonary changes reflecting extrapulmonary involvement in paediatric HIV disease

    International Nuclear Information System (INIS)

    Pitcher, Richard D.; Goddard, Elizabeth; Hendricks, Marc; Lawrenson, John

    2009-01-01

    Respiratory infections are the commonest cause of pulmonary change on chest radiographs of HIV-infected children. However, HIV-related neurological, oropharyngeal, oesophageal, cardiac and haematological abnormalities may also manifest with pulmonary changes and must be considered in the interpretation of the chest radiograph in HIV-infected children. (orig.)

  10. 74 Year-Old-Man With Pneumopericardium Due to Blunt Chest Trauma: Case Report

    Directory of Open Access Journals (Sweden)

    Alper Avcı

    2008-12-01

    Full Text Available Pneumopericardium is the presence of air in the pericardial space. It may be seen in the context with severe blunt chest trauma. Usually, pneumopericardium is self-limiting and requiring no specific therapy. However, a continuous monitoring of the electrocardiography and the blood pressure is necessary at an intermediate care unit. We report a 74 year-old-man had been presented with Pneumopericardium, after a car striking. He had bilateral pneumohematothoraces, pneumomediastinum and bilateral multiple rib fractures. Pneumopericardium was diasappeared without surgical management like written in english literature. Frequent cardiac and vital signs monitoring and general support treatment were successful in our treatment.

  11. Rupture of the right upper pulmonary vein and left atrium caused by blunt chest trauma.

    Science.gov (United States)

    Osaka, Motoo; Nagai, Ryo; Koishizawa, Tadashi

    2017-11-01

    A 49-year-old man was transferred to our hospital by ambulance due to blunt chest trauma sustained in a car accident. Echocardiography and enhanced computed tomography showed hemopericardium without other vital organ damage. Emergent surgery was performed under strong suspicion of traumatic cardiac rupture. Careful inspection showed a rupture of the right upper pulmonary vein at the junction of the left atrium, a laceration of the inferior vena cava, and a left-side pericardium rupture, and they were repaired with running 4-0 polypropylene suture. Postoperative hemodynamics were stable. The patient was discharged ambulatory on postoperative day 15.

  12. Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Maximilian Andreas Storz

    2017-01-01

    Full Text Available Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT demonstrated right-sided costal fractures (ribs 7 to 9, with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment.

  13. Factors Associated with Complications in Older Adults with Isolated Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Lotfipour, Shahram

    2009-05-01

    Full Text Available OBJECTIVE: To determine the prevalence of adverse events in elderly trauma patients with isolated blunt thoracic trauma, and to identify variables associated with these adverse events.METHODS: We performed a chart review of 160 trauma patients age 65 and older with significant blunt thoracic trauma, drawn from an American College of Surgeons Level I Trauma Center registry. Patients with serious injury to other body areas were excluded to prevent confounding the cause of adverse events. Adverse events were defined as acute respiratory distress syndrome or pneumonia, unanticipated intubation, transfer to the intensive care unit for hypoxemia, or death. Data collected included history, physical examination, radiographic findings, length of hospital stay, and clinical outcomes.RESULTS: Ninety-nine patients had isolated chest injury, while 61 others had other organ systems injured and were excluded. Sixteen patients developed adverse events [16.2% 95% confidence interval (CI 9.5-24.9%], including two deaths. Adverse events were experienced by 19.2%, 6.1%, and 28.6% of those patients 65-74, 75-84, and >/=85 years old, respectively. The mean length of stay was 14.6 days in patients with an adverse event and 5.8 days in patients without. Post hoc analysis revealed that all 16 patients with an adverse event had one or more of the following: age >/=85, initial systolic blood pressure <90 mmHg, hemothorax, pneumothorax, three or more unilateral rib fractures, or pulmonary contusion (sensitivity 100%, CI 79.4-100%; specificity 38.6%, CI 28.1-49.9%.CONCLUSION: Adverse events from isolated thoracic trauma in elderly patients complicate 16% of our sample. These criteria were 100% sensitive and 38.5% specific for these adverse events. This study is a first step to identifying variables that might aid in identifying patients at high risk for serious adverse events.

  14. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT).

    Science.gov (United States)

    Rodriguez, Robert M; Langdorf, Mark I; Nishijima, Daniel; Baumann, Brigitte M; Hendey, Gregory W; Medak, Anthony J; Raja, Ali S; Allen, Isabel E; Mower, William R

    2015-10-01

    Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs) for selective chest computed tomography (CT) in adult blunt trauma patients. From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity). In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients-6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1) abnormal chest X-ray, (2) rapid deceleration mechanism, (3) distracting injury, (4) chest wall tenderness, (5) sternal tenderness, (6) thoracic spine tenderness, and (7) scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of 20.8% (95% CI 19.2%-22.4%), and a negative predictive value (NPV) of 99.8% (95% CI 98.9%-100%) for major injury, and a sensitivity of 95.4% (95% CI 93.6%-96.9%), a specificity of 25.5% (95% CI 23.5%-27.5%), and a NPV of 93.9% (95% CI 91.5%-95.8%) for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of

  15. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

    Science.gov (United States)

    Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

    2015-12-01

    Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two

  16. Paediatric frontal chest radiograph screening with fine-tuned convolutional neural networks

    CSIR Research Space (South Africa)

    Gerrand, Jonathan D

    2017-07-01

    Full Text Available of fine-tuned convolutional neural networks (CNN). We use two popular CNN models that are pre-trained on a large natural image dataset and two distinct datasets containing paediatric and adult radiographs respectively. Evaluation is performed using a 5...

  17. Ruptura do septo interventricular após trauma torácico fechado Ventricular septal rupture following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Ronaldo Peixoto de Mello

    2006-12-01

    Full Text Available Relatamos a seguir um caso de ruptura do septo interventricular após trauma torácico automobilístico com evolução relativamente benigna a despeito da extensão da lesão anatômica.We report a case of ventricular septal rupture following chest trauma resulting from a car accident. The outcome was relatively favorable despite the extension of the anatomic lesion.

  18. Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

    International Nuclear Information System (INIS)

    Sutherland, G.R.; Driedger, A.A.; Holliday, R.L.; Cheung, H.W.; Sibbald, W.J.

    1983-01-01

    Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly lower (31 +/- 11% and 47 +/- 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 +/- 8% and 58 +/- 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle

  19. Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients.

    Science.gov (United States)

    Vafaei, Ali; Hatamabadi, Hamid Reza; Heidary, Kamran; Alimohammadi, Hosein; Tarbiyat, Mohammad

    2016-01-01

    Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the

  20. Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients

    Directory of Open Access Journals (Sweden)

    Ali Vafaei

    2016-01-01

    Full Text Available Introduction: Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. Methods: In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. Results: 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67, were enrolled (77.6% male. Chest CT scan showed pulmonary contusion in 48 (31.6% patients, hemothorax in 29 (19.1%, and pneumothorax in 55 (36.2% cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96, 0.86 (95% CI: 0.78‒0.94, and 0.80 (95% CI: 0.736‒0.88, respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87 for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86 for hemothorax, and 0.58 (95% CI: 0.5‒0.67 for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02 and pulmonary contusion (p < 0.001. However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08. Conclusion: The results of the present study showed that ultrasonography is preferable to radiography in the initial

  1. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

    Directory of Open Access Journals (Sweden)

    Tripat Bindra

    2011-01-01

    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  2. The significance of routine thoracic computed tomography in patients with blunt chest trauma.

    Science.gov (United States)

    Çorbacıoğlu, Seref Kerem; Er, Erhan; Aslan, Sahin; Seviner, Meltem; Aksel, Gökhan; Doğan, Nurettin Özgür; Güler, Sertaç; Bitir, Aysen

    2015-05-01

    The purpose of this study is to investigate whether the use of thoracic computed tomography (TCT) as part of nonselective computed tomography (CT) guidelines is superior to selective CT during the diagnosis of blunt chest trauma. This study was planned as a prospective cohort study, and it was conducted at the emergency department between 2013 and 2014. A total of 260 adult patients who did not meet the exclusion criteria were enrolled in the study. All patients were evaluated by an emergency physician, and their primary surveys were completed based on the Advanced Trauma Life Support (ATLS) principles. Based on the initial findings and ATLS recommendations, patients in whom thoracic CT was indicated were determined (selective CT group). Routine CTs were then performed on all patients. Thoracic injuries were found in 97 (37.3%) patients following routine TCT. In 53 (20%) patients, thoracic injuries were found by selective CT. Routine TCT was able to detect chest injury in 44 (16%) patients for whom selective TCT would not otherwise be ordered based on the EP evaluation (nonselective TCT group). Five (2%) patients in this nonselective TCT group required tube thoracostomy, while there was no additional treatment provided for thoracic injuries in the remaining 39 (15%). In conclusion, we found that the nonselective TCT method was superior to the selective TCT method in detecting thoracic injuries in patients with blunt trauma. Furthermore, we were able to demonstrate that the nonselective TCT method can change the course of patient management albeit at low rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma.

    Science.gov (United States)

    Nummela, Mari T; Bensch, Frank V; Pyhältö, Tuomo T; Koskinen, Seppo K

    2018-02-01

    Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ 2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion

  4. Selective common and uncommon imaging manifestations of blunt nonaortic chest trauma: when time is of the essence.

    Science.gov (United States)

    Altoos, Rola; Carr, Robert; Chung, Jonathan; Stern, Eric; Nevrekar, Dipti

    2015-01-01

    This is a pictorial essay in which we review and illustrate a variety of thoracic injuries related to blunt trauma. Non-aortic blunt thoracic trauma can be divided anatomically into injuries of the chest wall, lungs, pleura, mediastinum, and diaphragm. Some injuries involve more than one anatomic compartment, and multiple injuries commonly coexist. This article provides common imaging findings and discussion of both common and uncommon but critical thoracic injuries encountered. Published by Elsevier Inc.

  5. Management of paediatric splenic injury in the New South Wales trauma system.

    Science.gov (United States)

    Adams, Susan E; Holland, Andrew; Brown, Julie

    2017-01-01

    Since the 1980's, paediatric surgeons have increasingly managed blunt splenic injury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere. To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related to the odds of operation. Secondarily, to investigate whether the likelihood of operation varied by year. Children age 0-16 admitted to a NSW hospital between July 2000 and December 2011 with a diagnosis of BSI were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages, and Bureau of Statistics. The operation rate was calculated and compared between different hospital types. Univariable analysis was used to determine patient and hospital factors associated with operative management. The difference in the odds of operation between the oldest data (July 2000-December 2005) and most recent (January 2006-December 2011) was also examined. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of operative management according to hospital category and era, adjusting for potential confounders. 955 cases were identified, with 101(10.6%) managed operatively. On multivariable analysis, factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, psplenic disruption (OR 3.10, 95% CI 1.61-6.19, ptrauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, ptrauma centre (OR 3.72 95% CI 1.83-7.83, ptrauma system is required. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Diagnostic Accuracy of Ultrasonography in the Initial Evaluation of Patients with Penetrating Chest Trauma

    Directory of Open Access Journals (Sweden)

    Farhad Heydari

    2014-03-01

    Full Text Available Introduction: Traumatic chest injuries (TCI are one of the most common causes of referring to the emergency departments, with high mortality and disability. This study was designed to evaluate the diagnostic accuracy of ultrasonography versus chest X ray (CXR in detection of hemo-pneumothorax for patients suffering penetrating TCI. Methods: The present cross-sectional study was performed to evaluate the diagnostic accuracy of ultrasonography in penetrating TCI victims referred to the emergency department of Shahid Kashani and Alzahra hospitals of Isfahan, Iran, from July 2012 to June 2013. Bedside ultrasonography and plain CXR was done on arrival and three hours after admission. The results of ultrasonography and radiography were separately evaluated by an emergency medicine specialist and a radiologist, who were blind to the aims of the study. Then, sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV, and kappa coefficient was considered to evaluate the accuracy of ultrasonography. Results: In this research 64 patients with penetrating chest trauma were assessed (98.4% male. The mean age of them was 25.6±8.5 years (rang: 13-65. The plain radiography revealed the eight (12.5 % cases of pneumothorax and one (1.6% hemothorax. The findings of primary ultrasonography also showed the same number of hemo-pneumothorax. Sensitivity and specificity of primary ultrasound in diagnosis of pneumothorax were 100% (95% Cl: 60.7- 100 and 100.0% (95% Cl, 92.0% to 100.0% and in detection of hemothorax were 100% (95% Cl: 50.5-100 and 100% (95% Cl: 92.8-100, respectively. Sensitivity and specificity of ultrasound in the third hour were 100% (95% Cl: 31.3-100 and 100% (95% Cl: 91.4-100, respectively. Conclusion: Findings of the present study have shown that ultrasonography has an acceptable diagnostic accuracy in the initial assessment of patients with penetrating chest trauma. However, because of its dependency on operator

  7. Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures

    OpenAIRE

    Hwang, Eun Gu; Lee, Yunjung

    2016-01-01

    Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractu...

  8. Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries.

    Science.gov (United States)

    Hoysted, Claire; Babl, Franz E; Kassam-Adams, Nancy; Landolt, Markus A; Jobson, Laura; Van Der Westhuizen, Claire; Curtis, Sarah; Kharbanda, Anupam B; Lyttle, Mark D; Parri, Niccolò; Stanley, Rachel; Alisic, Eva

    2018-01-01

    Background : Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective : To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method : Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t -tests and multiple regression. Results : Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions : There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries.

  9. Utility of extended FAST in blunt chest trauma: is it the time to be used in the ATLS algorithm?

    Science.gov (United States)

    Abdulrahman, Yassir; Musthafa, Shameel; Hakim, Suhail Y; Nabir, Syed; Qanbar, Ahad; Mahmood, Ismail; Siddiqui, Tariq; Hussein, Wafaa A; Ali, Hazim H; Afifi, Ibrahim; El-Menyar, Ayman; Al-Thani, Hassan

    2015-01-01

    The clinical significance of extended Focused Assessment with Sonography for Trauma (EFAST) for diagnosis of pneumothorax is not well defined. To investigate the utility of EFAST in blunt chest trauma (BCT) patients. A single blinded, prospective study. All patients admitted with BCT (2011-2013). Level 1 trauma center in Qatar. Patients were screened by EFAST and results were compared to the clinical examination (CE) and chest X-ray (CXR). Chest-computed tomography (CT) scoring system was used to confirm and measure the pneumothorax. Diagnostic accuracy of diagnostic modalities of pneumothorax was measured using sensitivity, specificity, predictive values (PVs), and likelihood ratio. A total of 305 BCT patients were included with median age of 34 (18-75). Chest CT was positive for pneumothorax in 75 (24.6 %) cases; of which 11 % had bilateral pneumothorax. Chest CT confirmed the diagnosis of pneumothorax in 43, 41, and 11 % of those who were initially diagnosed by EFAST, CE, and CXR, respectively. EFAST was positive in 42 hemithoraces and its sensitivity (43 %) was higher in comparison to CXR (11 %). Positive and negative PVs of EFAST were 76 and 92 %, respectively. The frequency of missed cases by CXR was higher in comparison to EFAST and CE. The lowest median score of missed pneumothorax was observed by EFAST. EFAST can be used as an efficient triaging tool in BCT patients to rule out pneumothorax. Based on our analysis, we would recommend EFAST as an adjunct in ATLS algorithm.

  10. The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma.

    Science.gov (United States)

    Markel, Troy A; Kumar, Rajiv; Koontz, Nicholas A; Scherer, L R; Applegate, Kimberly E

    2009-07-01

    There is a growing concern that computed tomography (CT) is being unnecessarily overused for the evaluation of pediatric patients. The purpose of this study was to analyze the trends and utility of chest CT use compared with chest X-ray (CXR) for the evaluation of children with blunt chest trauma. A 4-year retrospective review was performed for pediatric patients who underwent chest CT within 24 hours of sustaining blunt trauma at a Level-I trauma center. Trends in the use of CT and CXR were documented, and results of radiology reports were analyzed and compared with clinical outcomes. Three hundred thirty-three children, mean age 11 years, had chest CTs, increasing from 5.5% in 2001-2002 to 10.5% in 2004-2005 (p tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.

  11. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.

    Science.gov (United States)

    Wilkerson, R Gentry; Stone, Michael B

    2010-01-01

    Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from

  12. Outcomes of patients with blunt chest trauma encountered at emergency department and possible risk factors affecting mortality

    Directory of Open Access Journals (Sweden)

    Yuan-Ming Tsai

    2017-01-01

    Full Text Available Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries who underwent thoracic computed tomography on arrival in the emergency department (January 2010–December 2013. Patients with brain injuries were excluded from the study. The prognostic values of age, sex, trauma type, injury severity score, revised trauma score (RTS, ventilator requirement, days in Intensive Care Unit (ICU, associated thoracic injury, and laboratory examinations (including arterial blood gas [ABG] were evaluated. Results: Fifteen of 30 analyzed patients died during their ICU stays; accordingly, we classified patients as survivors and nonsurvivors. These groups differed significantly regarding the RTS (P = 0.002, mechanical ventilation requirement (P = 0.007, total stay length (P = 0.009, and the presence of hemothorax (P = 0.030. However, no significant differences in the pneumothorax, rib fractures, and blood tests (including ABG analysis were observed between the groups. Conclusion: Among hospitalized trauma patients with blunt thoracic injuries, RTS, mechanical ventilation requirement, and hemothorax were identified as risk factors for mortality. Patients with hemothorax should receive multidisciplinary care and be monitored closely to improve survival.

  13. Chest x-ray as a screening tool for blunt thoracic trauma in children.

    Science.gov (United States)

    Yanchar, Natalie L; Woo, Kenneth; Brennan, Maureen; Palmer, Cameron S; Zs Ee, Michael; Sweeney, Brian; Crameri, Joe

    2013-10-01

    With the increasing use of thoracic computed tomography (CT) to screen for injuries in pediatric blunt thoracic trauma (BTT), we determined whether chest x-ray (CXR) and other clinical and epidemiologic variables could be used to predict significant thoracic injuries, to inform the selective use of CT in pediatric BTT. We further queried if these were discrepant from factors associated with the decision to obtain a thoracic CT. This retrospective cohort study included cases of BTT from three Level I pediatric trauma centers between April 1999 and March 2008. Pre-CT epidemiologic, clinical, and radiologic variables associated with CT findings of any thoracic injury or a significant thoracic injury as well as the decision to obtain a thoracic CT were determined using logistic regression. Of 425 patients, 40% patients had a significant thoracic injury, 49% had nonsignificant thoracic injury, and 11% had no thoracic injury at all. Presence of hydrothorax and/or pneumothorax on CXR significantly increased the likelihood of significant chest injury visualized by CT (adjusted odds ratio 10.8; 95% confidence interval, 6.5-18), as did the presence of isolated subcutaneous emphysema (adjusted odds ratio, 19.8; 95% confidence interval, 2.3-168). Although a normal CXR finding was not statistically associated with a reduced risk of significant thoracic injury, 8 of the 9 cases with normal CXR findings and significant injuries involved occult pneumothoraces or hemothoraces not requiring intervention. Converse to features suggesting increased risk of significant injury, the decision to obtain a thoracic CT was only associated with later period in the study and obtaining a CT scan of another body region. CXR can be used to screen for significant thoracic injuries and direct the selective use of thoracic CT in pediatric BTT. Prospective studies are needed to validate these findings and develop guidelines that include CXR to define indications for thoracic CT in pediatric BTT

  14. [Diagnostic management in paediatric blunt abdominal trauma - a systematic review with metaanalysis].

    Science.gov (United States)

    Schöneberg, C; Tampier, S; Hussmann, B; Lendemans, S; Waydhas, C

    2014-12-01

    The objective of this systematic review was to investigate the diagnostic management in paediatric blunt abdominal injuries. A literature research was performed using following sources: MEDLINE, Embase and Cochrane. Where it was possible a meta-analysis was performed. Furthermore the level of evidence for all publications was assigned. Indicators for intraabdominal injury (IAI) were elevated liver transaminases, abnormal abdominal examinations, low systolic blood pressure, reduced haematocrit and microhematuria. Detecting IAI with focused assessment with sonography for trauma (FAST) had an overall sensitivity of 56.5 %, a specificity of 94.68 %, a positive likelihood ratio of 10.63 and a negative likelihood ratio of 0.46. The accuracy was 84.02 %. Among haemodynamically unstable children the sensitivity and specificity were 100 %. The overall prevalence of IAI and negative CT was 0.19 %. The NPV of abdominal CT for diagnosing IAI was 99.8 %. The laparotomy rate in patients with isolated intraperitoneal fluid (IIF) in one location was 3.48 % and 56.52 % in patients with IIF in more than one location. FAST as an isolated tool in the diagnostics after blunt abdominal injury is very uncertain, because of the modest sensitivity. Discharging children after blunt abdominal trauma with a negative abdominal CT scan seems to be safe. When IIF is detected on CT scan, it depends on the number of locations involved. If IIF is found only in 1 location, IAI is uncommon, while IIF in two or more locations results in a high laparotomy rate. Georg Thieme Verlag KG Stuttgart · New York.

  15. Accuracy of the interpretation of chest radiographs for the diagnosis of paediatric pneumonia.

    Directory of Open Access Journals (Sweden)

    Mohamed A Elemraid

    Full Text Available World Health Organization (WHO radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.There was significant disagreement (22% between the first and second reports (kappa = 0.70, P<0.001, notably in those aged <5 years (26%, kappa = 0.66, P<0.001. The most frequent sources of disagreement were the reporting of patchy and perihilar changes.This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.

  16. Evaluation of the entrance skin dose due to paediatric chest X-rays examinations carried out at a great hospital in Rio de Janeiro city

    International Nuclear Information System (INIS)

    Mohamadain, K.E.M.; Azevedo, A.C.P.; Rosa, L.A.R. da; Mota, H.C.; Goncalves, O.D.; Guebel, M.R.N.

    2001-01-01

    A dosimetric survey in paediatric radiology is currently being carried out at the paediatric unit of a great hospital in Rio de Janeiro city, aiming the assessment of patient doses and image quality. The aim of this work was to estimate the entrance skin dose for frontal and lateral chest X-rays exposure to paediatric patients. Three examination techniques were investigated, namely PA, AP and lateral positions. For entrance skin dose evaluation, two different TL dosimeters were used, namely LiF:Mg,Ti and CaSO4:Dy. The age intervals considered were 0-1 year, 1-5 years, 5-10 years and 10-15 years. The results obtained with both dosimeters are similar and the entrance skin dose values evaluated for the different age intervals considered are compared with previous values found in Brazil and also in Europe. (author)

  17. CT evaluation of pulmonary parenchymal injury due to blunt chest trauma and its clinical significance

    International Nuclear Information System (INIS)

    Niimi, Hiroshi

    1990-01-01

    The CT findings of pulmonary parenchymal injury due to blunt chest trauma in 73 patients and their clinical significance were analyzed. CT was obtained within 6 hours after trauma. Findings were analyzed according to the number of injured segments and severity which was classified into three grades. A correlation was also made with arterial blood PaO 2 and thoracic complications. Pulmonary parenchymal injury was identified in multisegmental portions bilaterally in most cases. It was most frequently observed in the posterior portion of the lung such as segment 6. More than 50% of lesions were classified as Grade 1. Pulmonary laceration, defined as patchy density with the cavitary lesion (Grade 3), was noted in 9.2%. There was a good correlation between extent of pulmonary injury and degree of hypoxia. The correlation of pneumothorax was also found with extensive lesion and frequency of Grade 3 lesion. Cases with pulmonary laceration tend to have extensive injury, and be related to the degree of hypoxia. In conclusion, CT evaluation of pulmonary parenchymal injury is valuable not only for morphological evaluation but also for estimation of hypoxia. (author)

  18. CT evaluation of pulmonary parenchymal injury due to blunt chest trauma and its clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Niimi, Hiroshi (St. Marianna University School of Medicine, Kawasaki, Kanagawa (Japan))

    1990-10-01

    The CT findings of pulmonary parenchymal injury due to blunt chest trauma in 73 patients and their clinical significance were analyzed. CT was obtained within 6 hours after trauma. Findings were analyzed according to the number of injured segments and severity which was classified into three grades. A correlation was also made with arterial blood PaO{sub 2} and thoracic complications. Pulmonary parenchymal injury was identified in multisegmental portions bilaterally in most cases. It was most frequently observed in the posterior portion of the lung such as segment 6. More than 50% of lesions were classified as Grade 1. Pulmonary laceration, defined as patchy density with the cavitary lesion (Grade 3), was noted in 9.2%. There was a good correlation between extent of pulmonary injury and degree of hypoxia. The correlation of pneumothorax was also found with extensive lesion and frequency of Grade 3 lesion. Cases with pulmonary laceration tend to have extensive injury, and be related to the degree of hypoxia. In conclusion, CT evaluation of pulmonary parenchymal injury is valuable not only for morphological evaluation but also for estimation of hypoxia. (author).

  19. Evaluation of chest and abdominal injuries in trauma patients hospitalized in the surgery ward of poursina teaching hospital, guilan, iran.

    Science.gov (United States)

    Hemmati, Hossein; Kazemnezhad-Leili, Ehsan; Mohtasham-Amiri, Zahra; Darzi, Ali Asghar; Davoudi-Kiakalayeh, Ali; Dehnadi-Moghaddam, Anoush; Kouchakinejad-Eramsadati, Leila

    2013-01-01

    Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients. This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran. In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire. In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%). Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care

  20. Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient: A Rare Complication of Blunt Chest Trauma.

    Science.gov (United States)

    Orlik, Kseniya; Simon, Erin Leslie; Hemmer, Carrie; Ramundo, Maria

    2016-07-01

    We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.

  1. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

    Directory of Open Access Journals (Sweden)

    Baig M. Idris

    2016-01-01

    Conclusion: Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy.

  2. Paediatric Northern Score centile charts for the chest radiograph in cystic fibrosis

    International Nuclear Information System (INIS)

    McCormick, J.; Conway, S.P.; Mehta, A.

    2007-01-01

    Aim: To create the first national centile charts for the chest radiograph Northern Score using the UK Cystic Fibrosis (CF) Database (UKCFD). Materials and methods: All active patients for 2002 from the UKCFD were analysed in 1-year cohorts from 0 to 18 years. Northern Score results from the annual review forms were used to construct centile lines for the 5th, 25th, 50th, 75th, 95th centiles. Results: There were 1806 patients with recorded Northern Score data for 2002 (927 male patients, male:female ratio 1.05). The centile chart demonstrates a quasi-linear rise throughout childhood. A Northern Score in excess of age in years equates to >95th centile in school-aged CF patients. Conclusion: This centile chart provides a disease-specific reference range for monitoring individual patients or for evaluating therapeutic change using the dominant chest radiograph scoring system in the UK. Patients, parents and clinicians may find these useful during the annual review process

  3. Outcomes and indications for intervention in non-operative management of paediatric liver trauma: A 5 year retrospective study

    International Nuclear Information System (INIS)

    Inchingolo, R.; Ljutikov, A.; Deganello, A.; Kane, P.; Karani, J.

    2014-01-01

    Aim: To determine the applicability of accurate computed tomography (CT) evaluation and embolization as non-operative management for liver trauma in a paediatric population. Material and methods: A retrospective observational study of 37 children (mean age 10.5 years) with hepatic trauma (28 blunt, 9 penetrating) admitted to a trauma referral centre over a 5 year period. All patients were evaluated with CT and scored with an Association for the Surgery of Trauma score. Inpatient information was reviewed for demographics, associated injuries, modes of management, efficacy and complications of management, and outcome. Statistical analysis was performed. Results: There were seven contusions, two grade I, two grade II, nine grade III, and 17 grade IV liver lacerations. Only two patients (grade IV, penetrating) underwent surgery for the management of bowel perforation. All children had non-surgical treatment of their liver trauma: three cases (grade IV) had primary angiography due to CT evidence of active bleeding and embolization was performed in two of these. Seven patients (two grade III, five grade IV) had angiography during the follow-up for evidence of a complicating pseudoaneurysm and embolization was performed in six of them. Embolization was successful in all the children; one minor complication occurred (cholecystitis). Endoscopic retrograde cholangiopancreatography (ERCP) plus stenting was performed in two cases for a bile leak. All 37 children had a positive outcome. Conclusion: The present study demonstrates that non-operative management of hepatic trauma is applicable to children and may have a higher success rate than in adults

  4. Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew – case identification rates and effect on the Sydney paediatric trauma system

    Directory of Open Access Journals (Sweden)

    Garner Alan A

    2012-12-01

    Full Text Available Abstract Background Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC. Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC. Methods Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available. Results Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011, and shorter times to PTC (67 vs 261mins, p = 0.015 and length of intensive care unit stays (2 vs 0 days, p = 0.045. Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P  Conclusions Physician staffed HEMS crew dispatch is significantly more likely to identify cases of severe paediatric trauma and is associated with a greater proportion of transports

  5. Occult pneumothoraces in Chinese patients with significant blunt chest trauma: radiological classification and proposed clinical significance.

    Science.gov (United States)

    Lee, Ryan K L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

    2012-12-01

    An occult pneumothorax (OP) is a pneumothorax not seen on a supine chest X-ray (CXR) but detected on abdominal or thoracic computed tomography (CT) scanning. With the increasing use of CT in the management of significantly injured trauma patients, more OPs are being detected. The aim of this study was to classify OPs diagnosed on thoracic CT (TCT) and correlate them with their clinical significance. Retrospective analysis of prospectively collected trauma registry data. Total 36 (N=36) consecutive significantly injured trauma patients admitted through the emergency department (ED) who sustained blunt chest trauma and underwent TCT between 1 January 2007 and 31 December 2008 were included. OP was defined as the identification (by a consultant radiologist) of a pneumothorax on TCT that had not been detected on supine CXR. OPs were classified by laterality (unilateral/bilateral) and location (apical, basal, non apical/basal). The size of pneumothoraces, severity of injury [including number of associated thoracic injuries and injury severity score (ISS)], length of hospital stay and mortality were compared between groups. The need for tube thoracostomy and clinical outcome were also analysed. Patients with bilateral OPs (N=8) had significantly more associated thoracic injuries (median: 2 vs. 1, p=0.01), higher ISS (median: 35 vs. 23, p=0.02) and longer hospital stay (median: 20 days vs. 11 days, p=0.01) than those with a unilateral OP (N=28). Basal OPs (N=7) were significantly larger than apical (N=10) and non-apical/basal Ops (N=11). Basal OPs were associated with significantly more associated thoracic injuries (median: 2 vs. 1, p=0.01), higher ISS (median: 35 vs. 25, p=0.04) and longer hospital stays (median: 23 days vs. 17 days, p=0.02) than apical Ops, which had higher ISS (median: 35 vs. 25, p=0.04) and longer hospital stays (median: 23 days vs. 15 days, p=0.02) than non-apical/basal OPs. Non-apical/basal OPs were associated with more related injuries (median: 2

  6. What is the yield of routine chest radiography following tube thoracostomy for trauma?

    Science.gov (United States)

    Kong, Victor Y; Oosthuizen, George V; Clarke, Damian L

    2015-01-01

    Routine chest radiography (CXR) following tube thoracostomy (TT) is a standard practice in most trauma centres worldwide. Evidence supporting this routine practice is lacking and the actual yield is unknown. We performed a retrospective review of 1042 patients over a 4-year period who had a routine post-insertion CXR performed in accordance with current ATLS® recommendations. A total 1042 TTs were performed on 1004 patients. Ninety-one per cent of patients (913/1004) were males, and the median age for all patients was 24 years. Seventy-five per cent of all injuries (756/1004) were from penetrating trauma, and the remaining 25% (248/1004) were from blunt. The initial pathologies requiring TT were: haemopneumothorax: 34% (339/1042), haemothroax: 31% (314/1042), simple pneumothorax: 25% (256/1042), tension pneumothorax: 8% (77/1042) and open pneumothorax: 5% (54/1042). One hundred and three patients had TTs performed on clinical grounds alone without a pre-insertion CXR [Group A]. One hundred and ninety-one patients had a pre-insertion CXR but had persistent clinical concerns following insertion [Group B]. Seven hundred and ten patients had pre-insertion CXR but no clinical concerns following insertion [Group C]. Overall, 15% (152/1004) [9 from Group A, 111 from Group B and 32 from Group C] of all patients had their clinical management influenced as a direct result of the post-insertion CXR. Despite the widely accepted practice of routine CXR following tube thoracostomy, the yield is relatively low. In many cases, good clinical examination post tube insertion will provide warnings as to whether problems are likely to result. However, in the more rural setting, and in resource challenged environments, there is a relatively high yield from the CXR, which alters management. Further prospective studies are needed to establish or refute the role of the existing ATLS® guidelines in these specific environments. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Blunt trauma of bone structures of the chest--computed tomography vs multidetector computed tomography.

    Science.gov (United States)

    Petrović, Kosta; Turkalj, Ivan; Stojanović, Sanja; Vucaj-Cirilović, Viktorija; Nikolić, Olivera; Stojiljković, Dragana

    2013-08-01

    Computerized tomography (CT), especially multidetector CT (MDCT), has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT) examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR). This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists inde pendently and separately described the findings for 5-mm-thick axial CT slices (5 mm CT) as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thin-slice examination together which was ultimately considered as a real, true finding. No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05). Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

  8. [Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)].

    Science.gov (United States)

    Moreno-Pérez, D; Andrés Martín, A; Tagarro García, A; Escribano Montaner, A; Figuerola Mulet, J; García García, J J; Moreno-Galdó, A; Rodrigo Gonzalo de Lliria, C; Saavedra Lozano, J

    2015-09-01

    The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  9. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries).

    Science.gov (United States)

    de Lesquen, Henri; Avaro, Jean-Philippe; Gust, Lucile; Ford, Robert Michael; Beranger, Fabien; Natale, Claudia; Bonnet, Pierre-Mathieu; D'Journo, Xavier-Benoît

    2015-03-01

    This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D). All traumatic pneumothoraces are considered for chest tube insertion. However, observation is possible for selected patients with small unilateral pneumothoraces without respiratory disease or need for positive pressure ventilation (Grade C). Symptomatic traumatic haemothoraces or haemothoraces >500 ml should be treated by chest tube insertion (Grade D). Occult pneumothoraces and occult haemothoraces are managed by observation with daily chest X-rays (Grades B and C). Periprocedural antibiotics are used to prevent chest-tube-related infectious complications (Grade B). No sign of life at the initial assessment and cardiopulmonary resuscitation duration >10 min are considered as contraindications of Emergency Department Thoracotomy (Grade C). Damage Control Thoracotomy is performed for either massive air leakage or refractive shock or ongoing bleeding enhanced by chest tube output >1500 ml initially or >200 ml/h for 3 h (Grade D). In the case of haemodynamically stable patients, early video-assisted thoracic surgery is performed for retained haemothoraces (Grade B). Fixation of flail chest can be considered if mechanical ventilation for 48 h is probably required (Grade B). Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life

  10. Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock

    International Nuclear Information System (INIS)

    Barber, J.L.; Touska, P.; Negus, A.S.

    2016-01-01

    Aim: To investigate whether inferior vena cava (IVC) calibre on paediatric trauma computed tomography (CT) can help anticipate outcomes in children. Materials and methods: The imaging and clinical records of 52 paediatric trauma admissions to the level 1 major trauma centre at St George's Hospital, London, UK, were retrospectively reviewed. The IVC dimensions, evidence of significant haemorrhage on CT, and the presence of components of the classical hypoperfusion complex, such as bowel and adrenal hyperenhancement, were recorded. Clinical data included observations at the time of admission and for the subsequent 48-hour period where available, blood gas results, length of stay, and mortality. Results: There was a significant relationship between IVC dimensions in this cohort and the development of shock during the 24-hour admission period. IVC dimensions did not, however, reflect the haemodynamic status at the time of admission, and were not predictive of a longer hospital stay. There were no mortalities among the cases. A weak correlation was also seen with serum lactate, a finding that has also been seen in adults, but is of uncertain clinical significance. Conclusions: IVC calibre was found to be a more useful predictor of shock than heart rate or blood pressure, and may, therefore, prove to be a useful predictor of impending haemodynamic instability in children as it is in adults. Although the study was carried out at a busy unit, the numbers are acknowledged to be small and a larger study would be needed to validate these findings and identify whether there is any variation in the CT appearances between different age groups. - Highlights: • Haemodynamic shock in children is a late and ominous sign. • The IVC was significantly flatter in children who developed shock after major trauma. • IVC flatness on CT was a better predictor of shock than clinical parameters.

  11. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis.

    Science.gov (United States)

    Battle, Ceri E; Hutchings, Hayley; Evans, Phillip A

    2012-01-01

    The risk factors for mortality following blunt chest wall trauma have neither been well established or summarised. To summarise the risk factors for mortality in blunt chest wall trauma patients based on available evidence in the literature. A systematic review of English and non-English articles using MEDLINE, EMBASE and the Cochrane Library from their introduction until May 2010. Additional studies were identified by hand-searching bibliographies and contacting relevant clinical experts. Grey literature was sought by searching abstracts from all Emergency Medicine conferences. Broad search terms and inclusion criteria were used to reduce the number of missed studies. A two step study selection process was used. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. A two step data extraction process using pre-defined data fields, including study quality indicators. Each study was appraised using a previously designed quality assessment tool and the STROBE checklist. Where sufficient data were available, odds ratios with 95% confidence intervals were calculated using Mantel-Haenszel method for the risk factors investigated. The I(2) statistic was calculated for combined studies in order to assess heterogeneity. Age, number of rib fractures, presence of pre-existing disease and pneumonia were found to be related to mortality in 29 identified studies. Combined odds ratio of 1.98 (1.86-2.11, 95% CI), 2.02 (1.89-2.15, 95% CI), 2.43 (1.03-5.72, 95% CI) and 5.24 (3.51-7.82) for mortality were calculated for blunt chest wall trauma patients aged 65 years or more, with three or more rib fractures, pre-existing conditions and pneumonia respectively. The risk factors for mortality in patients sustaining blunt chest wall trauma were a patient age of 65 years or more, three or more rib fractures and the presence of pre-existing disease especially

  12. Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.

    Science.gov (United States)

    Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Boix, Ricardo; Lopez-Perez, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

    2012-09-01

    To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4). Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.

  13. Detection of alveolar epithelial injury by 99mTc-DTPA radioaerosol inhalation lung scan following blunt chest trauma

    International Nuclear Information System (INIS)

    Okudan, B.; Han, S.; Baldemir, M.; Yildiz, M.

    2004-01-01

    DTPA clearance rate is a reliable index of alveolar epithelial permeability, and is a highly sensitive marker of pulmonary epithelial damage, even of mild degree. In this study, 99m Tc-DTPA aerosol inhalation scintigraphy was used to assess the pulmonary epithelial membrane permeability and to investigate the possible application of this permeability value as an indicator of early alveolar or interstitial changes in patients with blunt chest trauma. A total of 26 patients was chest trauma (4 female, 22 male, 31-80 yrs, mean age; 53±13 yrs) who were referred to the emergency department in our hospital participated in this study. Technetium-99m diethylene triamine pentaacetic acid (DTPA) aerosol inhalation scintigraphy was performed on the first and thirtieth days after trauma. Clearance half times (T 1/2 ) were calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was calculated on the first-minute image. On the first day, mean T 1/2 value of the whole lung was 63±19 minutes (min), and thirtieth day mean T 1/2 value was 67±21 min. On the first day, mean PI values of the lung and 30th day mean PI value were 0.60±0.05, and 0.63 ±0.05, respectively. Significant changes were observed in radioaerosol clearance and penetration indices. Following chest trauma, clearance of 99m Tc-DTPA increased owing to breakdown of the alveolar-capillary barrier. This increase in the epithelial permeability of the lung appears to be an early manifestation of lung disease that may lead to efficient therapy in the early phase. (author)

  14. Effects of exogenous ubiquitin in a polytrauma model with blunt chest trauma

    Science.gov (United States)

    Baker, Todd A.; Romero, Jacqueline; Bach, Harold H.; Strom, Joel A.; Gamelli, Richard L.; Majetschak, Matthias

    2013-01-01

    Objective To determine whether treatment with the CXC chemokine receptor (CXCR) 4 agonist ubiquitin results in beneficial effects in a polytrauma model consisting of bilateral femur fractures plus blunt chest trauma (Injury Severity Score 18-25). Design Treatment study. Setting Research Laboratory. Subjects Seventeen Yorkshire pigs. Interventions Intravenous (i.v.) injection of 1.5 mg/kg ubiquitin or albumin (=control) at 60 min after polytrauma. Measurements and Main Results Anesthetized, mechanically ventilated pigs underwent polytrauma, followed by a simulated 60 min shock phase. At the end of the shock phase ubiquitin or albumin were administered and animals were resuscitated to a mean arterial blood pressure of 70 mmHg until t = 420 min. After i.v. ubiquitin, ubiquitin plasma concentrations increased sixteen-fold to 2870 ± 1015 ng/mL at t = 90 min and decreased with t1/2 = 60 min. Endogenous plasma ubiquitin increased two-fold in the albumin group with peak levels of 359 ± 210 ng/mL. Plasma levels of the cognate CXCR4 ligand stromal cell-derived factor (SDF)-1α were unchanged in both groups. Ubiquitin treatment reduced arterial lactate levels and prevented a continuous decrease in arterial oxygenation, which occurred in the albumin group during resuscitation. Wet weight to dry weight ratios of the lung contralateral from the injury, heart, spleen and jejunum were lower with ubiquitin. With ubiquitin treatment, tissue levels of IL-8, IL-10, TNFα and SDF-1α were reduced in the injured lung and of IL-8 in the contralateral lung, respectively. Conclusions Administration of exogenous ubiquitin modulates the local inflammatory response, improves resuscitation, reduces fluid shifts into tissues and preserves arterial oxygenation after blunt polytrauma with lung injury. This study further supports the notion that ubiquitin is a promising protein therapeutic and implies CXCR4 as a drug target after polytrauma. PMID:22622399

  15. Blunt trauma of bone structures of the chest: Computed tomography vs multidetector computed tomography

    Directory of Open Access Journals (Sweden)

    Petrović Kosta

    2013-01-01

    Full Text Available Background/Aim. Computerized tomography (CT, especially multidetector CT (MDCT, has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR. Methods. This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists independently and separately described the findings for 5-mmthick axial CT slices (5 mm CT as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thinslice examination together which was ultimately considered as a real, true finding. Results. No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05. Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p < 0.05 in favor of better display of injury by MDCT examination. Conclusion. MDCT is a powerful diagnostic tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

  16. High plasma levels of high mobility group box 1 is associated with the risk of sepsis in severe blunt chest trauma patients: a prospective cohort study.

    Science.gov (United States)

    Wang, Xiao-Wen; Karki, Avash; Zhao, Xing-Ji; Xiang, Xiao-Yong; Lu, Zhi-Qian

    2014-08-02

    High mobility group box 1 (HMGB1) is a late mediator of systemic inflammation. Extracellular HMGB1 play a central pathogenic role in critical illness. The purpose of the study was to investigate the association between plasma HMGB1 concentrations and the risk of poor outcomes in patients with severe blunt chest trauma. The plasma concentrations of HMGB1 in patients with severe blunt chest trauma (AIS ≥ 3) were measured by a quantitative enzyme-linked immunosorbent assay at four time points during seven days after admission, and the dynamic release patterns were monitored. The biomarker levels were compared between patients with sepsis and non-sepsis, and between patients with multiple organ dysfunction syndrome (MODS) and non-MODS. The related factors of prognosis were analyzed by using multivariate logistic regression analysis. The short-form 36 was used to evaluate the quality of life of patients at 12 months after injury. Plasma HMGB1 levels were significantly higher both in sepsis and MODS group on post-trauma day 3, 5, and 7 compared with the non-sepsis and non-MODS groups, respectively. Multivariate analysis showed that HMGB1 levels and ISS were independent risk factors for sepsis and MODS in patients with severe blunt chest trauma. Plasma HMGB1 levels were significantly elevated in patients with severe blunt chest trauma. HMGB1 levels were associated with the risk of poor outcome in patients with severe blunt chest trauma. Daily HMGB1 levels measurements is a potential useful tool in the early identification of post-trauma complications. Further studies are needed to determine whether HMGB1 intervention could prevent the development of sepsis and MODS in patients with severe blunt chest trauma.

  17. The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy.

    Science.gov (United States)

    de Abreu, Emanuelle Maria Sávio; Machado, Carla Jorge; Pastore Neto, Mario; de Rezende Neto, João Baptista; Sanches, Marcelo Dias

    2015-01-01

    to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention. A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes. Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (pchest tube days. Respiratory therapy was independently linked to significant reduction (pchest tube insertion was associated with significant (ptrauma patients.

  18. Blow/trauma to the chest and sudden cardiac death: Commotio cordis and contusio cordis are leading causes.

    Science.gov (United States)

    Krexi, Lydia; Sheppard, Mary N

    2018-01-01

    Background In forensic practice, a blow to the chest can lead to sudden cardiac death (SCD). Commotio cordis and contusio cordis are leading causes. Methods From a database of 4678 patients who suffered from SCD, we found three patients with commotio cordis and two patients with contusio cordis. All the patients were examined macroscopically and microscopically and had negative toxicology screen. Results The three patients who died due to commotio cordis were young males (16, 23 and 38 years old). The circumstances of death were: a blow to the chest by a football, by a friend during a party and during an assault. The hearts were completely normal at autopsy. The two patients who had contusio cordis were older males (42 and 63 years old). Both patients died during traffic accidents. At autopsy, one had significant contusion over the left ventricle, and the second had contusion over the right ventricle. Conclusion This study indicates that a blow to the chest is very important to document in the circumstances of death, and a detailed history is vital. It raises the left ventricular intra-cavitary pressure, leading to commotio cordis with immediate death with a normal heart. Blunt chest trauma can cause direct myocardial lesions, with acute changes leading to contusio cordis.

  19. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases

    Directory of Open Access Journals (Sweden)

    Al-Koudmani Ibrahim

    2012-04-01

    Full Text Available Abstract Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41% followed by traffic accidents (33%. Pneumothorax (51%, Hemothorax (38%, rib fractures (34%, and lung contusion (15% were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%. A minority of the patients required thoracotomy (5.7%, and tube thoracostomy (56% was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%. Conclusions New traffic laws (including seat belt enforcement reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.

  20. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases.

    Science.gov (United States)

    Al-Koudmani, Ibrahim; Darwish, Bassam; Al-Kateb, Kamal; Taifour, Yahia

    2012-04-19

    Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.

  1. The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective

    OpenAIRE

    Cowley, Alan; Durge, Neal

    2014-01-01

    Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout the western world. Both the physical and psychological consequences of trauma are well documented and it is shown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed, parental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital accompaniment, and where research has be...

  2. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100% O2.

    Science.gov (United States)

    Wagner, Katja; Gröger, Michael; McCook, Oscar; Scheuerle, Angelika; Asfar, Pierre; Stahl, Bettina; Huber-Lang, Markus; Ignatius, Anita; Jung, Birgit; Duechs, Matthias; Möller, Peter; Georgieff, Michael; Calzia, Enrico; Radermacher, Peter; Wagner, Florian

    2015-01-01

    Cigarette smoking (CS) aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1) CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2) hyperoxia may attenuate this effect. Immediately after blast wave-induced blunt chest trauma, mice (n=32) with or without 3-4 weeks of CS exposure underwent 4 hours of pressure-controlled, thoraco-pulmonary compliance-titrated, lung-protective mechanical ventilation with air or 100% O2. Hemodynamics, lung mechanics, gas exchange, and acid-base status were measured together with blood and tissue cytokine and chemokine concentrations, heme oxygenase-1 (HO-1), activated caspase-3, and hypoxia-inducible factor 1-α (HIF-1α) expression, nuclear factor-κB (NF-κB) activation, nitrotyrosine formation, purinergic receptor 2X4 (P2XR4) and 2X7 (P2XR7) expression, and histological scoring. CS exposure prior to chest trauma lead to higher pulmonary compliance and lower PaO2 and Horovitz-index, associated with increased tissue IL-18 and blood MCP-1 concentrations, a 2-4-fold higher inflammatory cell infiltration, and more pronounced alveolar membrane thickening. This effect coincided with increased activated caspase-3, nitrotyrosine, P2XR4, and P2XR7 expression, NF-κB activation, and reduced HIF-1α expression. Hyperoxia did not further affect lung mechanics, gas exchange, pulmonary and systemic cytokine and chemokine concentrations, or histological scoring, except for some patchy alveolar edema in CS exposed mice. However, hyperoxia attenuated tissue HIF-1α, nitrotyrosine, P2XR7, and P2XR4 expression, while it increased HO-1 formation in CS exposed mice. Overall, CS exposure aggravated post

  3. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100% O2.

    Directory of Open Access Journals (Sweden)

    Katja Wagner

    Full Text Available Cigarette smoking (CS aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1 CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2 hyperoxia may attenuate this effect. Immediately after blast wave-induced blunt chest trauma, mice (n=32 with or without 3-4 weeks of CS exposure underwent 4 hours of pressure-controlled, thoraco-pulmonary compliance-titrated, lung-protective mechanical ventilation with air or 100% O2. Hemodynamics, lung mechanics, gas exchange, and acid-base status were measured together with blood and tissue cytokine and chemokine concentrations, heme oxygenase-1 (HO-1, activated caspase-3, and hypoxia-inducible factor 1-α (HIF-1α expression, nuclear factor-κB (NF-κB activation, nitrotyrosine formation, purinergic receptor 2X4 (P2XR4 and 2X7 (P2XR7 expression, and histological scoring. CS exposure prior to chest trauma lead to higher pulmonary compliance and lower PaO2 and Horovitz-index, associated with increased tissue IL-18 and blood MCP-1 concentrations, a 2-4-fold higher inflammatory cell infiltration, and more pronounced alveolar membrane thickening. This effect coincided with increased activated caspase-3, nitrotyrosine, P2XR4, and P2XR7 expression, NF-κB activation, and reduced HIF-1α expression. Hyperoxia did not further affect lung mechanics, gas exchange, pulmonary and systemic cytokine and chemokine concentrations, or histological scoring, except for some patchy alveolar edema in CS exposed mice. However, hyperoxia attenuated tissue HIF-1α, nitrotyrosine, P2XR7, and P2XR4 expression, while it increased HO-1 formation in CS exposed mice. Overall, CS exposure

  4. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Science.gov (United States)

    Suzuki, Kodai; Inoue, Shigeaki; Morita, Seiji; Watanabe, Nobuo; Shintani, Ayumi; Inokuchi, Sadaki; Ogura, Shinji

    2016-01-01

    Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions. This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching. In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1%) underwent emergency resuscitative thoracotomy and 893 (64.9%) received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P chest compressions (P chest compressions.

  5. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Ceri Battle

    Full Text Available INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  6. Co-existence of Posttraumatic Empyema Thoracis and Lung Abscess in a Child After Blunt Chest Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Chang-Hung Kuo

    2010-01-01

    Full Text Available Posttraumatic empyema is a rare complication of trauma with an incidence of 1.6–2.4% in trauma patients. However, it is rarely reported in children. We report the case of a 15-year-old boy who was involved in a traffic accident and diagnosed with a pulmonary contusion at a local hospital. Fourteen days after the accident, posttraumatic empyema thoracis and lung abscess developed with clinical presentations of fever, productive cough and right chest pain. He was successfully treated with computed tomography-guided catheter drainage and intravenous cefotaxime. We emphasize that posttraumatic empyema thoracis and lung abscess are very rare in children, and careful follow-up for posttraumatic lung contusion is essential. Image-guided catheter drainage can be an adjunctive tool for treating selected patients, although most complicated cases of post-traumatic empyema thoracis require decortication therapy.

  7. Paediatric trauma and safety in the media: An audit of its coverage in ...

    African Journals Online (AJOL)

    With 32% of South Africa's population under the age of 15,1 and trauma being a leading cause of morbidity, mortality and disability in childhood, child safety remains a concern that requires national attention. The tragic nature of many trauma incidents frequently makes them the subject of media attention, but it is ...

  8. Pathophysiological effects and changes in potassium, ionised calcium, glucose and haemoglobin early after severe blunt chest trauma.

    Science.gov (United States)

    Rocksén, David; Gryth, Dan; Druid, Henrik; Gustavsson, Jenny; Arborelius, Ulf P

    2012-05-01

    Severe lung contusion is often observed after blunt chest trauma due to traffic accidents or fall from heights, but may also occur after a non-penetrating ballistic impact against body armour. Such trauma has been designated behind armour blunt trauma (BABT). Our aim in the present study has been to evaluate pathophysiological changes and compensatory mechanisms that occur early after such severe lung contusion. Twelve pigs wearing body armour were shot with a 7.62mm assault rifle to produce a standardised pulmonary contusion. Exposed animals were compared with five control animals shot with blank ammunition. Physiological parameters and levels of potassium, glucose, haemoglobin, calcium, lactate and pH were monitored for two hours after the shot. The impact induced severe pulmonary contusion with apnoea, desaturation and hypotension in all exposed animals. Increased haemoglobin, glucose and severe hyperkalaemia were seen shortly after impact. Seven of twelve animals died due to the trauma. Dense cardiac tissue was observed during post mortem examination in six of the animals that died during the experimental course. In conclusion, this study has shown that life-threatening hyperkalaemia occurs early after severe lung contusion. Moreover, dense cardiac tissue and early increase of haemoglobin and glucose are intriguing findings that should be investigated in future studies. Copyright © 2010 Elsevier Ltd. All rights reserved.

  9. Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre.

    Science.gov (United States)

    Koyama, Tomohide; Skattum, Jorunn; Engelsen, Peder; Eken, Torsten; Gaarder, Christine; Naess, Pål Aksel

    2016-11-29

    Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. Patients trauma registry and medical records. A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated.

  10. Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew - case identification rates and effect on the Sydney paediatric trauma system.

    Science.gov (United States)

    Garner, Alan A; Lee, Anna; Weatherall, Andrew

    2012-12-18

    Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC. Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect) and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available. Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011), and shorter times to PTC (67 vs 261mins, p = 0.015) and length of intensive care unit stays (2 vs 0 days, p = 0.045). Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P system was available (RR 1.81, 95% CI 1.20-2.73). The median time (minutes) to arrival at the PTC was shorter when HEMS available (HEMS available 92, IQR 50-261 versus HEMS unavailable 296, IQR 84-583, P < 0.01). Physician staffed

  11. The UK Paediatric Ocular Trauma Study 2 (POTS2): demographics and mechanisms of injuries.

    Science.gov (United States)

    Sii, Freda; Barry, Robert J; Abbott, Joseph; Blanch, Richard J; MacEwen, Caroline J; Shah, Peter

    2018-01-01

    Pediatric ocular trauma is an important cause of visual morbidity worldwide, accounting for up to one-third of all ocular trauma admissions. It has long-term implications for those affected and significant economic consequences for healthcare providers. It has been estimated that 90% of all ocular trauma is preventable. Targeted strategies are required to reduce the incidence and the severity of pediatric ocular trauma; this requires an understanding of the epidemiology and characteristics of these injuries and the children involved. Prospective, observational study of pediatric ocular trauma cases presenting to UK-based ophthalmologists over a 1-year period; reporting cards were distributed by the British Ophthalmological Surveillance Unit, and clinicians were asked to report incidents of acute orbital and ocular trauma in children aged ≤16 years requiring inpatient or day-case admission. A validated, standardized questionnaire was sent to reporting ophthalmologists to collect data on the demographics and circumstances of injury. Median age at presentation was 7.7 years, with boys more than twice as likely to be affected than girls (M:F =2.1:1.0). Almost 50% of injuries occurred at home, with 25% occurring in school or nursery. A total of 67% of injuries occurred during play, and 31% involved a sharp implement. Pediatric ocular trauma remains an important public health problem. At least three-quarters of all injuries are preventable through measures, including education of children and responsible adults, restricting access to sharp implements, improving adult supervision, and appropriate use of eye protection.

  12. Radiological assessment of paediatric cervical spine injury in blunt trauma: the potential impact of new NICE guidelines on the use of CT

    International Nuclear Information System (INIS)

    Davies, J.; Cross, S.; Evanson, J.

    2016-01-01

    Aim: To determine the potential effect of changes to the National Institute for Health and Care Excellence (NICE) guidelines to the use of computed tomography (CT) in the assessment of suspected paediatric cervical spine (c-spine) injury. Material and methods: A 5 year retrospective study was conducted of c-spine imaging in paediatric (<10 years) patients presenting following blunt trauma at a Level 1 trauma centre in London. All patients under the age of 10 years who underwent any imaging of the c-spine following blunt trauma were included. Clinical data relating to the presenting signs and symptoms were obtained from the retrospective review of electronic records and paper notes. This was then applied to the previous NICE guideline (CG56) and to the new NICE guideline (CG176). Patients with incomplete data were excluded. Results: Two hundred and seventy-eight patients <10 years underwent imaging of the c-spine following blunt trauma. Two hundred and seventy (97.12%) examinations had complete data and were included in further analysis. One hundred and forty-nine (55.19%) met the criteria for a CT of the c-spine under NICE CG56, whereas 252 (93.33%) met the updated NICE CG176 criteria for c-spine CT. Five (1.85%) patients had a c-spine injury and met the criteria under both CG56 and CG176 NICE guidelines. Conclusion: Recent changes to NICE Head Injury Guidelines relating to radiological assessment of paediatric c-spine following blunt trauma are likely to result in an increased usage of CT as the initial radiological investigation over plain radiographs, without an apparent increase in specificity in the present series. - Highlights: • Paediatric CSI is a rare but serious consequence of blunt trauma. • New NICE 176 criteria broadened the criteria for c-spine CT following trauma. • 69% more patients may be eligible for assessment with CT under new guidelines. • 5 cases of CSI occurred in this series of 278 paediatric trauma cases. • All 5 cases met CG176

  13. Short-term impact of pictorial posters and a crash course on radiographic errors for improving the quality of paediatric chest radiographs in an unsupervised unit - a pilot study for quality-assurance outreach

    International Nuclear Information System (INIS)

    Tebogo Hlabangana, Linda; Andronikou, Savvas

    2015-01-01

    Chest radiography is the most commonly performed diagnostic X-ray examination. The radiation dose to the patient for this examination is relatively low but because of its frequent use, the contribution to the collective dose is considerable. Optimized image quality not only allows for more accurate diagnosis but also supports radiation protection, which is particularly important in children. To determine whether the introduction of a poster of technical errors in paediatric radiography accompanied by a short lecture (crash course) for radiographers on common errors can sustainably decrease the number and rate of these errors in an unsupervised radiology department (without a paediatric-trained radiologist or paediatric-trained radiography personnel). We conducted a pilot study for quality-assurance outreach, with retrospective and prospective components, in the paediatric radiology department of a teaching hospital. The technical errors in frontal chest radiographs performed in the unit were assessed by quality-assurance analysis using a customized tick-sheet. The review was performed before and after an intervention that involved a half-hour crash course and poster displays in the department. We compared the rate of technical errors made before and after the intervention. There was statistically significant improvement in quality of radiographs (P 2 months after the intervention. A simple intervention of a crash course and poster placement resulted in improved quality of paediatric chest radiographs. A decline in quality after 2 months suggests the need to repeat this or another type of intervention regularly. (orig.)

  14. Diagnostic significance of rib series in minor thorax trauma compared to plain chest film and computed tomography.

    Science.gov (United States)

    Hoffstetter, Patrick; Dornia, Christian; Schäfer, Stephan; Wagner, Merle; Dendl, Lena M; Stroszczynski, Christian; Schreyer, Andreas G

    2014-01-01

    Rib series (RS) are a special radiological technique to improve the visualization of the bony parts of the chest. The aim of this study was to evaluate the diagnostic accuracy of rib series in minor thorax trauma. Retrospective study of 56 patients who received RS, 39 patients where additionally evaluated by plain chest film (PCF). All patients underwent a computed tomography (CT) of the chest. RS and PCF were re-read independently by three radiologists, the results were compared with the CT as goldstandard. Sensitivity, specificity, negative and positive predictive value were calculated. Significance in the differences of findings was determined by McNemar test, interobserver variability by Cohens kappa test. 56 patients were evaluated (34 men, 22 women, mean age =61 y.). In 22 patients one or more rib fracture could be identified by CT. In 18 of these cases (82%) the correct diagnosis was made by RS, in 16 cases (73%) the correct number of involved ribs was detected. These differences were significant (p = 0.03). Specificity was 100%, negative and positive predictive value were 85% and 100%. Kappa values for the interobserver agreement was 0.92-0.96. Sensitivity of PCF was 46% and was significantly lower (p = 0.008) compared to CT. Rib series does not seem to be an useful examination in evaluating minor thorax trauma. CT seems to be the method of choice to detect rib fractures, but the clinical value of the radiological proof has to be discussed and investigated in larger follow up studies.

  15. Prehospital endotracheal intubation and chest tubing does not prolong the overall resuscitation time of severely injured patients: a retrospective, multicentre study of the Trauma Registry of the German Society of Trauma Surgery.

    Science.gov (United States)

    Kulla, Martin; Helm, Matthias; Lefering, Rolf; Walcher, Felix

    2012-06-01

    The aim of this study was to determine whether prehospital endotracheal intubation (ETI) and chest tube placement is unnecessarily time consuming in severely injured patients. A retrospective, multicentre study including all adult patients (ISS ≥9; 2002-7) of the Trauma Registry of the German Society of Trauma Surgery who were not secondarily transferred to a trauma centre and received a definitive airway and a chest tube. Creating four groups: AA (n=963) receiving ETI and chest tube on scene, AB (n=1547) ETI performed in the prehospital setting but chest tubing later in the emergency department (ED) and BB (n=640) receiving both procedures in the ED. The BA collective (ETI performed in the ED, but chest tubing on scene) was excluded from the study because of the small sample size (n=41). The trauma resuscitation time (TRT), demographic data, injuries, treatment and outcome of the remaining three collectives were compared. The prehospital TRT of the AA collective was longer than the AB and BB subgroups (80±37 min vs 77±44 min 65±46 min; pchest tube placement do not prolong the total TRT of severely injured patients.

  16. Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

    Directory of Open Access Journals (Sweden)

    Makbule Ergin

    2011-01-01

    fractures were the most common injury. Thorax computed tomography was significantly superior to chest radiography in detecting pneumothorax , hemothorax and lung contusion. Eightyone life threatening lesions were detected and 50 (61%; pneumothorax 13, hemothorax 24, lung contusion 9,and pneumomediastinum 4 of these lesions could not be detected with plain chest radiography. The clinical management [in 15 patients (30%], and the forensic assesment was changed [in 14 (28%] patients were changed.  Conclusion:We concluded that using Computed Tomography of the thorax in thoracic travmas prive meticulous assesment in management of patients and forens icissues.

  17. Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization

    Directory of Open Access Journals (Sweden)

    Karam E. Moslam

    2015-01-01

    Conclusion: Surgical stabilization of flail chest with metallic plates is a safe and effective therapy in properly selected patients. These patients had a significantly smoother course during the intensive care unit and hospital stays, had improved respiratory functions and decreased rate of complications.

  18. An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa.

    Science.gov (United States)

    Kong, V Y; Oosthuizen, G V; Sartorius, B; Keene, C; Clarke, D L

    2014-11-01

    Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20-29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54). Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the 'triangle of safety' but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p Conclusions ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation.

  19. MODERN DIAGNOSTIC AND THERAPEUTIC TECHNOLOGIES FOR THE CHEST TRAUMA ASSOCIATED WITH THE FALL FROM A HEIGHT IN THE REPUBLIC RESEARCH CENTRE OF EMERGENCY MEDICINE

    Directory of Open Access Journals (Sweden)

    A. M. Khadzhibayev

    2015-01-01

    Full Text Available BACKGROUND. The rate of the multisystem chest trauma and mortality in patients with catatrauma remains high.OBJECTIVE. To study the diagnosis and treatment of the multisystem chest trauma in patients associated with the fall from a height.MATERIAL AND METHODS. 243 patients (208 multisystem injuries and 35 isolated injuries with a chest trauma associated with the fall from a height were examined in the surgical department of Republic research centre of emergency medicine. We performed X-ray, CT and endosurgical examinations.RESULTS. Instrumental examination revealed pneumothorax and hydrothorax in 24.4% and 22.6% of victims respectively. The rib injuries were observed in 181 patients, sternum fractures in 8 victims and thoracic vertebrae fractures in 84 patients. The puncture and thoracocentesis of the pleural cavities were performed in 85 cases. The thoracoscopy was performed in 21 patients, the thoracotomy – in 15 patients, suturing of the lung – in 22 patients, coagulation – in 15 patients, external plate fixation of multiple injured ribs – in 10 patients. The mortality rate was 21.4%.CONCLuSION. The specifics of the multisystem chest trauma associated with the fall from a height is the development of hemothorax and pneumothorax. Thoracocentesis and videothoracoscopy allow to diagnose and stop the hemorrhage properly, to restore the lung rupture and perform the thoracotomy in severe cases, as well as reduce of complications frequency and mortality rate. 

  20. [Rupture of interventricular septum secondary to blunt chest trauma. Report of a case surgically treated with success (author's transl)].

    Science.gov (United States)

    Gallotti, R; Gordini, V; Botta, M; Pezzano, A

    1976-01-01

    A case of interventricular septal defect secondary to blunt chest trauma is reported. It was characterized by a disconnection of the interventricular muscolar septal in the anterosuperior part of the heart wall. The diagnosis, suspected by clinical and instrumental parameters, was definitely confirmedy by hemodynamic and contrastographic examination. Repair surgery of the defect with a dacron patch was performed, using extracorporea normothermic circulation seven months after the accident. The patient was examined three months and twelve months after the operation; the clinical examinations did not reveal any cardiac murmur and the patient's health was satisfactory. The incidence, mechanism of rupture of interventricular septum and the main surgical and clinical aspects of this type of pathology are discussed.

  1. Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study.

    Science.gov (United States)

    Caragounis, Eva-Corina; Fagevik Olsén, Monika; Pazooki, David; Granhed, Hans

    2016-01-01

    Multiple rib fractures and unstable thoracic cage injuries are common in blunt trauma. Surgical management of rib fractures has received increasing attention in recent years and the aim of this 1-year, prospective study was to assess the long-term effects of surgery. Fifty-four trauma patients with median Injury Severity Score 20 (9-66) and median New Injury Severity Score 34 (16-66) who presented with multiple rib fractures and flail chest, and underwent surgical stabilization with plate fixation were recruited. Patients responded to a standardized questionnaire concerning pain, local discomfort, breathlessness and use of analgesics and health-related quality of life (EQ-5D-3 L) questionnaire at 6 weeks, 3 months, 6 months and 1 year. Lung function, breathing movements, range of motion and physical function were measured at 3 months, 6 months and 1 year. Symptoms associated with pain, breathlessness and use of analgesics significantly decreased from 6 weeks to 1 year following surgery. After 1 year, 13 % of patients complained of pain at rest, 47 % had local discomfort and 9 % used analgesics. The EQ-5D-3 L index increased from 0.78 to 0.93 and perceived overall health state increased from 60 to 90 % (p rib fractures and flail chest show a gradual improvement in symptoms associated with pain, quality of life, mobility, disability and lung function over 1 year post surgery. Therefore, the final outcome of surgery cannot be assessed before 1 year post-operatively.

  2. Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma

    International Nuclear Information System (INIS)

    Scaglione, M.; Pinto, A.; Pinto, F.; Romano, L.; Ragozzino, A.; Grassi, R.

    2001-01-01

    The purpose of this retrospective study was to determine the value of contrast-enhanced helical CT for detecting and managing acute thoracic aortic injury (ATAI). Between June 1995 and February 2000, 1419 consecutive chest CT examinations were performed in the setting of major blunt trauma. The following CT findings were considered indicative of ATAI: intimal flap; pseudoaneurysm; contour irregularity; lumen abnormality; and extravasation of contrast material. On the basis of these direct findings no further diagnostic investigations were performed. Isolated mediastinal hematoma on CT scans was considered an indirect sign of ATAI: In these cases, thoracic aortography was performed even if CT indicated normal aorta. Seventy-seven patients had abnormal CT scans: Among the 23 patients with direct CT signs, acute thoracic aortic injuries was confirmed at thoracotomy in 21. Two false-positive cases were observed. The 54 remaining patients had isolated mediastinal hematoma without aortic injuries at CT and corresponding negative angiograms. The 1342 patients with negative CT scans were included in the 8-month follow-up program and did not show any adverse sequela based on clinical and radiographic criteria. Contrast-enhanced helical CT has a critical role in the exclusion of thoracic aortic injuries in patient with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of ATAI do not require further diagnostic investigations to confirm the diagnosis: Isolated aortic bands or contour vessel abnormalities should be first considered as possible artifacts or related to non-traumatic etiologies especially when mediastinal hematoma is absent. In cases of isolated mediastinal hematoma other possible sources of bleeding should be considered before directing patients to thoracic aortography. (orig.)

  3. Forensic aspects of paediatric fractures. Differentiating accidental trauma from child abuse

    International Nuclear Information System (INIS)

    Bilo, Rob A.C.

    2010-01-01

    Fractures are a common finding in children and it is estimated that 2.1% of all children will suffer at least one fracture before the age of 16. With young children in particular, the question may arise if this is related to child abuse. The aim of this book is to help physicians involved in child abuse cases to interpret radiological findings in light of the forensic circumstances under which they occurred. The authors present up-to-date literature related to the mechanisms underlying non-accidental cases of trauma. In this book not only the radiological findings in child-abuse are discussed, but more importantly, these findings are analyzed from a forensic perspective. Careful attention is paid to evidence regarding reported trauma mechanisms and their clinical outcome; for example, can a fall from a couch result in a femoral fracture, and if not, where is the supporting evidence? (orig.)

  4. Forensic aspects of paediatric fractures. Differentiating accidental trauma from child abuse

    Energy Technology Data Exchange (ETDEWEB)

    Bilo, Rob A.C. [Netherlands Forensic Institute, The Hague (Netherlands). Department of Pathology and Toxicology; Rijn, Rick R. van [Emma Childrens' s Hospital/Academic, Medical Center Amsterdam (Netherlands). Department of Radiology; Robben, Simon G.F. [Maastricht University Medical Center, Maastricht (Netherlands)

    2010-07-01

    Fractures are a common finding in children and it is estimated that 2.1% of all children will suffer at least one fracture before the age of 16. With young children in particular, the question may arise if this is related to child abuse. The aim of this book is to help physicians involved in child abuse cases to interpret radiological findings in light of the forensic circumstances under which they occurred. The authors present up-to-date literature related to the mechanisms underlying non-accidental cases of trauma. In this book not only the radiological findings in child-abuse are discussed, but more importantly, these findings are analyzed from a forensic perspective. Careful attention is paid to evidence regarding reported trauma mechanisms and their clinical outcome; for example, can a fall from a couch result in a femoral fracture, and if not, where is the supporting evidence? (orig.)

  5. A paediatric case of bilateral mandibular condyle fracture presenting with bloody otorrhoea following trauma.

    Science.gov (United States)

    Chan, Yat Chun; Au-Yeung, Kwan Leong

    2017-04-22

    A 7-year-old boy presented to the emergency department with bilateral bloody otorrhoea after falling from his scooter. Skull base fracture was suspected. CT showed no evidence of skull base fracture but bilateral mandibular condyle and external acoustic canals fractures. We report this case to illustrate a rare possibility of bilateral external acoustic canal fracture associated with condylar fracture in trauma patients presented with bloody otorrhoea. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Successful management of threatened aortic rupture late after rib fracture caused by blunt chest trauma.

    Science.gov (United States)

    Morimoto, Yoshihisa; Sugimoto, Takaki; Sakahira, Hideki; Matsuoka, Hidehito; Yoshioka, Yuki; Arase, Hiroki

    2014-05-01

    A 62-year-old man was crushed in a car accident and diagnosed with a fractured left ninth rib, pulmonary and heart contusion, hemopneumothorax, and descending aortic injury based on a computed tomography scan. He underwent chest tube drainage and was intubated for mechanical ventilation because a bone fragment of the ninth rib threatened to penetrate the descending aorta. On the second posttrauma day, computed tomography showed the bone fragment of the ninth rib approaching the descending aorta. He underwent graft replacement of the injured portion of the descending thoracic aorta, and we removed the fractured left ninth rib. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Effective dose estimation in whole-body multislice CT in paediatric trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Munk, Robin D.; Saueressig, Ulrich; Kotter, Elmar; Langer, Mathias; Bley, Thorsten A. [University Hospital, Department of Radiology, Freiburg im Breisgau (Germany); Strohm, Peter C.; Zwingmann, Joern; Suedkamp, Norbert P. [University Hospital, Department of Orthopaedic and Trauma Surgery, Freiburg im Breisgau (Germany); Uhl, Markus [University Hospital, Department of Radiology, Section of Paediatric Radiology, Freiburg im Breisgau (Germany)

    2009-03-15

    The number of multislice CT (MSCT) scans performed in polytraumatized children has increased rapidly. There is growing concern regarding the radiation dose in MSCT and its long-term consequences, especially in children. To determine the effective dose to polytraumatized children who undergo whole-body MSCT. A total of 51 traumatized children aged 0-16 years underwent a polytrauma protocol CT scan between November 2004 and August 2006 at our institution. The effective dose was calculated retrospectively by a computer program (CT-Expo 1.5, Hannover, Germany). The mean effective dose was 20.8 mSv (range 8.6-48.9 mSv, SD{+-}7.9 mSv). There was no statistically significant difference in the effective dose between male and female patients. Whole-body MSCT is a superior diagnostic tool in polytraumatized children with 20.8 mSv per patient being a justified mean effective dose. In a potentially life-threatening situation whole-body MSCT provides the clinicians with relevant information to initiate life-saving therapy. Radiologists should use special paediatric protocols that include dose-saving mechanisms to keep the effective dose as low as possible. Further studies are needed to examine and advance dose-saving strategies in MSCT, especially in children. (orig.)

  8. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  9. Short-term impact of pictorial posters and a crash course on radiographic errors for improving the quality of paediatric chest radiographs in an unsupervised unit - a pilot study for quality-assurance outreach

    Energy Technology Data Exchange (ETDEWEB)

    Tebogo Hlabangana, Linda; Andronikou, Savvas [University of the Witwatersrand, Department of Diagnostic Radiology, Johannesburg (South Africa)

    2014-08-17

    Chest radiography is the most commonly performed diagnostic X-ray examination. The radiation dose to the patient for this examination is relatively low but because of its frequent use, the contribution to the collective dose is considerable. Optimized image quality not only allows for more accurate diagnosis but also supports radiation protection, which is particularly important in children. To determine whether the introduction of a poster of technical errors in paediatric radiography accompanied by a short lecture (crash course) for radiographers on common errors can sustainably decrease the number and rate of these errors in an unsupervised radiology department (without a paediatric-trained radiologist or paediatric-trained radiography personnel). We conducted a pilot study for quality-assurance outreach, with retrospective and prospective components, in the paediatric radiology department of a teaching hospital. The technical errors in frontal chest radiographs performed in the unit were assessed by quality-assurance analysis using a customized tick-sheet. The review was performed before and after an intervention that involved a half-hour crash course and poster displays in the department. We compared the rate of technical errors made before and after the intervention. There was statistically significant improvement in quality of radiographs (P < 0.0083) performed immediately after the intervention. There was a statistically significant decline in the quality of radiographs performed >2 months after the intervention. A simple intervention of a crash course and poster placement resulted in improved quality of paediatric chest radiographs. A decline in quality after 2 months suggests the need to repeat this or another type of intervention regularly. (orig.)

  10. Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?

    Science.gov (United States)

    Tallapragada, Krishna; Peddada, Ratna Soundarya; Dexter, Mark

    2018-03-01

    Previous studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals. We retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13-15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009-2014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with P value <0.05 considered significant. Four hundred and ten children were analysed. Three hundred and eighty-one (93%) children were managed conservatively, 18 (4%) underwent evacuation of extradural haematoma (TBI surgery) and 11 (3%) needed fracture repair surgery. Two children evolved a surgical lesion 24 h post-admission. Only 17 of 214 children transferred from peripheral hospitals needed neurosurgery. Overall outcomes: zero deaths, one needed brain injury rehabilitation and 63 needed child protection unit intervention. Seventy-five percentage of children with non-surgical lesions were discharged within 2 days. Eighty-three percentage of road transfers were discharged within 3 days. Children with small intracranial haematomas and/or skull fractures who need no surgery only require brief inpatient symptomatic treatment and could be safely managed in primary hospitals. Improved tertiary hospital transfer guidelines with protocols to manage clinical deterioration could have cost benefit without risking patient safety. © 2017 Royal Australasian College of Surgeons.

  11. [Cohort study on the prevalence and risk factors of late pulmonary complications in adults following a closed minor chest trauma].

    Science.gov (United States)

    Plourde, Miville; Émond, Marcel; Lavoie, André; Guimont, Chantal; Le Sage, Natalie; Chauny, Jean-Marc; Bergeron, Éric; Vanier, Laurent; Moore, Lynne; Allain-Boulé, Nadine; Fratu, Ramona-Florina; Dufresne, Maryline

    2013-11-01

    The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma. A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for a trauma, and available for outpatient follow-up at 2, 7, and 14 days posttrauma. The clinical outcome investigated was the presence of delayed pneumothorax or hemothorax on the follow-up chest x-ray. Delayed hemothorax occurred in 11.8% (95% CI 8.8-14.8), and delayed pneumothorax occurred in 0.9% (95% CI 0.2-2.3) of participants. During the 14-day follow-up period, 87.0% of these delayed complications developed in the first week. In the multivariate analysis, the only statistically significant risk factor for delayed complications was the location of fractures on the x-ray of the hemithorax. The adjusted odds ratio was 1.52 (95% CI 0.62-3.73) for the lower ribs (tenth to twelfth rib), 3.11 (95% CI 1.60-6.08) for the midline ribs (sixth to ninth rib), and 5.05 (95% CI 1.80-14.19) for the upper ribs (third to fifth rib) versus patients with no fractures. The presence of at least one rib fracture between the third and ninth rib on the x-ray of the hemithorax is a significant risk factor for delayed hemothorax and pneumothorax.

  12. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    Energy Technology Data Exchange (ETDEWEB)

    Demir, F. [Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır (Turkey); Güzel, A. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Katı, C. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Karadeniz, C. [Pediatric Cardiology Services, Behçet Uz Children' s Hospital, İzmir (Turkey); Akdemir, U. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Okuyucu, A. [Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Gacar, A. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey); Özdemir, S. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Güvenç, T. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey)

    2014-08-01

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg{sup −1}·day{sup −1}), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

  13. FLAIL CHEST

    Directory of Open Access Journals (Sweden)

    Anton Crnjac

    2003-12-01

    Full Text Available Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.

  14. Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma

    International Nuclear Information System (INIS)

    Esme, H.; Kaya, E.; Solak, O.; Yavuz, Y.; Yurumez, Y.; Sezer, M.

    2007-01-01

    Detection of pulmonary contusion in patients with blunt chest trauma is very important so as to commence therapy immediately to avoid irreversible damage. The purpose of our study was to evaluate the efficacy of technetium-99m diethylene triamine penta-acetic acid ( 99m Tc-DTPA) aerosol inhalation lung scintigraphy in comparison with chest computed tomography (CT) in the diagnosis of pulmonary contusion at acute blunt chest trauma. Twenty-nine patients with isolated blunt chest trauma were referred to the emergency department of our hospital, and nine healthy people participated in this study. Sixteen patients who had pulmonary contusion on CT scans were referred to as group 1, and 13 patients who had normal CT scans as group 2. Nine healthy people comprised a control group. 99m Tc-DTPA aerosol inhalation lung scintigraphy was performed on the first day in all patients. The mean half time (T 1/2 ) and penetration index values of 99m Tc-DTPA clearance were significantly lower in groups 1 and 2 compared with the control group. Among the three groups, there were no significant differences in arterial blood gas analysis except for PO 2 . The mean T 1/2 value of 99m Tc-DTPA clearance did correlate with PO 2 values but not with pH, PCO 2 , or HCO 3 values. 99m Tc-DTPA radioaerosol inhalation lung imaging may serve as a useful adjunct and supportive method to chest CT scanning for detecting mild pulmonary contusion. (author)

  15. Paediatric trauma on the Last Frontier: an 11-year review of injury mechanisms, high-risk injury patterns and outcomes in Alaskan children

    Directory of Open Access Journals (Sweden)

    Christopher W. Snyder

    2014-08-01

    Full Text Available Background: Paediatric trauma system development in Alaska is complicated by a vast geographic coverage area, wide regional variations in environment and culture, and a lack of available published data. Objective: To provide a detailed description of paediatric trauma mechanisms, high-risk injury patterns and outcomes in Alaska. Design: This retrospective study included all children aged 17 years or younger in the State of Alaska Trauma Registry database admitted with traumatic injury between 2001 and 2011. Each injury record was reviewed individually and assigned a mechanism based on Centers for Disease Control E-codes. Geographic definitions were based on existing Emergency Medical Services regions. Mechanisms were compared by geographic region, patient demographics, injury characteristics and outcome. Subgroup analysis of fatal injuries was performed to identify causes of death. Results: Of 5,547 patients meeting inclusion criteria, the most common mechanisms of injury were falls (39%, motor vehicle collisions (10% and all-terrain vehicle (ATV accidents (9%. The overall case fatality rate was 2%. Mechanisms with the greatest risk of death were gunshot wounds (21%, pedestrians struck by motorized vehicles (9% and motor vehicle collisions (5%. These 3 mechanisms accounted for 15% of injuries but 60% of deaths in the overall cohort. Injury patterns involving combined central nervous system (CNS and torso injuries were unusual but especially lethal, occurring in 3% of patients but carrying a case fatality rate of 18%. Although the distribution of mechanisms was generally similar for each geographic region, ATV and snowmobile injuries were significantly more common in remote areas (23% remote vs. 7% non-remote, p < 0.0001. Conclusions: Mechanisms of paediatric trauma in Alaska have widely varying impacts on outcome and show some variation by region. Highest-risk mechanisms include gunshot wounds and motorized vehicle-related accidents. Prevention

  16. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Directory of Open Access Journals (Sweden)

    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  17. Dose evaluation for paediatric chest x-ray examinations in Brazil and Sudan: low doses and reliable examinations can be achieved in developing countries

    International Nuclear Information System (INIS)

    Mohamadain, K E M; Rosa, L A R da; Azevedo, A C P; Guebel, M R N; Boechat, M C B; Habani, F

    2004-01-01

    Radiation protection in paediatric radiology deserves special attention since it is assumed that children are more sensitive to radiation than adults. The aim of this work is to estimate the entrance skin dose (ESD), the body organ dose (BOD) and the effective dose (E) for chest x-ray exposure of paediatric patients in five large units, three in Sudan and two in Brazil, and to compare the results obtained in both countries with each other and with other values obtained by some European countries. Two examination projections have been investigated, namely, postero-anterior (PA) and antero-posterior (AP). The age intervals considered were: 0-1 year, 1-5 years, 5-10 years and 10-15 years. The results have been obtained with the use of a software called DoseCal. Results of mean ESD for the age interval 1-5 years and AP projection are: 66 μGy (Instituto de Pediatria e Puericultura Martagao Gesteira-IPPMG Hospital), 41, 86 and 68 μGy (Instituto Fernandes Figueira-IFF Hospital), 161 μGy (Omdurman Hospital), 395 μGy (Khartoum Hospital) and 23 μGy (Ahmed Gasim Hospital). In the case of the IFF Hospital, the results refer, respectively, to rooms 1, 2 and for the six mobile equipments. The reference dose values given by the European Guidelines were exceeded in the Khartoum Hospital whilst in all the other hospitals results obtained were below CEC reference values and comparable with the results found in Sweden, Germany, Spain and Italy. The mean E for the same age interval was 11 μSv in the IPPMG, 6, 15 and 11 μSv in the IFF, respectively for rooms 1, 2 and the 6 mobiles, 25 μSv in the Omdurman Hospital, 45 μSv in the Khartoum Hospital and 3 μSv in the Ahmed Gasim Hospital. These are some examples of the large discrepancies that have been detected in this survey

  18. Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures.

    Science.gov (United States)

    Hwang, Eun Gu; Lee, Yunjung

    2016-12-01

    Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography ( P =0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

  19. The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma.

    Science.gov (United States)

    Chou, Yi-Pin; Kuo, Liang-Chi; Soo, Kwan-Ming; Tarng, Yih-Wen; Chiang, Hsin-I; Huang, Fong-Dee; Lin, Hsing-Lin

    2014-07-01

    Retained haemothorax and pneumothorax are the most common complications after blunt chest traumas. Lung lacerations derived from fractures of the ribs are usually found in these patients. Video-assisted thoracoscopic surgery (VATS) is usually used as a routine procedure in the treatment of retained pleural collections. The objective of this study was to find out if there is any advantage in adding the procedure for repairing lacerated lungs during VATS. Patients who were brought to our hospital with blunt chest trauma were enrolled into this prospective cohort study from January 2004 to December 2011. All enrolled patients had rib fractures with type III lung lacerations diagnosed by CT scans. They sustained retained pleural collections and surgical drainage was indicated. On one group, only evacuation procedure by VATS was performed. On the other group, not only evacuations but also repair of lung injuries were performed. Patients with penetrating injury or blunt injury with massive bleeding, that required emergency thoracotomy, were excluded from the study, in addition to those with cardiovascular or oesophageal injuries. During the study period, 88 patients who underwent thoracoscopy were enrolled. Among them, 43 patients undergoing the simple thoracoscopic evacuation method were stratified into Group 1. The remaining 45 patients who underwent thoracoscopic evacuation combined with resection of lung lacerations were stratified into Group 2. The rates of post-traumatic infection were higher in Group 1. The durations of chest-tube drainage and ventilator usage were shorter in Group 2, as were the lengths of patient intensive care unit stay and hospital stay. When compared with simple thoracoscopic evacuation methods, repair and resection of the injured lungs combined may result in better clinical outcomes in patients who sustained blunt chest injuries. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio

  20. Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre experience

    NARCIS (Netherlands)

    Slaar, Annelie; Fockens, M. Matthijs; van Rijn, Rick R.; Maas, Mario; Goslings, J. Carel; Bakx, Roel; Streekstra, Geert J.; Beenen, Ludo F. M.; Schep, Niels W. L.

    2016-01-01

    International guidelines define if and what type of radiography is advised in children to clear the cervical spine (C-spine). However, adherence to these guidelines has never been evaluated in a paediatric population. Therefore, we wanted to assess the adherence to the guidelines for C-spine

  1. Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT.

    Science.gov (United States)

    Cho, S H; Sung, Y M; Kim, M S

    2012-10-01

    The objective of this study was to review the prevalence and radiological features of rib fractures missed on initial chest CT evaluation, and to examine the diagnostic value of additional coronal images in a large series of trauma patients. 130 patients who presented to an emergency room for blunt chest trauma underwent multidetector row CT of the thorax within the first hour during their stay, and had follow-up CT or bone scans as diagnostic gold standards. Images were evaluated on two separate occasions: once with axial images and once with both axial and coronal images. The detection rates of missed rib fractures were compared between readings using a non-parametric method of clustered data. In the cases of missed rib fractures, the shapes, locations and associated fractures were evaluated. 58 rib fractures were missed with axial images only and 52 were missed with both axial and coronal images (p=0.088). The most common shape of missed rib fractures was buckled (56.9%), and the anterior arc (55.2%) was most commonly involved. 21 (36.2%) missed rib fractures had combined fractures on the same ribs, and 38 (65.5%) were accompanied by fracture on neighbouring ribs. Missed rib fractures are not uncommon, and radiologists should be familiar with buckle fractures, which are frequently missed. Additional coronal imagescan be helpful in the diagnosis of rib fractures that are not seen on axial images.

  2. Lesão da valva tricúspide por trauma torácico penetrante Lesión de la válvula tricúspide por trauma torácico penetrante Tricuspid valve lesion due to penetrating chest trauma

    Directory of Open Access Journals (Sweden)

    Renata de Carvalho Bicalho Carneiro

    2010-02-01

    Full Text Available As lesões da valva tricúspide decorrentes de trauma torácico penetrante são raras e frequentemente subdiagnosticadas. O objetivo deste relato é descrever um caso de insuficiência tricúspide grave secundária a acidente por arma branca com evolução insidiosa, diagnosticada 19 anos após o ocorrido. O caso enfatiza a importância do acompanhamento adequado dos pacientes vítimas de trauma torácico penetrante por longo período após a injúria, para detecção de possíveis complicações tardias do trauma.Las lesiones de la válvula tricúspide resultantes de trauma torácico penetrante son raras y frecuentemente subdiagnosticadas. El objetivo de este relato es describir un caso de insuficiencia tricúspide severa secundaria a accidente por arma blanca con evolución insidiosa, diagnosticada 19 años tras lo sucedido. El caso enfatiza la importancia del seguimiento adecuado de los pacientes víctimas de trauma torácico penetrante por largo período tras la injuria, para detección de posibles complicaciones tardías del trauma.Tricuspid valve lesions caused by penetrating chest trauma are rare and often underdiagnosed. The objective of this report is to describe a case of severe tricuspid insufficiency secondary to a knifing incident with an insidious evolution, diagnosed 19 years after the incident. The case emphasizes the importance of adequate follow-up of patients that are victims of penetrating chest trauma for a long period after the injury, to detect possible late complications of the trauma.

  3. Ethyl pyruvate ameliorates hepatic injury following blunt chest trauma and hemorrhagic shock by reducing local inflammation, NF-kappaB activation and HMGB1 release.

    Science.gov (United States)

    Wagner, Nils; Dieteren, Scott; Franz, Niklas; Köhler, Kernt; Mörs, Katharina; Nicin, Luka; Schmidt, Julia; Perl, Mario; Marzi, Ingo; Relja, Borna

    2018-01-01

    The treatment of patients with multiple trauma including blunt chest/thoracic trauma (TxT) and hemorrhagic shock (H) is still challenging. Numerous studies show detrimental consequences of TxT and HS resulting in strong inflammatory changes, organ injury and mortality. Additionally, the reperfusion (R) phase plays a key role in triggering inflammation and worsening outcome. Ethyl pyruvate (EP), a stable lipophilic ester, has anti-inflammatory properties. Here, the influence of EP on the inflammatory reaction and liver injury in a double hit model of TxT and H/R in rats was explored. Female Lewis rats were subjected to TxT followed by hemorrhage/H (60 min, 35±3 mm Hg) and resuscitation/R (TxT+H/R). Reperfusion was performed by either Ringer`s lactated solution (RL) alone or RL supplemented with EP (50 mg/kg). Sham animals underwent all surgical procedures without TxT+H/R. After 2h, blood and liver tissue were collected for analyses, and survival was assessed after 24h. Resuscitation with EP significantly improved haemoglobin levels and base excess recovery compared with controls after TxT+H/R, respectively (ptrauma and hemorrhagic shock is associated with NF-κB. In particular, the beneficial anti-inflammatory effects of ethyl pyruvate seem to be regulated by the HMGB1/NF-κB axis in the liver, thereby, restraining inflammatory responses and liver injury after double hit trauma in the rat.

  4. TRAUMA

    African Journals Online (AJOL)

    trauma and on most vascular injuries. South Africa is one of the few .... scan of the brain and abdomen showed a sliver of left subdural and subarachnoid .... and especially on RT. In the event of a life-threatening condition, the rapid response ...

  5. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... However, the physical and financial resources to manage this massive burden of disease are inadequate. This is especially the case in terms of access to critical care facilities. The development of an electronic trauma registry at our institution has allowed us to capture data in real time on all patients and.

  6. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... unit in Durban, and to correlate it with injury severity, length of hospital stay ... and via a password protected mobile application program within 6 ..... usage and costs performed in larger numbers on major trauma patients will ...

  7. MINIMALLY INVASIVE TECHNIQUES IN THE INTEGRATED TREATMENT OF THOSE SUFFERING FROM SEVERE CONCURRENT INJURY WITH DOMINATING CHEST TRAUMA

    Directory of Open Access Journals (Sweden)

    E. A. Tseymakh

    2016-01-01

    Full Text Available Treatment outcomes of 226 patients have been analyzed. Treatment and diagnostic algorithm has been developed for the management of patients with severe concurrent injury and dominating chest trauma. The indications for the following interventions have been formulated: emergency thoracotomy, emergency and urgent video-assisted thoracoscopy, local fibrinolytic therapy in case of clotted hemothorax and post-traumatic pleural empyema, valve bronchial block in tension and continuously persistent pneumothorax, osteosynthesis of fragmentary costal fractures. Using minimally invasive treatment techniques allowed decreasing the number of surgeries in the patients and increasing the number of recovered patients when discharged from the hospital.

  8. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2012-01-01

    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  9. Spontaneous obliteration of right ventricular pseudoaneurysm after blunt chest trauma: Diagnosis and follow-up with multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Tae Kyung; Kang, Mi Jin; Kim, Jae Hyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2014-06-15

    Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.

  10. Paediatric CT dose: a multicentre audit of subspecialty practice in Australia and New Zealand

    Energy Technology Data Exchange (ETDEWEB)

    Jackson, D.; Atkin, K.; Clark, J. [Monash Health, Diagnostic Imaging, Clayton, VIC (Australia); Bettenay, F. [Princess Margaret Hospital for Children, Perth, Western Australia (Australia); Ditchfield, M.R. [Monash Health, Diagnostic Imaging, Clayton, VIC (Australia); Monash Children' s, Clayton, Victoria (Australia); Monash University, Clayton, Victoria (Australia); Grimm, J.E. [Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales (Australia); Linke, R. [Women' s and Children' s Hospital, Adelaide, South Australia (Australia); Long, G. [Royal Children' s Hospital, Brisbane, Queensland (Australia); Onikul, E. [The Children' s Hospital at Westmead, Westmead, New South Wales (Australia); Pereira, J. [Sydney Children' s Hospital, Randwick, New South Wales (Australia); The University of New South Wales, Kensington, New South Wales (Australia); Phillips, M. [Mater Children' s Hospital, Brisbane, Queensland (Australia); Wilson, F. [Starship Children' s Health, Auckland (New Zealand); Paul, E. [Monash University, School of Public Health and Preventive Medicine, Clayton, Victoria (Australia); Goergen, S.K. [Monash Health, Diagnostic Imaging, Clayton, VIC (Australia); Monash University, Department of Surgery, Southern Clinical School, Clayton, Victoria (Australia)

    2015-11-15

    To evaluate paediatric CT dosimetry in Australia and New Zealand and calculate size-specific dose estimates (SSDEs) for chest and abdominal examinations. Eight hospitals provided data from 12 CT systems for 1462 CTs in children aged 0-15. Imaging data were recorded for eight examinations: head (trauma, shunt), temporal bone, paranasal sinuses, chest (mass) and chest HRCT (high-resolution CT), and abdomen/pelvis (mass/inflammation). Dose data for cranial examinations were categorised by age and SSDEs by lateral dimension. Diagnostic reference ranges (DRRs) were defined by the 25th and 75th percentiles. Centralised image quality assessment was not undertaken. DRRs for 201 abdominopelvic SSDEs were: 2.8-4.7, 3.6-11.5, 8.5-15.0, 7.6-15, and 10.6-16.2 for the <15 cm, 15-19 cm, 20-24 cm, 25-29 cm and >30 cm groups, respectively. For 147 chest examinations using these body width categories, SSDE DRRs were 2.0-4.4, 3.3-7.9, 4.0-9.4, 4.5-12, and 6.5-12. Kilovoltage peak (kVp), but not AEC or IR, was associated with SSDE (parameter estimate [standard error]: 0.12 (0.03); p < 0.0001). Australian and New Zealand paediatric CT DRRs and abdominal SSDEs are comparable to international data. SSDEs for chest examinations are proposed. Dose variations could be reduced by adjusting kVp. (orig.)

  11. 12 A multi-centre randomised feasibility study evaluating the impact of a prognostic model for management of blunt chest wall trauma patients: stumbl trial.

    Science.gov (United States)

    Battle, Ceri; Hutchings, Hayley; Abbott, Zoe; O'neill, Claire; Groves, Sam; Watkins, Alan; Lecky, Fiona; Jones, Sally; Gagg, James; Body, Rick; Evans, Phillip

    2017-12-01

    A new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the Emergency Department (ED). A definitive randomised controlled trial (impact trial), is required to assess the clinical and cost effectiveness of the new model, before it can be accepted in clinical practice. The purpose of this trial is to assess the feasibility and acceptability of such a definitive trial and inform its design. This feasibility trial is designed to test the methods of a multi-centre, cluster-randomised (stepped wedge) trial, with a substantial qualitative component. Four EDs in England and Wales will collect data for all blunt chest wall trauma patients over a five month period; in the initial period acting as the controls (normal care) and the second period, acting as the interventions (in which the new model will be used). Baseline measurements including completion of the SF-12v2 will be obtained on initial assessment in the ED. Patient outcome data will then be collected for any subsequent hospitalisations. Data collection will conclude with a six week follow-up completion of two surveys (SF-12v2 and Client Services Receipt Inventory).Analysis of outcomes will focus on feasibility, acceptability and trial processes and will include recruitment and retention rates, attendance at clinician training rates and use of model in the ED. Qualitative feedback will be obtained through clinician interviews and a research nurse focus group. An evaluation of the feasibility of health economics outcomes data will be completed. Wales Research Ethics Committee 6 granted approval for the trial in September 2016. Health Care Research Wales Research Permissions and the HRA have granted approval for the study. Patient recruitment commenced in February 2017. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal, presentation at appropriate conferences and to

  12. Protocol for a multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL trial.

    Science.gov (United States)

    Battle, Ceri; Abbott, Zoe; Hutchings, Hayley A; O'Neill, Claire; Groves, Sam; Watkins, Alan; Lecky, Fiona E; Jones, Sally; Gagg, James; Body, Richard; Evans, Philip A

    2017-07-10

    A new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the emergency department (ED). A definitive randomised controlled trial (impact trial) is required to assess the clinical and cost effectiveness of the new model before it can be accepted in clinical practice. The purpose of this trial is to assess the feasibility and acceptability of such a definitive trial and inform its design. This feasibility trial is designed to test the methods of a multicentre, cluster-randomised (stepped- wedge) trial, with a substantial qualitative component. Four EDs in England and Wales will collect data for all blunt chest wall trauma patients over a 5-month period; in the initial period acting as the controls (normal care), and in the second period acting as the interventions (in which the new model will be used). Baseline measurements including completion of the SF-12v2 will be obtained on initial assessment in the ED. Patient outcome data will then be collected for any subsequent hospitalisations. Data collection will conclude with a 6-week follow-up completion of two surveys (SF-12v2 and Client Services Receipt Inventory). Analysis of outcomes will focus on feasibility, acceptability and trial processes and will include recruitment and retention rates, attendance at clinician training rates and use of model in the ED. Qualitative feedback will be obtained through clinician interviews and a research nurse focus group. An evaluation of the feasibility of health economics outcomes data will be completed. Wales Research Ethics Committee 6 granted approval for the trial in September 2016. Patient recruitment will commence in February 2017. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal , presentation at appropriate conferences and to stakeholders at professional meetings. ISRCTN95571506; Pre-results. © Article author(s) (or their

  13. Penetrating chest trauma caused by a blank cartridge actuated rubber ball projectile: case presentation and ballistic investigation of an uncommon weapon type.

    Science.gov (United States)

    Frank, Matthias; Peters, Dieter; Klemm, Wolfram; Grossjohann, Rico; Ekkernkamp, Axel; Bockholdt, Britta; Seifert, Julia

    2017-09-01

    Recently, an increasing number of an uncommon weapon type based on a caliber 6-mm Flobert blank cartridge actuated revolver which discharges 10-mm-diameter rubber ball projectiles has been confiscated by police authorities following criminal offenses. A recent trauma case presenting with a penetrating chest injury occasioned an investigation into the basic ballistic parameters of this type of weapon. Kinetic energy E of the test projectiles was calculated between 5.8 and 12.5 J. Energy density ED of the test projectiles was close to or higher than the threshold energy density of human skin. It can be concluded that penetrating skin injuries due to free-flying rubber ball projectiles discharged at close range cannot be ruled out. However, in case of a contact shot, the main injury potential of this weapon type must be attributed to the high energy density of the muzzle gas jet which may, similar to well-known gas or alarm weapons, cause life-threatening or even lethal injuries.

  14. Thoracic Trauma.

    Science.gov (United States)

    Dennis, Bradley M; Bellister, Seth A; Guillamondegui, Oscar D

    2017-10-01

    Management of chest trauma is integral to patient outcomes owing to the vital structures held within the thoracic cavity. Understanding traumatic chest injuries and appropriate management plays a pivotal role in the overall well-being of both blunt and penetrating trauma patients. Whether the injury includes rib fractures, associated pulmonary injuries, or tracheobronchial tree injuries, every facet of management may impact the short- and long-term outcomes, including mortality. This article elucidates the workup and management of the thoracic cage, pulmonary and tracheobronchial injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. TRIAGE OF PATIENTS TO ANGIOGRAPHY FOR DETECTION OF AORTIC RUPTURE AFTER BLUNT CHEST TRAUMA - COST-EFFECTIVENESS ANALYSIS OF USING CT

    NARCIS (Netherlands)

    HUNINK, MGM; BOS, JJ

    OBJECTIVE. The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest

  16. Surgical treatment of chest instability

    International Nuclear Information System (INIS)

    Kitka, M.; Masek, M.

    2015-01-01

    Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

  17. Paediatric multidetector CT optimisation training: a survey of common scanning procedures and the resultant dose reduction associated with paediatric MDCT investigations in Australia

    International Nuclear Information System (INIS)

    Wallace, Anthony; Sibelle, Kimberly; Stanley, Martin; Budd, Ray; Goergen, Stacey; Heggie, John

    2008-01-01

    The growing recognition of the increased risk of stochastic injury to paediatric patients from multidetector CT (MDCT) investigations prompted a survey sponsored by Royal Australian and New Zealand College of Radiology (RANZCR), Austin Health and Monash University to initiate a national paediatric dosimetry review for some of the most common investigations undertaken in MDCT paediatric practice. The survey forms included a data sheet requiring acquisition protocol parameters and a phantom graphic sheet requiring the marking of the inferior and superior acquisition margins. Survey forms were supplied for each of 13 common MDCT acquisitions to be tested. Response data was input into CT-Expo Version 1.5.1., a CT dosimetry calculation engine, to determine dose length product (DLP (mGy.cm)) and effective dose (ED (mSv)). Initial survey data was collected, calculated, blinded and collated into various presentations that were given at a MDCT optimisation seminar in November, 2006. All sites were re-surveyed in May 2007 and doses calculated. Initial survey data showed a range of dose efficiencies spread across the surveyed sites. A measure of the initial spread of DLP values per procedure ranged from a minimum of less than 2 for a head-trauma acquisition (372 - 520 mGy.cm) to 14 for a chest-trauma acquisition (28 - 388 mGy.cm). Results of the 2nd survey strongly indicate that the application of optimisation training to paediatric MDCT scanning can produce significant dose savings by the application of simple dose saving strategies. Many protocols demonstrated dose reductions of greater than 50% with significant reductions in both the maximum and minimum values of calculated DLP and ED. The development of a survey-training-resurvey model of MDCT optimisation has proven to be a successful strategy for paediatric MDCT dose reduction in Australia. (author)

  18. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

    OpenAIRE

    Chapman, Brandon C.; Overbey, Douglas M.; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T.; French, Andrew; Johnson, Jeffrey L.; Burlew, Clay C.; Barnett, Carlton; Moore, Ernest E.; Pieracci, Fredric M.

    2016-01-01

    Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective coho...

  19. Chest MRI

    Science.gov (United States)

    ... resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI Patient Instructions ... Gotway MB, Panse PM, Gruden JF, Elicker BM. Thoracic radiology. In: Broaddus VC, Mason RJ, Ernst JD, et ...

  20. Penetrating chest wound of the foetus

    Directory of Open Access Journals (Sweden)

    Albert Wandaogo

    2016-01-01

    Full Text Available Traumas of the foetus caused by stabbings are rare but actually life-threatening for both the foetus and the mother. We report a case of penetrating chest wound on a baby taken from the obstetrics unit to the paediatric surgical department. His mother was assaulted by his father, a mentally sick person with no appropriate follow-up. The foetus did not show any sign of vital distress. Surgical exploration of the wound has revealed a section of the 10 th rib, a laceration of the pleura and a tearing of the diaphragm. A phrenorraphy and a pleural drainage were performed. The new-born and its mother were released from hospital after 5 days and the clinical control and X-ray checks 6 months later showed nothing abnormal. We insisted a medical, psychiatric follow-up be initiated for the father. As regards pregnant women with penetrating wounds, the mortality rate of the foetus is 80%. The odds are good for our newborn due to the mild injuries and good professional collaboration of the medical staff. Penetrating transuterine wounds of the foetus can be very serious. The health care needed should include many fields due to the mother and the foetus′ lesions extreme polymorphism. In our case, it could have prevented by a good psychiatric followed up of the offender.

  1. Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile.

    Science.gov (United States)

    Díaz, Jaime; Bustos, Luís; Herrera, Samira; Sepulveda, Jaqueline

    2009-12-01

    The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.

  2. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    in increased mortality in developing nations.6,7 However, it has been shown ... Background: The time from birth to the first paediatric surgical consultation of neonates with gastroschisis is a predictor ... of Helsinki and its later amendments. Informed consent was obtained from the parents of the infants included in the study.

  3. Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan.

    Science.gov (United States)

    Schauer, Steven G; April, Michael D; Naylor, Jason F; Simon, Erica M; Fisher, Andrew D; Cunningham, Cord W; Morissette, Daniel M; Fernandez, Jessie Renee D; Ryan, Kathy L

    Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting. To evaluate adherence to TCCC guidelines for chest seal placement among personnel deployed to Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR). Joint Trauma System personnel linked patients to the Department of Defense Trauma Registry, when available, for outcome data upon reaching a fixed facility. In the PHTR, we identified 62 patients with documented gunshot wound (GSW) or puncture wound trauma to the chest. The majority (74.2%; n = 46) of these were due to GSW, with the remainder either explosive-based puncture wounds (22.6%; n = 14) or a combination of GSW and explosive (3.2%; n = 2). Of the 62 casualties with documented GSW or puncture wounds, 46 (74.2%) underwent chest seal placement. Higher proportions of patients with medical officers in their chain of care underwent chest seal placement than those that did not (63.0% versus 37.0%). The majority of chest seals placed were not vented. Of patients with a GSW or puncture wound to the chest, 74.2% underwent chest seal placement. Most of the chest seals placed were not vented in accordance with guidelines, despite the guideline update midway through the study period. These data suggest the need to improve predeployment training on TCCC guidelines and matching of the Army logistical supply chain to the devices recommended by the CoTCCC. 2017.

  4. Trauma Reports. Volume 12, Number 6, November/December 2011

    Science.gov (United States)

    2011-12-01

    lung injuries such as pneumothorax , Figure 3. Chest Radiograph of Intubated Trauma Patient with a Significant Pulmonary Contusion 6  Trauma ...Pulmonary Contusions Pulmonary contusions are a frequent complication of chest trauma and may have serious morbidity and mortality associated with...described in the medical literature by Morgani in 1761, when he noted extensive underlying parenchymal lung damage without evidence of chest wall trauma

  5. Effective doses in paediatric radiology

    International Nuclear Information System (INIS)

    Iacob, Olga; Diaconescu, Cornelia; Roca, Antoaneta

    2001-01-01

    Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study is to assess in terms of effective doses the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses to the patient. Effective doses have been derived from measurements of dose-area product (DAP) carried out on over 900 patients undergoing X-ray examinations, in five paediatric units. The conversion coefficients for estimating effective doses are those calculated by the NRPB using Monte-Carlo technique on a series of 5 mathematical phantoms representing 0, 1, 5, 10 and 15 year old children. The annual frequency of X-ray examinations necessary for collective dose calculation are those reported in our last national study on medical exposure, conducted in 1995. The annual effective doses from all medical examinations for the average paediatric patient are as follows: 1.05 mSv for 0 year old, 0.98 mSv for 1 year old, 0.53 mSv for 5 year old, 0.65 mSv for 10 year old and 0.70 mSv for 15 year old. The resulting annual collective effective dose was evaluated at 625 man Sv with the largest contribution of pelvis and hip examinations (34%). The annual collective effective associated with paediatric radiology in Romania represent 5% of the annual value resulting from all diagnostic radiology. Examination of the chest is by far the most frequent procedure for children, accounting for about 60 per cent of all annually performed X-ray conventional examinations. Knowledge of real level of patient dose is an essential component of quality assurance programs in paediatric radiology. (authors)

  6. Paediatric cervical spine injury but NEXUS negative

    OpenAIRE

    Maxwell, Melanie J; Jardine, Andrew D

    2007-01-01

    Cervical spine injuries in paediatric patients following trauma are extremely rare. The National Emergency X‐Radiography Utilization Study (NEXUS) guidelines are a set of clinical criteria used to guide physicians in identifying trauma patients requiring cervical spine imaging. It is validated for use in children. A case of a child who did not fulfil the NEXUS criteria for imaging but was found to have a cervical spine fracture is reported.

  7. Chest radiology

    International Nuclear Information System (INIS)

    Reed, J.C.

    1990-01-01

    This book is a reference in plain chest film diagnosis provides a thorough background in the differential diagnosis of 22 of the most common radiologic patterns of chest disease. Each chapter is introduced with problem cases and a set of questions, followed by a tabular listing of the appropriate differential considerations. The book emphasizes plain films, CT and some MR scans are integrated to demonstrate how these modalities enhance the work of a case

  8. Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.

    Science.gov (United States)

    Anand, Rahul J; Whelan, James F; Ferrada, Paula; Duane, Therese M; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

    2012-04-01

    The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

  9. Correção de aneurisma do tronco braquiocefálico, 10 anos após traumatismo torácico fechado Correction of an innominate artery aneurysm, 10 years after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    José Almeida Lopes

    2012-03-01

    Full Text Available Aneurismas do tronco braquiocefálico são extremamente raros. Os autores apresentam o caso clínico de um doente de 22 anos de idade, com antecedente de atropelamento de alta energia há cerca de 10 anos por motociclo, com traumatismo toraco-abdominal anterior, em quem foi acidentalmente descoberto um aneurisma do tronco braquiocefálico com 52mm. Para a exclusão do referido aneurisma o doente foi submetido com sucesso à construção de um bypass aorta ascendente-carotídio-subclávio com prótese bifurcada de Dacron® (14x7mm, com abordagem por esternotomia mediana, cervical e supra-clavicular. É feita uma revisão da literatura, sendo descritas e discutidas as características clínicas, o tratamento cirúrgico e o mecanismo de traumatismo torácico sobre o tronco braquiocefálico.Innominate artery aneurysms are extremely rare. The authors present a case report of a 22-year-old patient, in whom was accidently discovered an innominate artery aneurysm of 52 mm, 10 years after a blunt thoraco-abdominal trauma caused by a high energy running over by a motorcycle. For the exclusion of the aneurysm, the patient was successfully submitted to the construction of an ascending aorta-carotid-subclavian bypass with bifurcated Dacron® graft (14x7mm, by means of a median sternotomy, right cervical and supra-clavicular approaches. Review of the literature, clinical features, surgical treatment and chest trauma mechanisms over the innominate artery are described and discussed.

  10. Radiology of thoracic trauma

    International Nuclear Information System (INIS)

    Stark, P.

    1987-01-01

    This course provides an overview of the radiologic manifestations of trauma to the chest. The basic mechanisms of injury are discussed. The effect of trauma on the chest wall, the lung parenchyma, and the pleural space is described. Rib fractures, sternal fractures, lung contusion, lung hematoma, lung laceration, post-traumatic atelectasis, hemothorax, chylothorax, pneumothorax, and adult respiratory distress syndrome are discussed and illustrated. Injuries to the tracheobronchial tree, the aorta and brachiocephalic vessels, the esophagus, the diaphragm, and the heart are also presented. The purpose of the lecture is to familiarize the audience with common and unusual radiologic presentations of traumatic injury to the thorax

  11. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jong, Pim A. de; Nievelstein, Rutger-Jan A. [University Medical Center Utrecht and Wilhelmina Children' s Hospital, Department of Radiology, Utrecht (Netherlands)

    2012-02-15

    To study normal mediastinal and hilar lymph nodes on multi-detector chest computed tomography (CT). A cohort of 120 children aged 1-17 years underwent emergency CT, including the chest, after high-energy trauma. Axial 5-mm reconstructions were evaluated for lymph nodes at hilar and various mediastinal levels and the short-axis diameters were measured. At least one lymph node was found in 115 (96%) children, with subcarinal (69%), lower paratracheal (64%) and hilar (60%) nodes being most common. Up to 10 years of age most lymph nodes were smaller than or equal to 7 mm. In older children lymph nodes measuring up to 10-mm-short-axis diameter were found. Lymph nodes were rare along the mammary vessels, at lower oesophageal and at prevascular and posterior mediastinal levels in children. Mediastinal and hilar lymph nodes are more common than previously thought, probably because of increased detection by modern multi-detector CT. Lymph node location and age have to be taken into account when evaluating lymph nodes in the paediatric chest. (orig.)

  12. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography

    International Nuclear Information System (INIS)

    Jong, Pim A. de; Nievelstein, Rutger-Jan A.

    2012-01-01

    To study normal mediastinal and hilar lymph nodes on multi-detector chest computed tomography (CT). A cohort of 120 children aged 1-17 years underwent emergency CT, including the chest, after high-energy trauma. Axial 5-mm reconstructions were evaluated for lymph nodes at hilar and various mediastinal levels and the short-axis diameters were measured. At least one lymph node was found in 115 (96%) children, with subcarinal (69%), lower paratracheal (64%) and hilar (60%) nodes being most common. Up to 10 years of age most lymph nodes were smaller than or equal to 7 mm. In older children lymph nodes measuring up to 10-mm-short-axis diameter were found. Lymph nodes were rare along the mammary vessels, at lower oesophageal and at prevascular and posterior mediastinal levels in children. Mediastinal and hilar lymph nodes are more common than previously thought, probably because of increased detection by modern multi-detector CT. Lymph node location and age have to be taken into account when evaluating lymph nodes in the paediatric chest. (orig.)

  13. Advanced Technologies in Trauma Critical Care Management

    Science.gov (United States)

    2012-01-01

    largely replaced diagnostic peritoneal lavage for identifying intra-abdominal fluid in trauma patients. Furthermore, with the addition of chest windows...authors use chest ultrasound in the following manner: To identify a pneumothorax or hemothorax that needs to be drained acutely To differentiate...these situations, Technologies in the Trauma ICU 913 the authors first insert 2 or 3 chest tubes and position them as usual. A sterile nonad- herent

  14. Contemporary management of flail chest.

    Science.gov (United States)

    Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

    2014-06-01

    Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

  15. Paediatric Interventional Uroradiology

    International Nuclear Information System (INIS)

    Barnacle, Alex M.; Wilkinson, A. Graham; Roebuck, Derek J.

    2011-01-01

    Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.

  16. Chest X-Ray (Chest Radiography)

    Science.gov (United States)

    ... Resources Professions Site Index A-Z X-ray (Radiography) - Chest Chest x-ray uses a very small dose ... Radiography? What is a Chest X-ray (Chest Radiography)? The chest x-ray is the most commonly performed diagnostic ...

  17. Chest pain

    International Nuclear Information System (INIS)

    Martinez A, Juan Carlos; Saenz M, Oscar; Martinez M, Camilo; Gonzales A Francisco; Nicolas R, Jose; Vergara V, Erika P; Pereira G, Alberto M

    2010-01-01

    In emergency departments, chest pain is one of the leading motives of consultation. We thus consider it important to review aspects such as its classification, causes, and clinical profiles. Initial assessment should include a full clinical history comprising thorough anamnesis and physical examination. Adequate interpretation of auxiliary tests, ordered in accordance with suspected clinical conditions, should lead to accurate diagnosis. We highlight certain symptoms and clinical signs, ECG and X-ray findings, cardiac bio markers, arterial blood gases, and CT-scanning. Scores of severity and prognosis such as TIMI are assessed. Optimal treatment of the clinical conditions leading to chest pain depends on adequate initial approach and assessment.

  18. Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen

    Science.gov (United States)

    Kennedy, Raelene D; Potter, D Dean; Osborn, John B; Zietlow, Scott; Zarroug, Abdalla E; Moir, Christopher R; Ishitani, Michael B; McIntosh, Amy

    2012-01-01

    Objectives To review the need for operative intervention and critical care services for motocross truncal injuries in children. Design cohort Retrospective review of patients identified via the hospital trauma registry. Setting Our Level 1 Pediatric Trauma Center serves five motocross tracks. These patients require frequent medical care for injuries. Participants All patients ≤17 years of age with truncal injuries sustained during motocross activities, between 2000 and 2011, were identified through the trauma registry. Primary and secondary outcome measures Operative intervention, intensive care unit (ICU) admission, length of stay, morbidity and demographics were reviewed. Results Motocross injured 162 children. Thirty (18.5%) were thoracic or abdominal injuries. Operative intervention was required in eight (27%) patients. Mean injury severity score (ISS) was 11.8. ICU admission was required in 50% and average hospital length of stay was 4.1 days. The most common injuries include pulmonary contusion, pneumothorax, spleen and liver lacerations. 13% of subjects suffered truncal injury from motocross on more than one occasion. Conclusions Paediatric motocross-related truncal injuries are significant. Surgical intervention is required in 27% of patients. The lower ISS incurred from motocross combined with high surgical and ICU admission rates suggests focal high-impact injuries to the chest and abdomen. Despite significant injury, 13% of motocross patients suffer recurrent injuries. Parents and children need injury prevention education. PMID:23166134

  19. Chest X-Ray

    Medline Plus

    Full Text Available ... talk with you about chest radiography also known as chest x-rays. Chest x-rays are the ... treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray ...

  20. Computed tomography in the evaluation of trauma

    International Nuclear Information System (INIS)

    Federle, M.P.; Brant-Zawadzki, M.

    1982-01-01

    This book is intended to be the current standard for computed tomography in the evaluation of trauma. It summarizes two years of experience at San Francisco General Hospital. The book is organized into seven chapters, covering head, maxillofacial, laryngeal, spinal, chest, abdominal, acetabular, and pelvic trauma. Extremity trauma is not discussed

  1. Radiodiagnostic measurements radiation load of children by chest

    International Nuclear Information System (INIS)

    Nikodemova, D.; Vladar, M.; Ranogajec, M.; Horvathova, M

    1998-01-01

    With the aim of optimisation of the radiographic examinations in paediatric radiology the entrance surface doses measured by chest examinations, as the most frequent procedure for children in Slovakia were surveyed. In this paper the results of measurements and calculations of doses obtained by paediatric patients with ages ranging from newborn to 15 years, who undergone chest radiodiagnostic examinations during the year 1996 are presented.. The obtained results are compared with dose assessment procedures based on total absorbed dose calculations using the published conversion factors between energy impaired to the patient and and entrance surface doses integrated over the beam area

  2. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Chalumeau, Martin [Service de Pneumologie et d' Allergologie Pediatriques, Hopital Necker-Enfants Malades, Paris (France); Service de Pediatrie, Hopital Saint-Vincent-de-Paul, Paris (France); Foix-l' Helias, Laurence; Scheinmann, Pierre; Zuani, Pierre [Service de Pneumologie et d' Allergologie Pediatriques, Hopital Necker-Enfants Malades, Paris (France); Gendrel, Dominique [Service de Pediatrie, Hopital Saint-Vincent-de-Paul, Paris (France); Ducou-le-Pointe, Hubert [Service de Radiologie, Hopital d' Enfants Armand-Trousseau, Avenue du Docteur Arnold Netter, 75571 Paris Cedex 12 (France)

    2002-09-01

    Heading AbstractBackground. The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.Objective. To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.Materials and methods. We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.Results. Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1-5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.Conclusions. CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse. (orig.)

  3. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants

    International Nuclear Information System (INIS)

    Chalumeau, Martin; Foix-l'Helias, Laurence; Scheinmann, Pierre; Zuani, Pierre; Gendrel, Dominique; Ducou-le-Pointe, Hubert

    2002-01-01

    Heading AbstractBackground. The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.Objective. To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.Materials and methods. We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.Results. Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1-5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.Conclusions. CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse. (orig.)

  4. Pneumothorax and subcutaneous emphysema secondary to blunt chest injury

    OpenAIRE

    Porhomayon, Jahan; Doerr, Ralph

    2011-01-01

    This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process.

  5. Diagnosis and Treatment of Chest Injury and Emergency Diseases of Chest Organs

    Directory of Open Access Journals (Sweden)

    A. M. Khadjibaev

    2016-01-01

    Full Text Available Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs.Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1% victims. There were 477 (22,6% patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu#mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3% patients and complicated forms of lung echinococcosis were evident in 72 patients.Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1% patients, whereas the traditional methods were effective only in 905 cases (42,9%.Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

  6. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

    Science.gov (United States)

    Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

    2016-12-01

    Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

  7. Imaging of thoracic trauma

    International Nuclear Information System (INIS)

    Uffmann, M.; Herold, C.J.; Fuchs, M.

    1998-01-01

    Blunt trauma to the chest results from transfer of kinetic energy to the human body. It may cause a wide range of mostly life-threatening injuries, including fractures of the thoracic skeleton, disintegration of the pleural space, contusion or laceration of pulmonary parenchyma and damage to the mediastinal structures. For a systematic approach it may be helpful to follow an organ-based evaluation of thoracic trauma. However, it should be borne in mind that subtle injuries may be associated with serious complications. Trauma to the chest may affect different anatomic compartments at the same time, requiring and extending diagnostic approach. Conventional radiography plays a major role in diagnosting thoracic trauma, complemented by ultrasound examination of the pleura and abdomen. It is well documented that CT scanning represents a major technological improvement for assessment of thoracic trauma. With the advent of fast helical CT scanning this method becomes more applicable for severly traumatized patients and potentially replaces other time-consuming procedures. State-of-the-art imaging of both projection and cross-sectional techniques provides useful information for immediate and appropriate treatment mandatory in patients with thoracic trauma. (orig.) [de

  8. Chest X-Ray

    Medline Plus

    Full Text Available ... about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed x-ray exams and use a very small dose of ... of the inside of the chest. A chest x-ray is used to evaluate the lungs, heart and ...

  9. Interventional Radiology in Paediatrics.

    Science.gov (United States)

    Chippington, Samantha J; Goodwin, Susie J

    2015-01-01

    As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

  10. Papel da dosagem seriada de troponina nos pacientes com suspeita de contusão miocárdica após trauma torácico fechado The role of serial measurement of troponin in patients with a suspected myocardial injury after chest trauma

    Directory of Open Access Journals (Sweden)

    Thiago Domingos Corrêa

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A contusão miocárdica está freqüentemente associada ao trauma torácico fechado. Seu correto diagnóstico é um constante desafio aos profissionais que trabalham em unidades de emergência, devido aos seus sintomas inespecíficos e a ausência de exames subsidiários com precisão para fazer o diagnóstico. Dentre os diversos métodos diagnósticos estudados, tem-se destacado nos últimos anos o papel dos indicadores de necrose miocárdica troponina I e troponina T. Por serem proteí­nas constituintes do aparelho de regulação contrátil celular, são liberadas na corrente sanguínea somente após a perda da integridade de membrana dos miócitos e, portanto, são altamente específicas para detectar lesão miocárdica. CONTEUDO: Foi realizada uma revisão de estudos clínicos nas bases eletrônicas de dados MedLine e LILACS, no período de janeiro de 1980 a novembro de 2006, sobre a importância da dosagem seriada de troponina como instrumento diagnóstico e preditor de evolução clínica desfavorável nos pacientes com contusão miocárdica. CONCLUSÕES: Embora exista maior especificidade das troponinas I e T quando comparadas aos indicadores tradicionais, CKMB massa e CPK total, esses dois indicadores apresentarem sensibilidade e valor preditivo positivo baixos para diagnosticar contusão miocárdica. Pacientes que apresentam alterações eletrocardiográficas, elevação de troponinas, ou ambas, devem permanecer em observação em unidade de terapia intensiva (UTI, por no mínimo 24 horas, período em que se desenvolve a maioria das complicações decorrentes da contusão miocárdica.BACKGROUND AND OBJECTIVES: Myocardial contusion is often associated with blunt chest trauma. Its diagnosis is challenging to the professionals who work in emergency department due to nonspecific symptoms and the lack of auxiliary exams with enough accuracy to diagnose. Among the available diagnostic tools, the biomarkers of

  11. MRI of the Chest

    Medline Plus

    Full Text Available ... gives detailed pictures of structures within the chest cavity, including the mediastinum , chest wall, pleura, heart and ... helpful to assess the vessels of the chest cavity (arteries and veins). MRA can also demonstrate an ...

  12. MRI of the Chest

    Medline Plus

    Full Text Available ... to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI ... of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft ...

  13. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  14. BRONCHIAL FRACTURE FOLLOWING BLUNT CHEST TRAUMA*

    African Journals Online (AJOL)

    1971-01-02

    Jan 2, 1971 ... reversal of bronchiectasis after re-anastomosing the two bronchial ends, it is felt that this is the exception rather than the rule. Coxatto and Lanari," in their study of the pathogenesis of bronchiectasis, feel that where there is complete obstruction to the distal bronchus, bronchial secretion will cease before ...

  15. Chest injuries in Tikur Anbessa Hospital, Addis Ababa: a three year ...

    African Journals Online (AJOL)

    Chest drainage is a life-saving procedure for patients with chest injuries which all doctors should be confident with. Introduction. Trauma is a leading cause of .... This retrospective review of 72 cases demonstrated that the majority of patients presenting with chest injury can be treated with simple pleural cavity drainage.

  16. Clinician's gaze behaviour in simulated paediatric emergencies.

    Science.gov (United States)

    McNaughten, Ben; Hart, Caroline; Gallagher, Stephen; Junk, Carol; Coulter, Patricia; Thompson, Andrew; Bourke, Thomas

    2018-03-07

    Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Infarto do miocárdio causado por lesão arterial coronariana após trauma torácico fechado Infarto de miocardio causado por lesión arterial coronaria post traumatismo torácico cerrado Myocardial infarction caused by coronary artery injury after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Márcio Silva Miguel Lima

    2009-07-01

    Full Text Available Relatamos o caso de um indivíduo do sexo masculino de 29 anos de idade, vítima de um acidente de carro no qual sofreu trauma torácico fechado, evoluindo com insuficiência cardíaca congestiva. O paciente apresentava boa saúde previamente, sem sintomas de doença cardiovascular. Na avaliação inicial, o eletrocardiograma mostrou ondas Q nas derivações precordiais e o ecocardiograma mostrou disfunção ventricular esquerda importante. A angiografia coronária mostrou uma lesão na artéria coronária descendente anterior esquerda (ADE, com acinesia da parede anterior na ventriculografia com contraste. A tomografia computadorizada por emissão de fóton único (SPECT com Tálio-201 não mostrou viabilidade. O paciente foi mantido em tratamento clínico com boa evolução.Relatamos el caso de un individuo del sexo masculino, de 29 años de edad, víctima de accidente automovilístico en el cual sufrió traumatismo torácico cerrado, evolucionando con insuficiencia cardíaca congestiva. El paciente presentaba buena salud previamente, sin síntomas de enfermedad cardiovascular. En la evaluación inicial, el electrocardiograma mostró ondas Q en las derivaciones precordiales y el ecocardiograma mostró disfunción ventricular izquierda importante. La angiografía coronaria mostró una lesión en la arteria coronaria descendente anterior izquierda (ADI, con acinesia de la pared anterior en la ventriculografía de contraste. La tomografía computada por emisión de fotón único (SPECT con Talio-201 no mostró viabilidad. El paciente fue mantenido en tratamiento clínico con buena evolución.We report the case of a 29-year-old man, victim of a car accident, who suffered a severe blunt chest trauma, with evolving congestive heart failure. He had previously had a good overall health status, with no symptoms of cardiovascular disease. At the initial assessment, the electrocardiogram showed Q waves in the precordial leads and the echocardiogram

  18. Penetrating chest injury: A miraculous life salvage

    Directory of Open Access Journals (Sweden)

    Santosh B Dalavi

    2013-01-01

    Full Text Available An unusual penetrating chest injury was caused by high velocity road traffic accident. An 18-year-old had a four wheeler accident and was brought in emergency department with a ′bamboo′ stick on the left side chest exiting through back. After the stabilization of vital parameters, an inter-costal tube drainage was done on the left side. Except the minor brochopleural fistula which healed by 10 th day, his recovery was uneventful. The outcome was consistent with current aggressive management of penetrating chest injuries. Management of penetrating chest injury involving pulmonary trauma is based on three principles. One is stabilization of hemodynamics of patient with proper clinical evaluation. Second, a mere intercostal tube drainage sufficient for majority of the cases. Third, post-operative active as well as passive physiotherapy is necessary for speedy recovery.

  19. Paediatrics: messages from Munich

    Directory of Open Access Journals (Sweden)

    Fabio Midulla

    2015-05-01

    Full Text Available The aim of this article is to describe paediatric highlights from the 2014 European Respiratory Society (ERS International Congress in Munich, Germany. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology are presented in the context of the current literature.

  20. Paediatric doses from diagnostic radiology in Victoria

    International Nuclear Information System (INIS)

    Boal, T.J.; Cardillo, I.; Einsiedel, P.F.

    1998-01-01

    This study examines doses to paediatric patients from diagnostic radiology. Measurements were made at 29 hospitals and private radiology practices in the state of Victoria. Entrance skin doses in air were measured for the exposure factors used by hospital radiology departments and private radiology practices for a standard size 1, 5, 10 and 15 year old child, for the following procedures: chest AP/PA, lat; abdomen AP; pelvis AP; lumbar spine AP, lat; and skull AP, lat. There was a large range of doses for each particular procedure and age group. Factors contributing to the range of doses were identified. Guidance levels for paediatric radiology based on the third quartile value of the skin entrance doses have been recommended and are compared with guidance levels. Copyright (1998) Australasian Physical and Engineering Sciences in Medicine

  1. Chest X-Ray

    Medline Plus

    Full Text Available ... I’d like to talk with you about chest radiography also known as chest x-rays. Chest x-rays are the most ... far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot org. Thank you for your time! ...

  2. Chest Pain: First Aid

    Science.gov (United States)

    First aid Chest pain: First aid Chest pain: First aid By Mayo Clinic Staff Causes of chest pain can vary from minor problems, such as indigestion ... 26, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-chest-pain/basics/ART-20056705 . Mayo ...

  3. Chest X-Ray

    Medline Plus

    Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... d like to talk with you about chest radiography also known as chest x-rays. Chest x- ...

  4. Chest X-Ray

    Medline Plus

    Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... you about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed ...

  5. Trauma in Auckland: an overview.

    Science.gov (United States)

    Streat, S J; Donaldson, M L; Judson, J A

    1987-07-22

    Data are presented on all 569 subjects who, as a result of trauma, either died or were admitted to hospital in Auckland over a four week period. Median age was 23 with an overall 3:2 male:female ratio. Median injury severity score (ISS) was five with 9% of subjects having an ISS of 16 or more (major trauma). Blunt trauma accounted for 84% of all injuries. Life threatening injuries were most commonly to the head, thorax and abdomen while the largest number of less severe injuries were to the extremities. Eight subjects died before admission to hospital and a further six in hospital. Definitive care was given to 98% of patients at Middlemore and Auckland hospitals (including the onsite Princess Mary paediatric facility) but 26% had presented first to other hospitals and 43% of all patients were transferred from one hospital to another. The 561 patients used 6380 hospital days (including 314 intensive care days) and the following services--operating room 63%, orthopaedic ward 45%, plastic surgical ward 17%, paediatric ward 15%, neurosurgical ward 10%, general surgical ward 5%, intensive care 5% and CT scanner 4%. Only one hospital death was judged potentially preventable. This study reveals areas where trauma care could be improved, demonstrates the large amount of hospital resources required to treat trauma and particularly highlights the urgent need for studies into strategies for trauma prevention in New Zealand.

  6. The role of computed tomography in modern paediatric uroradiology

    International Nuclear Information System (INIS)

    Maudgil, D.D.; McHugh, K.

    2002-01-01

    Computed tomography (CT) has developed a well-recognised role within paediatric uroradiology, especially in imaging of trauma, malignancy (in particular Wilms' tumour), atypical infection, and congenital urogenital abnormalities. CT can also be used for problem solving in nephrolithiasis and renal transplant assessment. These applications are illustrated and discussed, with an emphasis on particular information that can be gained from the CT study

  7. The chest

    International Nuclear Information System (INIS)

    Berdon, W.E.

    1985-01-01

    Radiographic interpretation of chest films of newborns in respiratory distress remains one of the most difficult aspects of pediatric radiology. Complex pulmonary and cardiac adjustments to extrauterine life are rapidly taking place. The small, fluid-filled fetal lung must rid itself of fluid and fill with air. The high vascular resistance of the fetal pulmonary bed and the open ductus arteriosus allow shunting of blood in both directions. Films taken in this period of time may show lungs that resemble those seen in congestive heart failure or fluid overload. When these findings are observed in infants who may appear dusky or even cyanotic, the result may be the diagnosis of disease in normal infants passing through a stormy transition period. To make things worse, the films are taken as portable surpine films, usually in an isolette in the intensive care unit (ICU). The phase of respiration is difficult, if not impossible, to control, and lateral films are usually not obtained. Many of the infants are on assisted ventilation either by tube or nasal prongs-nasal continuous positive airway pressure (CPAP)-and lungs can appear over-inflated or whited out, depending on the pressures used and the phase of the respiratory cycle. Prolonged crying itself can make lungs appear semiopaque; the next breath may show such a dramatic reinflation that it is hard to believe the two films are of the same infant, made only seconds apart. Is the heart large? Or is it the thymus? Are the lungs ''wet''? Is there infection? Is there pulmonary vascular engorgement? Why are these films so hard to interpret? They have no easy answers. The radiologist must realize that the neonatal intensive care personnel, armed though they may be with blood gas values, are no better at interpreting films. If anything, they read into them what they wish to see

  8. Paediatric radiopharmaceutical administration

    DEFF Research Database (Denmark)

    Lassmann, Michael; Treves, S Ted; Borgwardt, Lise

    2014-01-01

    In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmoni...

  9. Pediatric chest imaging. Chest imaging in infants and children. 2. rev. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Lucaya, Javier [Vall d' Hebron Hospitals, Barcelona (Spain). Dept. of Pediatric Radiology and Inst. of Diagnostic Imaging; Hospital Quiron, Barcelona (Spain). Dept. of Radiology; Strife, Janet L. (eds.) [Cincinnati Univ. Coll. of Medicine, Cincinnati, OH (United States). Dept. of Radiology Cincinnati Children' s Hospital Medical Center

    2008-07-01

    Imaging of the pediatric chest continues to evolve rapidly. All chapters in this 2nd edition of Pediatric Chest Imaging have been extensively updated, with additional disease-specific information and numerous new illustrations. The book thus presents the state of the art in the diagnosis of pediatric chest disorders, highlighting the role played by advanced technology. As the conventional features of most of these disorders are extremely well known, special attention is devoted to the technical aspects of the modern imaging modalities, their indications, and the diagnostic information that they supply. Individual chapters focus on chest ultrasound, nuclear medicine imaging, high-resolution chest CT, helical CT, and pediatric cardiac CT and pediatric cardiacMRI. Others are directed towards specific disorders, including congenital malformations of the chest, chest tumors, pulmonary infection, trauma, the lung in systemic diseases, the pediatric airway, foreign bodies, the thymus, and the chest wall. Without exception, the authors of this book are internationally known specialists with great expertise in the field. This book will serve as a handy, superbly illustrated reference for all who routinely image children, as well as for those who need access to information on how best to image them. (orig.)

  10. Safety in paediatric imaging

    International Nuclear Information System (INIS)

    Carter, D.; Filice, I.; Murray, D.; Thomas, K.

    2006-01-01

    Those of us working in a dedicated paediatric environment are aware of the important safety issues with regard to paediatrics. Our goal when working with paediatric patients, the goal is to obtain the best quality images while keeping patients safe and their distress to a minimum. This article will discuss some of the issues regarding paediatric safety in a diagnostic imaging department, including radiation doses and the risk to paediatric patients, reducing medication errors, safe sedation practice and environmental safety. Also discussed are some conditions requiring special consideration to maintain patient safety such as epiglottitis and suspected child abuse. Promotion of a patient/family-centered care system will create an environment of trust where parents or guardians will know that their children are being well cared for in a safe, effective environment. (author)

  11. The forgotten view: Chest X-ray - Lateral view

    Directory of Open Access Journals (Sweden)

    Abraham M. Ittyachen

    2017-01-01

    Full Text Available With CT (computed tomography chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.

  12. CT detection of occult pneumothorax in head trauma

    International Nuclear Information System (INIS)

    Tocino, I.M.; Miller, M.H.; Frederick, P.R.; Bahr, A.L.; Thomas, F.

    1984-01-01

    A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia

  13. CT detection of occult pneumothorax in head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tocino, I.M.; Miller, M.H.; Frederick, P.R.; Bahr, A.L.; Thomas, F.

    1984-11-01

    A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia.

  14. Chest X-Ray

    Medline Plus

    Full Text Available ... some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a ... posted: How to Obtain and Share ...

  15. Chest X-Ray

    Medline Plus

    Full Text Available ... and chest wall and may be used to help evaluate shortness of breath, persistent cough, fever, chest ... or injury. It may also be useful to help diagnose and monitor treatment for a variety of ...

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... are the limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging ( ... heart, valves, great vessels, etc.). top of page What are some common uses of the procedure? MR ...

  17. Chest X-Ray

    Medline Plus

    Full Text Available ... breath, persistent cough, fever, chest pain or injury. It may also be useful to help diagnose and ... have some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to ...

  18. MRI of the Chest

    Medline Plus

    Full Text Available ... to assess the anatomy and function of the heart and its blood flow. Tell your doctor about ... chest cavity, including the mediastinum , chest wall, pleura, heart and vessels, from almost any angle. MRI also ...

  19. Chest tube insertion

    Science.gov (United States)

    Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... Be careful there are no kinks in your tube. The drainage system should always sit upright and be placed ...

  20. Paediatric Malignancies | Joseph | African Journal of Paediatric ...

    African Journals Online (AJOL)

    malignancies. Other common malignancies included sarcomas 10(14.71%), neurofibromatosis 9(13.24%), nephroblastoma 8(11.77%), acute lymphoblastic leukaemia 5(7.35%) and retinoblastoma 4(5.88%). The less common paediatric malignancies were melanoma, invasive lobular breast carcinoma and squamous cell ...

  1. The diagnosis and management of children with blunt injury of the chest.

    Science.gov (United States)

    Sartorelli, Kennith H; Vane, Dennis W

    2004-05-01

    Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.

  2. Chest computed tomography

    DEFF Research Database (Denmark)

    Loeve, Martine; Krestin, Gabriel P.; Rosenfeld, Margaret

    2013-01-01

    are not suitable to study CF lung disease in young children. Chest computed tomography (CT) holds great promise for use as a sensitive surrogate endpoint in CF. A large body of evidence has been produced to validate the use of chest CT as primary endpoint to study CF lung disease. However, before chest CT can...

  3. Paediatric Anxiety Disorders

    Directory of Open Access Journals (Sweden)

    Beena Johnson

    2017-07-01

    Full Text Available Anxiety disorders are highly prevalent among children and are associated with serious morbidity. Lifetime prevalence of paediatric anxiety disorders is about fifteen percent. Social phobia, generalized anxiety disorder and separation anxiety disorder are included in the triad of paediatric anxiety disorders. Specific phobia, obsessive compulsive disorder and post-traumatic stress disorder are also commonly seen in children. Overprotection by parents, parental death or separation, female sex, low educational status, family history of anxiety disorder, financial stress in family and adverse childhood experiences are risk factors for the development of anxiety disorders. If not diagnosed and managed at the earliest, paediatric anxiety disorders can cause life threatening problems in the future. Hence early and scientific management of anxiety disorders is essential. Cognitive behavioural therapy is the effective evidence based treatment for paediatric anxiety disorders.

  4. Paediatric interventional radiology

    African Journals Online (AJOL)

    2016-06-29

    Jun 29, 2016 ... Non-operative management is the standard of care in children with blunt solid ... treatment of choice in children with extensive deep venous ... thrombosis. An IVC .... children, a paediatric nurse comfortable with administering.

  5. American College of Chest Physicians

    Science.gov (United States)

    ... Foundation Participate in the e-Community Get Social Career Connection Publications CHEST Journal CHEST SEEK Guidelines & Consensus Statements CHEST Physician CHEST NewsBrief Coding for Chest Medicine Tobacco Dependence Toolkit (3rd Ed.) Mobile Websites and Apps CHEST Journal ...

  6. Challenges in paediatric neurosurgery

    Directory of Open Access Journals (Sweden)

    Pragati Ganjoo

    2017-01-01

    Full Text Available Improvements in technique, knowledge and expertise have brought about rapid advances in the fields of paediatric neurosurgery and anaesthesia, and many procedures limited earlier to adults are now being increasingly attempted in neonates and small children, with good outcomes. This article highlights the challenges faced by the operating team while handling some of the technically complex procedures like awake craniotomy, interventional neuroradiology, minimally invasive neurosurgery, procedures in intraoperative magnetic resonance imaging suites, and neonatal emergencies in the paediatric population.

  7. Radiological imaging of the neonatal chest. 2. rev. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Donoghue, Veronica (ed.) [Children' s University Hospital, Dublin (Ireland). Dept. of Radiology; National Maternity Hospital, Dublin (Ireland)

    2008-07-01

    This second, revised edition of Radiological Imaging of the Neonatal Chest provides a comprehensive and up-to-date discussion of the subject. It is written primarily from the point of view of the paediatric radiologist but will be of particular interest to all antenatal ultrasonographers, neonatologists, paediatric cardiologists, paediatricians and paediatric surgeons. It includes an update on clinical management and appraises the advantages of the various techniques available to image the newborn chest. There is particular emphasis on the impact of recent therapeutic advances on imaging findings. Extensive consideration is given to both antenatal and postnatal imaging of congenital chest malformations, as well as to controversies regarding the postnatal management of asymptomatic infants with these anomalies. There are dedicated chapters on upper airway problems, infection and congenital heart disease, with special emphasis on the current role of magnetic resonance imaging, computed tomography and interventional therapy. There is also a chapter devoted to computed radiography and digital radiography. This book contains important information for all those involved in caring for the neonate. (orig.)

  8. Reconstruction of the chest wall after excision of a giant malignant ...

    African Journals Online (AJOL)

    2011-07-29

    Jul 29, 2011 ... Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on ... manubrium. There was no preceding history of trauma, fever, ... were related to pneumothorax and respiratory failures.[5].

  9. CT quantification of pleuropulmonary lesions in severe thoracic trauma

    International Nuclear Information System (INIS)

    Kunisch-Hoppe, M.; Bachmann, G.; Weimar, B.; Bauer, T.; Rau, W.S.; Hoppe, M.; Zickmann, B.

    1997-01-01

    Purpose: Computed quantification of the extent of pleuropulmonary trauma by CT and comparison with conventional chest X-ray - Impact on therapy and correlation with mechanical ventilation support and clinical outcome. Method: In a prospective trial, 50 patients with clinically suspicious blunt chest trauma were evaluated using CT and conventional chest X-ray. The computed quantification of ventilated lung provided by CT volumetry was correlated with the consecutive artificial respiration parameters and the clinical outcome. Results: We found a high correlation between CT volumetry and artificial ventilation concerning maximal pressures and inspiratory oxygen concentration (FiO 2 , Goris-Score) (r=0.89, Pearson). The graduation of thoracic trauma correlated highly with the duration of mechanical ventilation (r=0.98, Pearson). Especially with regard to atelectases and lung contusions CT is superior compared to conventional chest X-ray; only 32% and 43%, respectively, were identified by conventional chest X-ray. (orig./AJ) [de

  10. Malnutrition in paediatric oncology patients

    African Journals Online (AJOL)

    Nutritional status of paediatric cancer patients at diagnosis ... Professor and Executive Head, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, .... can lead to decreased oral intake, weight loss.

  11. Genodermatoses in paediatric age group

    Directory of Open Access Journals (Sweden)

    Kumar Sunil

    1996-01-01

    Full Text Available Pattern of genodermatoses in paediatric age group was studied. The relative incidence of genodermatoses in paediatric dermatology out patient department was 0.62%. The commonest genodermatoses observed was ichthyosis.

  12. Drugs for the paediatric heart

    African Journals Online (AJOL)

    Head, Paediatric Cardiology Service of the Western Cape, Department of Paediatrics and Child Health, ... His interests also include the care of complex patients ... The pharmacy only has enalapril available – can you substitute this drug for the ...

  13. Review of simulation in paediatrics: The evolution of a revolution

    Directory of Open Access Journals (Sweden)

    Rahul eOjha

    2015-11-01

    Full Text Available Recent changes in medical education have highlighted the importance of experiential learning. Simulation is one model that has gained significant attention in the last decade and has been widely adopted as a training and assessment tool in medical education. Paediatric simulation has been utilized to teach various skills including resuscitation and trauma management, procedural skills and team training. It is also a valuable tool for health care educators, as it allows learners to achieve competence without putting patients at risk. Recent literature demonstrates increased retention of knowledge and skills after simulation based training. Further research is required to improve current simulation curriculums, develop validated assessment tools and to demonstrate improved clinical outcomes after simulation based training. We conducted an online search of original and review articles related to simulation and paediatric medical education and provide an overview of the role and utility of simulation in paediatrics.

  14. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  15. Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations.

    Science.gov (United States)

    McNamara, Caitlin; Mironova, Irina; Lehman, Erik; Olympia, Robert P

    2017-06-01

    Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. We performed a retrospective chart review of pediatric patients (trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. A prehospital use of ITClamp for haemostatic control and fixation of a chest tube

    DEFF Research Database (Denmark)

    Barnung, S; Steinmetz, J

    2014-01-01

    We here present three cases in which a new device, the ITClamp Hemorrhage Control System (Innovative Trauma Care, Inc., Edmonton, Canada), was used for bleeding control and for securing a chest tube.......We here present three cases in which a new device, the ITClamp Hemorrhage Control System (Innovative Trauma Care, Inc., Edmonton, Canada), was used for bleeding control and for securing a chest tube....

  17. African Journal of Paediatric Surgery

    African Journals Online (AJOL)

    The African Journal of Paediatric Surgery aims to promote research, post- graduate training and further education among Paediatric surgeons, Paediatric Surgical Trainees and paramedical personnel in the surgery of newborn infants and children particularly in Africa and other tropical regions of the world.AJPS welcomes ...

  18. African Journal of Paediatric Nephrology

    African Journals Online (AJOL)

    African Journal of Paediatric Nephrology is the official Journal of the African Paediatric Nephrology Association (AFPNA). The journal is dedicated to increasing awareness and knowledge of Paediatric nephrology in Africa and beyond. We publish research articles on renal diseases in children, on fluid and electrolyte ...

  19. Retinal detachment in paediatric patients

    International Nuclear Information System (INIS)

    Zafar, S. N.; Qureshi, N.; Azad, N.; Khan, A.

    2013-01-01

    Objective: To assess the causes of retinal detachment in children and the various operative procedures requiring vitreoretinal surgical intervention for the same. Study Design: Case series. Place and Duration of Study: Department of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2006 to May 2009. Methodology: A total of 281 eyes of 258 patients, (aged 0 - 18 years) who underwent vitreo-retinal surgical intervention for retinal detachment were included. Surgical log was searched for the type of retinal detachment and its causes. Frequencies of various interventions done in these patients viz. vitrectomy, scleral buckle, use of tamponading agents, laser photocoagulation and cryotherapy were noted. Results were described as descriptive statistics. Results: Myopia was the cause in 62 (22.1%) and trauma in 51 (18.1%) of the eyes. Total retinal detachment (RD) was treated in 94 (33.5%) eyes, sub total RD in 36 (12.8%), recurrent RD in 32 (11.4%), giant retinal tear in 28 (10%), tractional RD in 15 (5.3%) and exudative RD in 2 (0.7%). Prophylactic laser or cryotherapy was applied in 74 (26.3%) of the eyes. Pars plana vitrectomy (PPV) was carried out in 159 (56.6%) eyes while scleral buckle procedure was done in 129 (45.9%) eyes. Silicon oil was used in 149 (53%), perfluorocarbon liquid in 32 (11.4%) and gas tamponade in 20 (7.1%) eyes. Conclusion: The most common cause of retinal detachment in paediatric patients was myopia, followed by trauma. Total RD was more common as compared to the other types. The most common procedure adopted was pars plana vitrectomy followed by scleral buckle procedure. (author)

  20. TRAUMA SURGERY

    African Journals Online (AJOL)

    interest in developing an appropriate and sustainable trauma system in South ... trauma evolved with the social instability which accompanied political change in the ... increased use of military style assault weapons resulted in severe injuries ...

  1. Paediatric interventional radiology

    International Nuclear Information System (INIS)

    McLaren, Clare

    2014-01-01

    Paediatric interventional radiology (PIR) is a rapidly-growing subspecialty, which offers a wide range of procedures applicable to almost all areas of hospital paediatrics. There are many important differences between paediatric and adult practice in interventional radiology, including disease processes and treatment goals, anatomical considerations, periprocedural patient management, radiation exposure optimisation and legal aspects. The use of retrievable or absorbable interventional devices such as stents will probably become more widespread in PIR practice. Recent advances in the technology of imaging equipment have been accompanied by an increase in the complexity of the work done by the radiographer. These developments present challenges and opportunities related to training and maintenance of skills, staffing arrangements, and the potential for advanced practice. It is likely that specialisation in PIR will become a more common role for radiographers in the future

  2. The role of computed tomography in modern paediatric uroradiology

    Energy Technology Data Exchange (ETDEWEB)

    Maudgil, D.D.; McHugh, K. E-mail: kmchugh@gosh.nhs.uk

    2002-08-01

    Computed tomography (CT) has developed a well-recognised role within paediatric uroradiology, especially in imaging of trauma, malignancy (in particular Wilms' tumour), atypical infection, and congenital urogenital abnormalities. CT can also be used for problem solving in nephrolithiasis and renal transplant assessment. These applications are illustrated and discussed, with an emphasis on particular information that can be gained from the CT study.

  3. Paediatric airway management: basic aspects

    DEFF Research Database (Denmark)

    Holm-Knudsen, R J; Rasmussen, L S

    2009-01-01

    Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small...... children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children...

  4. MRI of the Chest

    Medline Plus

    Full Text Available ... chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, which either cannot be assessed ... in diagnosing a broad range of conditions, including cancer, heart and ... tissues, except for lung abnormalities where Chest CT is a preferred imaging ...

  5. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik

    on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...

  6. Picture quiz: a case of sudden severe chest pain.

    Science.gov (United States)

    Rabia, Mustafa Abu; Sullivan, P; Stivaros, Stavros M

    2007-01-01

    An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

  7. Acquired ventricular septal defect: A rare sequel of blunt chest ...

    African Journals Online (AJOL)

    Ventricular septal defect (VSD) is the most common congenital cardiac lesion encountered worldwide. Only very rarely is it acquired, and causation through blunt injury in a child is extremely rare. A previously healthy 7‑year‑old boy suffered blunt chest trauma while at play. He presented 11 days later with features of acute ...

  8. Trauma Imaging: A Literature Review.

    Science.gov (United States)

    Vela, Jason Heath; Wertz, Christopher Ira; Onstott, Kimberly L; Wertz, Joss R

    2017-01-01

    To inform radiologic technologists about which imaging modalities and examinations are best suited for evaluating specific anatomical structures in patients who have sustained a traumatic injury. Two scholarly research databases were searched to identify articles focused on trauma imaging of the head, cervical spine, thorax, abdomen, and pelvis. Articles focused on trauma diagnosis were excluded. Thirty-two articles were selected for analysis. Physical examination and plain-film radiographs typically are used to assess nasal bone fracures. Computed tomography (CT) can be used to assess zygomaticomaxillary complex, mandibular, and temporal bone fractures. Traumatic brain injuries are difficult to assess, and broad classifications are used. Depending on the severity of cervical spine trauma, plain-film radiographs or CT imaging is adequate, with magnetic resonance imaging used as a means for further evaluation. Trauma to the thorax typically is assessed with radiography and CT, and CT is recommended for assesment of abdominal and pelvic trauma. The literature was consistent regarding which examinations to perform to best evaluate suspected injuries to the chest, abdomen, and pelvis. The need for, and correct use of, imaging in evaluating trauma to the head and cervical spine is more controversial. Despite the need for additional research, emergency department care providers should be familiar with the structures most commonly injured during trauma and the role of medical imaging for diagnosis.

  9. A method to detect occult pneumothorax with chest radiography.

    Science.gov (United States)

    Matsumoto, Shokei; Kishikawa, Masanobu; Hayakawa, Koichi; Narumi, Atsushi; Matsunami, Katsutoshi; Kitano, Mitsuhide

    2011-04-01

    Small pneumothoraces are often not visible on supine screening chest radiographs because they develop anteriorly to the lung. These pneumothoraces are termed occult. Occult pneumothoraces account for an astonishingly high 52% to 63% of all traumatic pneumothoraces. A 19-year-old obese woman was involved in a head-on car accident. The admission anteroposterior chest radiographs were unremarkable. Because of the presence of right chest tenderness and an abrasion, we suspected the presence of a pneumothorax. Thus, we decided to take a supine oblique chest radiograph of the right side of the thorax, which clearly revealed a visceral pleural line, consistent with a diagnosis of traumatic pneumothorax. A pneumothorax may be present when a supine chest radiograph reveals either an apparent deepening of the costophrenic angle (the "deep sulcus sign") or the presence of 2 diaphragm-lung interfaces (the "double diaphragm sign"). However, in practice, supine chest radiographs have poor sensitivity for occult pneumothoraces. Oblique chest radiograph is a useful and fast screening tool that should be considered for cases of blunt chest trauma, especially when transport of critically ill patients to the computed tomographic suite is dangerous or when imminent transfer to another hospital is being arranged and early diagnosis of an occult pneumothorax is essential. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  10. Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest.

    Science.gov (United States)

    Nickerson, Terry P; Thiels, Cornelius A; Kim, Brian D; Zielinski, Martin D; Jenkins, Donald H; Schiller, Henry J

    2016-01-01

    Rib fractures are common after chest wall trauma. For patients with flail chest, surgical stabilization is a promising technique for reducing morbidity. Anatomical difficulties often lead to an inability to completely repair the flail chest; thus, the result is partial flail chest stabilization (PFS). We hypothesized that patients with PFS have outcomes similar to those undergoing complete flail chest stabilization (CFS). A prospectively collected database of all patients who underwent rib fracture stabilization procedures from August 2009 until February 2013 was reviewed. Abstracted data included procedural and complication data, extent of stabilization, and pulmonary function test results. Of 43 patients who underwent operative stabilization of flail chest, 23 (53%) had CFS and 20 (47%) underwent PFS. Anterior location of the fracture was the most common reason for PFS (45%). Age, sex, operative time, pneumonia, intensive care unit and hospital length of stay, and narcotic use were the same in both groups. Total lung capacity was significantly improved in the CFS group at 3 months. No chest wall deformity was appreciated on follow-up, and no patients underwent additional stabilization procedures following PFS. Despite advances in surgical technique, not all fractures are amenable to repair. There was no difference in chest wall deformity, narcotic use, or clinically significant impairment in pulmonary function tests among patients who underwent PFS compared with CFS. Our data suggest that PFS is an acceptable strategy and that extending or creating additional incisions for CFS is unnecessary.

  11. Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients

    Energy Technology Data Exchange (ETDEWEB)

    Peters, S., E-mail: soeren.peters@rub.d [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany); Nicolas, V.; Heyer, C.M. [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany)

    2010-04-15

    Accidental injuries are the leading cause of death in the 15 to 44-year-old age group. Blunt chest trauma is often encountered in these patients and is associated with a mortality of up to 25%. Although conventional radiography still plays an important role in the initial emergency room setting, for follow-up in the intensive care unit, multidetector computed tomography has established itself as the standard imaging method for the evaluation of chest trauma patients. The following review presents salient radiological findings of the chest wall and shoulder girdle, thoracic spine, pleural space, and lung in polytraumatized patients.

  12. Nutrition management of a trauma patient with pneumatosis ...

    African Journals Online (AJOL)

    Roberts K, BScDiet, Postgrad Dip Diet. Dietitian ... Keywords: developed pneumatosis intestinalis, trauma patient ... presented with blunt abdominal and chest trauma, a head injury and ... and the goal rate of 93 ml/hour was reached, providing 18% protein, .... result from the side-effects of medication, most commonly from.

  13. Studies on image quality and dose exposure in chest radiography in children

    International Nuclear Information System (INIS)

    Schumacher, R.

    1985-01-01

    Chest radiography accounts for almost 50% of all radiographies in radiological departments for children, thus clearly dominating X-ray performances. The indications for examination in children are frequent infections of the upper airways, congenital cardiac defects, and controls in oncological patients. By contrast, indications for radioscopy of the chest organs which figure greatly in adult age and are often required concurrently with every chest radiography, are rather rare in the patient group of a paediatric X-ray department with their rate of c. 0.5% related to chest radiography. Chest radiographs and phantom radiographs were produced using different techniques and were compared by means of subjective and objective image quality parameters. Concurrently, thermoluminescence dosimetry was used to perform dose measurements of the small gonadal dose occurring in patients in chest radiographies. The study aimed at finding a chest radiography technique appropriate for use in paediatric radiology while considering both image quality parameters and the radiation dose required for producing pictures. (orig./DG) [de

  14. Radiological diagnosis of chest wall tuberculosis: CT versus chest radiograph

    International Nuclear Information System (INIS)

    Liu Fugeng; Pan Jishu; Chen Qihang; Zhou Cheng; Yu Jingying; Tang Dairong

    2006-01-01

    Objective: To evaluate the role of CT or Chest radiograph in diagnosis of chest wall tuberculosis. Methods: The study population included 21 patients with chest wall tuberculosis confirmed by operation or biopsy. Chest radiograph and plain CT were performed in all eases, while enhanced CT in 9 cases, and all images were reviewed by 2 radiologists. Results: Single soft tissue mass of the chest wall was detected in all cases on CT, but not on chest radiograph(χ 2 =42.000, P 2 =4.421, P<0.05). Conclusion: CT, especially enhanced CT scan is the first choice in the diagnosis of chest wall tuberculosis. (authors)

  15. [Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].

    Science.gov (United States)

    Vodička, J; Doležal, J; Vejvodová, Š; Šafránek, J; Špidlen, V; Třeška, V

    2016-01-01

    PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma

  16. Research Status of the Skeletalre Construction of Chest Wall

    Directory of Open Access Journals (Sweden)

    Daixing ZHONG

    2018-04-01

    Full Text Available Chest wall defect may be caused by many factors such as the resection of tumor and trauma, and the reconstruction of bone-defection is still the key point of thoracic surgery. With the development of material science, more and more new materials have been used in medical practice, which makes huge progress in the surgery of chest wall. However, none of these materials satisfy all the practical needs of the reconstruction. Recently, with the development of the capacity of computer, 3D-printing technology has been gradually used in clinical work, and the idea of individual treatment has been accepted by more and more people. The weakness of these materials may be solved by the new material and the application of individual treatment, which could also make great advance in chest wall surgery. This article will make a summary of the research on the reconstruction of chest wall.

  17. Roentgenologic findings of non-penetrating extracardiac chest injuries

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Duck; Ra, Woo Youn [Presbyterian Medical Center, Jeonju (Korea, Republic of)

    1975-06-15

    Of the conventional P-A and A-P chest films which have been studied, many roentgenologic signs suggested for chest trauma. In the present study, an effort was designated to further clarify the x-ray findings of the nonpenetrating extracardiac chest injuries and to observe the x-ray findings being a leading maneuver of surgical procedure. Fat embolism and shock lung must be kept in mind on follow up films. The results thus obtained are summarized as follows; 1. Most of cases are visualized between the age of 10 and 50 and more common in male. 2. The denoting rib fracture, hemopneumothorax, and lung contusion are direct roentgenologic signs. 3. In case of serious result which showed pulmonary edema pattern on conventional chest films, we thought fat embolism or shock lung to be the cause of death.

  18. Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

    International Nuclear Information System (INIS)

    Menachem, S.; Sharfman, Z.T.; Perets, I.; Arami, A.; Eyal, G.; Drexler, M.; Chechik, O.

    2016-01-01

    Aim: To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. Materials and methods: A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. Results: The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1–16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. Conclusion: The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. - Highlights: • Compared outcomes of pediatric forearm fracture reduction with and without fluoroscopy. • The use of fluoroscopy during reduction of forearm fractures in the pediatric population apparently does not have a

  19. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

  20. MRI of the Chest

    Medline Plus

    Full Text Available ... a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will ... abnormalities where Chest CT is a preferred imaging test. MR imaging can assess blood flow without risking ...

  1. Chest X-Ray

    Medline Plus

    Full Text Available ... Disorders Video: The Basketball Game: An MRI Story Radiology and You Sponsored by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey ...

  2. Learning chest imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pedrozo Pupo, John C. (ed.) [Magdalena Univ., Santa Maria (Colombia). Respire - Inst. for Respiratory Care

    2013-03-01

    Useful learning tool for practitioners and students. Overview of the imaging techniques used in chest radiology. Aid to the correct interpretation of chest X-ray images. Radiology of the thorax forms an indispensable element of the basic diagnostic process for many conditions and is of key importance in a variety of medical disciplines. This user-friendly book provides an overview of the imaging techniques used in chest radiology and presents numerous instructive case-based images with accompanying explanatory text. A wide range of clinical conditions and circumstances are covered with the aim of enabling the reader to confidently interpret chest images by correctly identifying structures of interest and the causes of abnormalities. This book, which will be an invaluable learning tool, forms part of the Learning Imaging series for medical students, residents, less experienced radiologists, and other medical staff. Learning Imaging is a unique case-based series for those in professional education in general and for physicians in prarticular.

  3. MRI of the Chest

    Medline Plus

    Full Text Available ... to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed pictures ... over time. top of page What are the benefits vs. risks? Benefits MRI is a noninvasive imaging ...

  4. Chest x-ray

    Science.gov (United States)

    ... pain from a chest injury (with a possible rib fracture or lung complication) or from heart problems Coughing ... arteries Evidence of heart failure In the bones: Fractures or other problems of the ribs and spine Osteoporosis

  5. Chest X-Ray

    Medline Plus

    Full Text Available ... evaluate shortness of breath, persistent cough, fever, chest pain or injury. It may also be useful to ... of ionizing radiation, the benefit of an accurate diagnosis far outweighs any risk. For more information about ...

  6. MRI of the Chest

    Medline Plus

    Full Text Available ... to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed pictures ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  7. Chest X-Ray

    Medline Plus

    Full Text Available ... also be useful to help diagnose and monitor treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no ... Chest? Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose medical conditions. ...

  9. MRI of the Chest

    Medline Plus

    Full Text Available ... a CD or uploaded to a digital cloud server. MRI of the chest gives detailed pictures of ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed ...

  10. Chest X-Ray

    Medline Plus

    Full Text Available ... X-ray Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey Rubin, a radiologist ... about chest x-rays, visit Radiology Info dot org. Thank you for your time! Spotlight Recently posted: ...

  11. MRI of the Chest

    Medline Plus

    Full Text Available ... sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ... prior to your scheduled examination. Infants and young children usually require sedation or anesthesia to complete an ...

  12. MRI of the Chest

    Medline Plus

    Full Text Available ... sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ... on the child's age, intellectual development and the type of exam. Moderate and conscious sedation can be ...

  13. MRI of the Chest

    Medline Plus

    Full Text Available ... or headphones during the exam. MRI scanners are air-conditioned and well-lit. Music may be played ... the limitations of MRI of the Chest? High-quality images are assured only if you are able ...

  14. MRI of the Chest

    Medline Plus

    Full Text Available ... detailed pictures of the structures within the chest. It is primarily used to assess abnormal masses such ... and determine the size, extent and degree of its spread to adjacent structures. It’s also used to ...

  15. MRI of the Chest

    Medline Plus

    Full Text Available ... etc.). top of page What are some common uses of the procedure? MR imaging of the chest ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ...

  16. Chest X-Ray

    Medline Plus

    Full Text Available ... An MRI Story Radiology and You Sponsored by Image/Video Gallery Your Radiologist Explains Chest X-ray ... posted: How to Obtain and Share Your Medical Images Movement Disorders Video: The Basketball Game: An MRI ...

  17. MRI of the Chest

    Medline Plus

    Full Text Available ... determine the presence of certain diseases. The images can then be examined on a computer monitor, transmitted ... of the chest cavity (arteries and veins). MRA can also demonstrate an abnormal ballooning out of the ...

  18. Chest X-Ray

    Medline Plus

    Full Text Available ... accurate diagnosis far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot ... Inc. (RSNA). To help ensure current and accurate information, we do not permit copying but encourage linking ...

  19. MRI of the Chest

    Medline Plus

    Full Text Available ... MRI) of the chest uses a powerful magnetic field, radio waves and a computer to produce detailed ... there’s a possibility you are pregnant. The magnetic field is not harmful, but it may cause some ...

  20. MRI of the Chest

    Medline Plus

    Full Text Available ... primarily used to assess abnormal masses such as cancer and determine the size, extent and degree of ... chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, which either ...

  1. Chest X-Ray

    Medline Plus

    Full Text Available ... Site Index A-Z Spotlight Recently posted: Pancreatic Cancer The Limitations of Online Dose Calculators Video: The ... of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  2. MRI of the Chest

    Medline Plus

    Full Text Available ... etc.). top of page What are some common uses of the procedure? MR imaging of the chest ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  3. MRI of the Chest

    Medline Plus

    Full Text Available ... a computer to produce detailed pictures of the structures within the chest. It is primarily used to ... extent and degree of its spread to adjacent structures. It’s also used to assess the anatomy and ...

  4. MRI of the Chest

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Chest Magnetic resonance imaging (MRI) ... clearer and more detailed than with other imaging methods. This detail makes MRI an invaluable tool in ...

  5. MRI of the Chest

    Medline Plus

    Full Text Available ... copied to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed ... sedative prior to your scheduled examination. Infants and young children usually require sedation or anesthesia to complete ...

  6. Chest X-Ray

    Medline Plus

    Full Text Available ... exams and use a very small dose of ionizing radiation to produce pictures of the inside of the ... chest x-ray use a tiny dose of ionizing radiation, the benefit of an accurate diagnosis far outweighs ...

  7. Chest X-Ray

    Medline Plus

    Full Text Available ... However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a tiny dose of ionizing radiation, the benefit of an accurate diagnosis far outweighs any risk. ...

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... heart) and myocardial infarct (scar in the heart muscle due to prior obstruction of blood flow). determine ... ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around ...

  9. MRI of the Chest

    Medline Plus

    Full Text Available ... have a history of kidney disease or liver transplant, it will be necessary to perform a blood ... cancer, heart and vascular disease, heart valve abnormalities, bone and other soft tissue abnormalities of the chest. ...

  10. Chest X-Ray

    Medline Plus

    Full Text Available ... June is Men's Health Month Recently posted: Pancreatic Cancer The Limitations of Online Dose Calculators Video: The ... of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  11. MRI of the Chest

    Medline Plus

    Full Text Available ... around the heart) disease. characterize mediastinal or pleural lesions seen by other imaging modalities, such as chest ... ports artificial limbs or metallic joint prostheses implanted nerve stimulators metal pins, screws, plates, stents or surgical ...

  12. Radiological diagnosis and therapy of chest pain

    International Nuclear Information System (INIS)

    Kutzner, J.; Ernst, H.

    1980-01-01

    The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions, vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure. (orig.) [de

  13. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Vejle-Sørensen, Jens Kristian; Thomsen, Henrik

    ,3 mAs and SID SID of 180 centimetres using a phantom and lithium fluoride thermo luminescence dosimeter (TLD). Dose to risk organs mamma, thyroid and colon are measured at different collimations with one-centimetre steps. TLD results are used to estimate dose reduction for different collimations...... at the conference. Conclusion: Collimation improvement in basic chest radiography can reduce the radiation to female patients at chest x-ray examinations....

  14. Endovascular interventions for multiple trauma

    International Nuclear Information System (INIS)

    Kinstner, C.; Funovics, M.

    2014-01-01

    In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding. Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting. In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible. Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time. Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods. In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access. (orig.) [de

  15. Radiographic evaluation of hepatic trauma

    International Nuclear Information System (INIS)

    Federle, M.P.

    1985-01-01

    The incidence of significant abdominal trauma continues to rise and accounts currently for approximately 10 percent of the annual 130,000 trauma-related deaths in the United States. Over 60 percent of patients are from 10 to 40 years of age, with a striking predominance of males. Children are mostly victims of blunt trauma, while some large reviews of liver trauma in adults show a prevalence of penetrating injuries. Injury to the liver is second only to the spleen in incidence of intraperitoneal injuries. Morbidity and mortality from hepatic trauma are related to the mechanism and extent of injury. Penetrating injuries generally have a lower mortality, about 5 percent, especially if they are due to stab wounds or low velocity gunshot wounds. Shotgun and high velocity gunshot wounds may cause massive fragmentation of the liver and are associated with proportionately greater mortality. The mortality from blunt trauma is from 15 to 45 percent in many large series. Death from isolated liver injury is uncommon, but is usually due to uncontrolled hemorrhage. Injury to other abdominal organs is associated in many cases, as are injuries to the head, chest, and limbs. The extraabdominal injuries are frequently more apparent clinically, but may mask potentially life-threatening abdominal visceral injuries

  16. Prosthetics in Paediatric Dentistry

    Directory of Open Access Journals (Sweden)

    Vulićević Zoran

    2017-07-01

    Full Text Available Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations.

  17. Paediatric treadmill friction injuries.

    Science.gov (United States)

    Jeremijenko, Luke; Mott, Jonathan; Wallis, Belinda; Kimble, Roy

    2009-05-01

    The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards. This retrospective review of children with treadmill friction injuries was conducted in a single tertiary-level burns centre in Australia between January 1997 and June 2007. The study revealed 37 children who sustained paediatric treadmill friction injuries. This was a presentation of 1% of all burns. Thirty-three (90%) of the injuries occurred in the last 3.5 years (January 2004 to June 2007). The modal age was 3.2 years. Thirty-three (90%) injuries were either full thickness or deep partial friction burns. Eleven (30%) required split thickness skin grafts. Of those who became entrapped, 100% required skin grafting. This study found that paediatric treadmill friction injuries are severe and increasing in incidence. Australian standards should be developed, implemented and mandated to reduce this preventable and severe injury.

  18. Litigation in paediatrics

    LENUS (Irish Health Repository)

    Murphu, JFA

    2011-03-01

    on the issue. This is understandable. Most individuals are healthy during their childhood and have less need of and less interaction with medical services when compared with adults. However, Paediatric litigation does happen and furthermore it is likely to increase in parallel with other specialties. Carroll and Buddenbaum1 have described the pattern of Paediatric litigation in the US. The annual incidence of malpractice claims has been quoted to be as high as 6.6 claims per 100 Paediatricians per year. Almost 30% of Paediatricians have been sued with many being sued on more than one occasion. Of these cases 36% were settled out of court, 33% were dropped by the plaintiff with the remainder going before the judiciary. The authors point out that in the US medical malpractice is a hotly debated issue. Litigation has a questionable impact on health care quality, cost, and access to services. The AMA believes that rising premiums are resulting in the curtailment of medical care particularly in states with high medico-legal rates. The Physician Insurers Association of America (PIAA) is a trade organisation which insures 60% of all private practicing physicians and surgeons has been a useful source of data. In the 20 year period 1985-2005 among a total of 214,226 claims there were 6363 (2.9%) Paediatric claims which ranked it 10th among the 28 specialties covered. The claims arose in equal numbers from the hospital and Paediatrician’s office settings. Common reasons for Paediatric litigation were errors in diagnosis (32%), incorrect performance of a medical or surgical procedure (13%), failure to monitor or manage a case effectively (10%) and medication error (5%). The top five medico-legal conditions were meningitis, routine infant or child checks, newborn respiratory problems, appendicitis and brain-damaged infants as a co-defendant with Obstetrics. Good quality information about litigation is important because the discussion among doctors is frequently confused by

  19. Open pneumothorax resulting from blunt thoracic trauma: a case report.

    Science.gov (United States)

    McClintick, Colleen M

    2008-01-01

    Cases of open pneumothorax have been documented as early as 326 BC. Until the last 50 years, understanding of the epidemiology and treatment of penetrating chest trauma has arisen from military surgery. A better understanding of cardiopulmonary dynamics, advances in ventilatory support, and improvement in surgical technique have drastically improved treatment and increased the survival rate of patients with penetrating thoracic trauma. Open pneumothorax is rare in blunt chest trauma, but can occur when injury results in a substantial loss of the chest wall. This case study presents an adolescent who sustained a large open pneumothorax as a result of being run over by a car. Early and appropriate surgical intervention coupled with coordinated efforts by all members of the trauma team resulted in a positive outcome for this patient.

  20. Renal imaging in paediatrics

    International Nuclear Information System (INIS)

    Porn, U.; Hahn, K.; Fischer, S.

    2003-01-01

    The most frequent renal diseases in paediatrics include urinary tract infections, hydronephrosis, kidney anomalies and reflux. The main reason for performing DMSA scintigraphy in paediatrics is the detection of cortical abnormalities related to urinary tract infection. Because the amount of tracer retained in the tubular cells is associated with the distribution of functioning renal parenchyma in the kidney, it is possible, to evaluate the split renal function. In comparison to ultrasound and intravenous urography the sensitivity in the detection of acute as well as chronic inflammatory changes is very high, however less specific. An indication for a renography in neonates and children is beside an estimation of the total renal function and the calculation of the split renal function, the assessment of renal drainage in patients with unclear dilatation of the collecting system in ultrasound. The analysis of the time activity curve provides, especially for follow-up studies, a reproducible method to assess the urinary outflow. The diuretic scintigraphy allows the detection of urinary obstruction. Subsequently it is possible to image the micturition phase to detect vesico-ureteric reflux (indirect MCU) after drainage of tracer from the renal pelvis. An reflux in the ureters or the pelvicalyceal system is visible on the scintigraphic images and can be confirmed by time activity curves. A more invasive technique is the direct isotope cystography with bladder catheterization. The present paper should give an overview about the role of nuclear medicine in paediatric urology. (orig.) [de

  1. Multi-Detector CT Findings of Palpable Chest Wall Masses in Children: A Pictorial Essay

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Ho; Kim, Young Tong [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of); Hong, Hyun Sook [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2013-03-15

    A wide variety of diseases manifest as palpable chest wall masses in children. These include normal variation, congenital anomalies, trauma, infection, axillary lymphadenopathies, soft tissue tumors and bone tumors. Given that most of these diseases are associated with chest wall deformity, diagnosis is difficult by physical examination or ultrasonography alone. However, multi-detector CT with three dimensional reconstruction is useful in the characterization and differential diagnosis of palpable chest wall lesions. In this article, we review the spectrum of palpable chest wall diseases and illustrate their multi-detector CT presentation.

  2. Use of the omentum in chest-wall reconstruction

    International Nuclear Information System (INIS)

    Fix, R.J.; Vasconez, L.O.

    1989-01-01

    Increased use of the omentum in chest-wall reconstruction has paralleled the refinement of anatomic knowledge and the development of safe mobilization techniques. Important anatomic points are the omental attachments to surrounding structures, the major blood supply from the left and right gastroepiploic vessels, and the collateral circulation via the gastroepiploic arch and Barkow's marginal artery. Mobilization of the omentum to the thorax involves division of its attachments to the transverse colon and separation from the greater curvature to fabricate a bipedicled flap. Most anterior chest wounds and virtually all mediastinal wounds can be covered with the omentum based on both sets of gastroepiploic vessels. The arc of transposition is increased when the omentum is based on a single pedicle, allowing coverage of virtually all chest-wall defects. The final method of increasing flap length involves division of the gastroepiploic arch and reliance on Barkow's marginal artery as collateral circulation to maintain flap viability. With regard to chest-wall reconstruction, we have included the omentum in the armamentarium of flaps used to cover mediastinal wounds. The omentum is our flap of choice for the reconstruction of most radiation injuries of the chest wall. The omentum may also be used to provide protection to visceral anastomoses, vascular conduits, and damaged structures in the chest, as well as to cover defects secondary to tumor excision or trauma. In brief, the omentum has proved to be a most dependable and versatile flap, particularly applicable to chest-wall reconstruction

  3. Paediatric Crohn's disease: a radiological review

    International Nuclear Information System (INIS)

    Ali, S.I.; Carty, H.M.L.

    2000-01-01

    Paediatric Crohn's disease can be a serious and complex condition which is not always easy to diagnose if it presents in an atypical manner. Although the pathological processes are the same in adults and children, the clinical presentation and disease distribution can be different in children. The impact of the disease can also be much more significant in a growing and developing child than in an adult. Numerous investigations are available to establish the diagnosis, define the complications and to demonstrate the extra-intestinal manifestations. Close co-operation is required between the clinician and radiologist when investigating a child suspected of having Crohn's disease or its symptoms to minimise the radiation dose and the psychological and physical trauma. We review the clinical and radiological aspects of Crohn's disease and discuss the imaging modalities available in diagnosing Crohn's disease and its complications and suggest an investigation pathway as used in our institution. (orig.)

  4. Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management.

    Science.gov (United States)

    Rickard, Annette C; Vassallo, James; Nutbeam, Tim; Lyttle, Mark D; Maconochie, Ian K; Enki, Doyo G; Smith, Jason E

    2018-04-28

    Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy. 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation. This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan.

    Science.gov (United States)

    Nagarsheth, Khanjan; Kurek, Stanley

    2011-04-01

    Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

  6. Development of the major trauma case review tool.

    Science.gov (United States)

    Curtis, Kate; Mitchell, Rebecca; McCarthy, Amy; Wilson, Kellie; Van, Connie; Kennedy, Belinda; Tall, Gary; Holland, Andrew; Foster, Kim; Dickinson, Stuart; Stelfox, Henry T

    2017-02-28

    As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater agreement was assessed for both the pilot and finalised versions of the tool. The final trauma case review tool contained ten sections, including patient factors (such as pre-existing conditions), presenting problem, a timeline of events, factors contributing to the care delivery problem (including equipment, work environment, staff action, organizational factors), positive aspects of care and the outcome of panel discussion. After refinement, the inter-rater reliability of the human factors and outcome components of the tool improved with an average 86% agreement between raters. This research developed an evidence-informed tool for use in paediatric trauma case review that considers both system safety and human factors to facilitate clinical review of trauma patient care. This tool can be used to identify opportunities for improvement in trauma care and guide quality assurance activities. Validation is required in the adult population.

  7. Diagnostic problems in chest injuries (angiography)

    International Nuclear Information System (INIS)

    Wenz, W.; Strecker, E.P.; Kloehn, I.

    1979-01-01

    Roentgenography is the simplest and most reliable means to arrive at the diagnosis of chest injury. General roentgenograms are difficult to interpret as they tend to be technically imperfect. Fractures, emphysema, pneumothorax, accumulation of fluid can usually be ascertained directly; but the traumatic origin of changes in the pulmonary parenchyma or of an enlarged heart shadow cannot be reliably deduced from the X-ray appearance. It may provide some differential-diagnostic information but the correct interpretation of the findings depends on further observation. In 6-7% of severe chest trauma with vascular injuries and rupture of the diaphragm angiography is indicated. The evidence to be obtained from chest radiography should not be overestimated: fractures of ribs are sometimes overlocked, even by the expert; parenchymatous lesions may manifest themselves as shadows but their nature remains obscure until they have been related to the clinical and subsequent radiological findings. The same applies to rupture of the diaphragm, bronchi or vessels, if only the immediate posttraumatic roentgenographs are examined. A tent-shaped heart shadow is considered characteristic of the presence of fluid in the pericardium; this is valid only for chronic hydropericardium, but not for the potentially fatal cardiac tamponade; if the pericardium has lost its elasticity a haemorrhage of not more than 150 ml may prove fatal. Nor does the roentgenogram provide information about pulmonary function. Especially in cases of pulmonary shock minor changes in the chest roentgenogram may give a false sense of security when, in fact, blood gas analyses show that a life-endangering situation has developed. The radiologist who is aware of the limitations of the method will derive maximum diagnostic benefit from a chest angiography. No other method is capable of supplying information of such great importance in such a short time. (orig.) [de

  8. EVALUATION OF THORACOSCOPY IN THE DIAGNOSIS OF DIAPHRAGMATIC INJURIES IN PENETRATING THORACOABDOMINAL TRAUMA WITHOUT LUNG DEFLATION AT DR GEORGE MUKHARI ACADEMIC HOSPITAL.

    Science.gov (United States)

    Nsakala, L

    2017-06-01

    With a mortality estimated at 25% when missed, diaphragmatic injuries due to penetrating thoracoabdominal trauma present a diagnostic challenge for both the radiologist and the surgeon. In the current literature, chest x-ray has a sensitivity of 27-60% for left-sided injuries and only 17% for right-sided injuries while, CT scan has a sensitivity of 14-61% and a specificity of 76-99%. Thoracoscopy using a single lung ventilation is one of the modalities of choice for the diagnosis of these injuries with a specificity of 100% and a sensitivity of 87.5%. This was a prospective study; all stable trauma patients with penetrating thoracoabdominal injury aged 18 years and above admitted to the trauma unit at Dr George Mukhari Academic Hospital during the period of the study were included. All patients with penetrating thoracoabdominal trauma who were unstable, or necessitating prompt management and all paediatric patients were excluded from the study. In theatre, under general anaesthesia, we first performed thoracoscopy without single lung ventilation followed by laparoscopy as control on each patient. Data was collected using a standard proforma by the attending surgeon and was analysed by a statistician using IBM SPSS 22 software. A total of 32 patients met the inclusion criteria of which 4 were female (12.5%) and 28 male (87.5%) with the median age of 29 years. Of the 32 patients, 27 had thoracoabdominal stab wounds (84.3%) and 5 had gunshot wounds (15.6%). Fourteen patients (43.75%) had left sided injury and 18 patients (56.25%) had injury to the right side. The incidence of diaphragmatic injury was 37.5% (n = 12). No injuries were missed on thoracoscopy; there was no mortality or morbidity. Thoracoscopy without single lung ventilation is safe and comparable to thoracoscopy with single lung ventilation as a diagnostic tool for diaphragmatic injuries in stable patients with penetrating thoracoabdominal trauma.

  9. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms.

    Science.gov (United States)

    Alvarez, Bruno Durante; Razente, Danilo Mardegam; Lacerda, Daniel Augusto Mauad; Lother, Nicole Silveira; VON-Bahten, Luiz Carlos; Stahlschmidt, Carla Martinez Menini

    2016-01-01

    to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencefálico. As variáveis analisadas foram: sexo, idade, dia da semana, mecanismo de trauma, tipo de transporte, RTS, tempo de internamento e mortalidade. analisou-se 200 pacientes, com média de idade de 36,42 ± 17,63 anos, sendo 73,5% do sexo masculino. A média de idade no G1 foi significativamente menor do que nos demais grupos (p grupos (p grupos G1, G2 e G3, respectivamente. A mediana do RTS entre os óbitos foi 5,49, 7,84 e 1,16, respectivamente, para os três grupos. a maioria dos pacientes eram homens jovens. O RTS mostrou-se efetivo na predição de mortalidade no trauma cranioencefálico, entretanto falhou ao analisar pacientes vítimas de trauma contuso e penetrante.

  10. The effect of increased body mass index on patient dose in paediatric radiography

    Energy Technology Data Exchange (ETDEWEB)

    Ladia, Arsenoi P., E-mail: arsenoh@gmail.com; Skiadopoulos, Spyros G., E-mail: skiado@upatras.gr; Karahaliou, Anna N., E-mail: akarahaliou@upatras.gr; Messaris, Gerasimos A.T., E-mail: messaris@upatras.gr; Delis, Harry B., E-mail: hdelis@gmail.com; Panayiotakis, George S., E-mail: panayiot@upatras.gr

    2016-10-15

    Radiation protection is of particular importance in paediatric radiology. In this study, the influence of increased body mass index (BMI) in radiation dose and associated risk was investigated for paediatric patients aged 5–6.5 years, undergoing chest (64 patients) or abdomen (64 patients) radiography. Patients were categorized into normal and overweight, according to the BMI classification scheme. Entrance surface dose (ESD), organ dose, effective dose (ED) and risk of exposure induced cancer death (REID) were calculated using the Monte Carlo based code PCXMC 2.0. Statistically significant increase in patient radiation dose and REID was obtained for overweight patients as compared to normal ones, in both chest and abdomen examinations (Wilcoxon singed-rank test for paired data, p < 0.001). The percentage increase in overweight as compared to normal patients of ESD, organ dose (maximum value), ED and REID was 13.6%, 24.4%, 18.9% and 20.6%, respectively, in case of chest radiographs. Corresponding values in case of abdomen radiographs were 15.0%, 24.7%, 21.8% and 19.8%, respectively. An increased BMI results in increased patient radiation dose in chest and abdomen paediatric radiography.

  11. Predictors of abdominal injuries in blunt trauma.

    Science.gov (United States)

    Farrath, Samiris; Parreira, José Gustavo; Perlingeiro, Jacqueline A G; Solda, Silvia C; Assef, José Cesar

    2012-01-01

    To identify predictors of abdominal injuries in victims of blunt trauma. retrospective analysis of trauma protocols (collected prospectively) of adult victims of blunt trauma in a period of 15 months. Variables were compared between patients with abdominal injuries (AIS>0) detected by computed tomography or/and laparotomy (group I) and others (AIS=0, group II). Student's t, Fisher and qui-square tests were used for statistical analysis, considering p3) in head (18.5% vs. 7.9%), thorax (29.2% vs. 2.4%) and extremities (40.0% vs. 13.7%). The highest odds ratios for the diagnosis of abdominal injuries were associated flail chest (21.8) and pelvic fractures (21.0). Abdominal injuries were more frequently observed in patients with hemodynamic instability, changes in Glasgow coma scale and severe lesions to the head, chest and extremities.

  12. ABDOMINAL TRAUMA- CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Vanaja Ratnakumari Billa

    2017-08-01

    Full Text Available BACKGROUND In the recent times there has been increased incidence of abdominal trauma cases due to several causes. Quick and prompt intervention is needed to decrease the mortality of the patients. So we conducted a study to assess the cause and the management of abdominal trauma cases in our institution. The aim of this study was to know the incidence of blunt and penetrating injuries and their causes, age and sex incidence, importance of various investigations, mode of treatment offered and post-operative complications. To study the cause of death and evolve better management. MATERIALS AND METHODS The present study comprises of patients admitted to and operated in various surgical units in the Department of Surgery at Government General Hospital, attached to Guntur Medical College Guntur, from August 2014 to October 2016. RESULTS Increase incidence seen in age group 20-29 years (30%. Male predominance 77.5%. Mechanism of injury–road traffic accidents 65%. Isolated organ injury–colon and rectum 40%. Other associated injuries–chest injuries with rib fractures 7.5%. Complications–wound infection 17.5%. Duration of hospital stay 8–14 days. Bowel injury management–closure of perforation 84.6%. Resection anastomosis 15.38%. CONCLUSION Thorough clinical examination, diagnostic paracentesis, plain X-ray erect abdomen and ultrasound proved to be very helpful in the diagnosis of intra-abdominal injuries. Spleen is the commonest organ involved in blunt trauma and colon is the commonly injured organ in penetrating abdominal trauma, many patients have associated extremity and axial skeleton injuries. With advances in diagnosis and intensive care technologies, most patients of solid visceral injuries with hemodynamic stability can be managed conservatively. Surgical site infection is the most common complication following surgery. The mortality is high; reason might be patient reaching the hospital late, high incidence of postoperative septic

  13. What is optimal timing for trauma team alerts? A retrospective observational study of alert timing effects on the initial management of trauma patients

    Directory of Open Access Journals (Sweden)

    Lillebo B

    2012-08-01

    Full Text Available Borge Lillebo,1 Andreas Seim,2 Ole-Petter Vinjevoll,3 Oddvar Uleberg31Norwegian EHR Research Centre, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Computer and Information Science, Faculty of Information Technology, Mathematics and Electrical Engineering, NTNU, Trondheim, Norway; 3Department of Anaesthesia and Emergency Medicine, St Olav's University Hospital, Trondheim, NorwayBackground: Trauma teams improve the initial management of trauma patients. Optimal timing of trauma alerts could improve team preparedness and performance while also limiting adverse ripple effects throughout the hospital. The purpose of this study was to evaluate how timing of trauma team activation and notification affects initial in-hospital management of trauma patients.Methods: Data from a single hospital trauma care quality registry were matched with data from a trauma team alert log. The time from patient arrival to chest X-ray, and the emergency department length of stay were compared with the timing of trauma team activations and whether or not trauma team members received a preactivation notification.Results: In 2009, the trauma team was activated 352 times; 269 times met the inclusion criteria. There were statistically significant differences in time to chest X-ray for differently timed trauma team activations (P = 0.003. Median time to chest X-ray for teams activated 15–20 minutes prearrival was 5 minutes, and 8 minutes for teams activated <5 minutes before patient arrival. Timing had no effect on length of stay in the emergency department (P = 0.694. We found no effect of preactivation notification on time to chest X-ray (P = 0.474 or length of stay (P = 0.684.Conclusion: Proactive trauma team activation improved the initial management of trauma patients. Trauma teams should be activated prior to patient arrival.Keywords: emergency medical service communication systems

  14. Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

    Science.gov (United States)

    Arshid, Muhammad; Lo, Tsz-Yan Milly; Reynolds, Fiona

    2009-05-01

    Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

  15. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

    NARCIS (Netherlands)

    Schuurmans, Jaap; Goslings, J. C.; Schepers, T.

    2017-01-01

    Flail chest is a life-threatening complication of severe chest trauma with a mortality rate of up to 15 %. The standard non-operative management has high comorbidities with pneumonia and often leads to extended Intensive Care Unit (ICU) stay, due to insufficient respiratory function and

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... immediately available, as is often necessary in trauma situations. Although there is no reason to believe that ... of North America, Inc. (RSNA). To help ensure current and accurate information, we do not permit copying ...

  17. MRI of the Chest

    Medline Plus

    Full Text Available ... be necessary. Your doctor will explain the exact reason why another exam is requested. Sometimes a follow- ... necessary in trauma situations. Although there is no reason to believe that magnetic resonance imaging harms the ...

  18. Metastatic paediatric colorectal carcinoma.

    LENUS (Irish Health Repository)

    Woods, R

    2012-03-01

    A 16-year-old girl presented to our unit with crampy abdominal pain, change in bowel habit, a subjective impression of weight loss and a single episode of haematochezia. She was found to have a rectosigmoid adenocarcinoma and proceeded to laparoscopic anterior resection, whereupon peritoneal metastases were discovered. She received chemotherapy and is alive and well ten month later with no radiological evidence of disease. Colorectal carcinoma is rare in the paediatric population but is increasing in incidence. Early diagnosis is critical to enable optimal outcomes.

  19. Paediatric nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Da Costa, H [Bhabha Atomic Research Centre, Bombay (India). Radiation Medicine Centre

    1978-05-01

    The use of radiopharmaceutical agents for the diagnosis of diseases frequently encountered in the paediatric age group is outlined. The agents suitable for scanning of brain, thyroid, kidney, liver and spleen are mentioned and their efficacy in diagnosis of pathological conditions based on practical experience is reported. Bromide partition test for diagnosis of intracranial tuberculosis and /sup 131/I uptake test for thyroid study are also described. Dose of the agent is smaller than that in the case of adults and depends upon the child's body weight.

  20. Chest sonography. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Mathis, Gebhard (ed.)

    2008-07-01

    Chest sonography is an established procedure in the stepwise imaging diagnosis of pulmonary and pleural disease. It is the method of choice to distinguish between solid and liquid lesions and allows the investigator to make an unequivocal diagnosis without exposing the patient to costly and stressful procedures. This book presents the state of the art in chest investigation by means of ultrasonography. A number of excellent illustrations and the compact text provide concise and easy-to-assimilate information about the diagnostic procedure. Basic elements such as indications, investigation techniques and image artifacts are detailed in separate chapters. (orig.)

  1. Chest sonography. 2. ed.

    International Nuclear Information System (INIS)

    Mathis, Gebhard

    2008-01-01

    Chest sonography is an established procedure in the stepwise imaging diagnosis of pulmonary and pleural disease. It is the method of choice to distinguish between solid and liquid lesions and allows the investigator to make an unequivocal diagnosis without exposing the patient to costly and stressful procedures. This book presents the state of the art in chest investigation by means of ultrasonography. A number of excellent illustrations and the compact text provide concise and easy-to-assimilate information about the diagnostic procedure. Basic elements such as indications, investigation techniques and image artifacts are detailed in separate chapters. (orig.)

  2. Utility of Chest Computed Tomography after a "Normal" Chest Radiograph in Patients with Thoracic Stab Wounds.

    Science.gov (United States)

    Nguyen, Brian M; Plurad, David; Abrishami, Sadaf; Neville, Angela; Putnam, Brant; Kim, Dennis Y

    2015-10-01

    Chest computed tomography (CCT) is used to screen for injuries in hemodynamically stable patients with penetrating injury. We aim to determine the incidence of missed injuries detected on CCT after a negative chest radiograph (CXR) in patients with thoracic stab wounds. A 10-year retrospective review of a Level I trauma center registry was performed on patients with thoracic stab wounds. Patients who were hemodynamically unstable or did not undergo both CXR and CCT were excluded. Patients with a negative CXR were evaluated to determine if additional findings were diagnosed on CCT. Of 386 patients with stab wounds to the chest, 154 (40%) underwent both CXR and CCT. One hundred and fifteen (75%) had a negative screening CXR. CCT identified injuries in 42 patients (37%) that were not seen on CXR. Pneumothorax and/or hemothorax occurred in 40 patients (35%), of which 14 patients underwent tube thoracostomy. Two patients had hemopericardium on CCT and both required operative intervention. Greater than one-third of patients with a normal screening CXR were found to have abnormalities on CCT. Future studies comparing repeat CXR to CCT are required to further define the optimal diagnostic strategy in patients with stab wounds to chest after normal screening CXR.

  3. Paediatric radiology. 2. enl. and tot. rev. ed.

    International Nuclear Information System (INIS)

    Benz-Bohm, G.

    2005-01-01

    This book presents a current, comprehensive and clearly written introduction to the often-neglected field of paediatric radiology, from important aspects of radiation protection to the specific anatomic features of the growing skeleton and the special anatomy of the thorax and abdomen of newborns and infants. Special knowledge is imparted on the radiology of trauma effects in infant age and the 'battered child syndrome'. The diseases and findings are presented in an organ-specific and topographic manner. There are special chapters on sonography, CT and MRT in infants. The structure of the book serves two purposes. First, the reader can obtain information on specific diseases; secondly, the particular features of examination techniques and the specifics of paediatric radiology are presented. (orig.) [de

  4. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  5. Tailbone trauma

    Science.gov (United States)

    For tailbone trauma when no spinal cord injury is suspected: Relieve pressure on the tailbone by sitting on an inflatable rubber ring or cushions. Take acetaminophen for pain. Take a stool softener to avoid constipation. If you suspect injury ...

  6. Thoracic trauma: presentation and management outcome

    International Nuclear Information System (INIS)

    Saaiq, M.; Shah, S. A.

    2008-01-01

    To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. out of 143 patients, 119 (83)% were males and 24 (17)% were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66)% patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45%) patients. Seventeen (11.88%) patients were managed with mechanical ventilation. there were 17 deaths with a mortality rate of 11.88%. Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions. (author)

  7. Facial trauma.

    Science.gov (United States)

    Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

    Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... Imaging (MRI) - Chest Sponsored by Please note RadiologyInfo.org is not a medical facility. Please contact your ... links: For the convenience of our users, RadiologyInfo .org provides links to relevant websites. RadiologyInfo.org , ACR ...

  9. MRI of the Chest

    Medline Plus

    Full Text Available ... transplant, it will be necessary to perform a blood test to determine whether the kidneys are functioning adequately. ... abnormalities where Chest CT is a preferred imaging test. MR imaging can assess blood flow without risking the side effects of conventional ( ...

  10. MRI of the Chest

    Medline Plus

    Full Text Available ... internal body structures. MRI does not use ionizing radiation (x-rays). Detailed MR images allow physicians to evaluate various ... seen by other imaging modalities, such as chest x-ray or CT. A special form of MRI called ...

  11. Chest X-Ray

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos ... x-ray is used to evaluate the lungs, heart and chest wall and may be used to ...

  12. MRI of the Chest

    Medline Plus

    Full Text Available ... of which shows a thin slice of the body. The images can then be studied from different angles by ... bear denotes child-specific content. Related Articles and Media MR ... Images related to Magnetic Resonance Imaging (MRI) - Chest Sponsored ...

  13. MRI of the Chest

    Medline Plus

    Full Text Available ... body structures. MRI does not use ionizing radiation (x-rays). Detailed MR images allow physicians to evaluate various ... seen by other imaging modalities, such as chest x-ray or CT. A special form of MRI called ...

  14. MRI of the Chest

    Medline Plus

    Full Text Available ... computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI ... cancer, heart and vascular disease, heart valve abnormalities, bone and other soft tissue abnormalities of the chest. MRI is also useful ...

  15. Chest X-Ray

    Medline Plus

    Full Text Available ... change into a gown. You may have some concerns about chest x-rays. However, it’s important to ... You Sponsored by About Us | Contact Us | FAQ | Privacy | Terms of Use | Links | Site Map Copyright © 2018 ...

  16. Paediatric nuclear medicine imaging.

    Science.gov (United States)

    Biassoni, Lorenzo; Easty, Marina

    2017-09-01

    Nuclear medicine imaging explores tissue viability and function by using radiotracers that are taken up at cellular level with different mechanism. This imaging technique can also be used to assess blood flow and transit through tubular organs. Nuclear medicine imaging has been used in paediatrics for decades and this field is continuously evolving. The data presented comes from clinical experience and some milestone papers on the subject. Nuclear medicine imaging is well-established in paediatric nephro-urology in the context of urinary tract infection, ante-natally diagnosed hydronephrosis and other congenital renal anomalies. Also, in paediatric oncology, I-123-meta-iodobenzyl-guanidine has a key role in the management of children with neuroblastic tumours. Bone scintigraphy is still highly valuable to localize the source of symptoms in children and adolescents with bone pain when other imaging techniques have failed. Thyroid scintigraphy in neonates with congenital hypothyroidism is the most accurate imaging technique to confirm the presence of ectopic functioning thyroid tissue. Radionuclide transit studies of the gastro-intestinal tract are potentially useful in suspected gastroparesis or small bowel or colonic dysmotility. However, until now a standardized protocol and a validated normal range have not been agreed, and more work is necessary. Research is ongoing on whether magnetic resonance imaging (MRI), with its great advantage of great anatomical detail and no ionizing radiations, can replace nuclear medicine imaging in some clinical context. On the other hand, access to MRI is often difficult in many district general hospitals and general anaesthesia is frequently required, thus adding to the complexity of the examination. Patients with bone pain and no cause for it demonstrated on MRI can benefit from bone scintigraphy with single photon emission tomography and low-dose computed tomography. This technique can identify areas of mechanical stress at

  17. Organ dose and risk assessment in paediatric radiography using the PCXMC 2.0

    Science.gov (United States)

    Ladia, A.; Messaris, G.; Delis, H.; Panayiotakis, G.

    2015-09-01

    Abdominal and chest radiographs are the most common examinations in paediatric radiology. X-ray examination of children attracts particular interest, mainly due to the increased risk for the expression of delayed radiogenic cancers as they have many years of expected life remaining. This study aims to calculate the organ dose and estimate the radiation Risk of Exposure Induced cancer Death (REID) to paediatric patients, using the PCXMC 2.0 Monte Carlo code.Patient data and exposure parameters were recorded during examinations of 240 patients, separated in four age groups undergoing chest or abdomen examinations.The organs received the highest dose in all patient groups were liver, lungs, stomach, thyroid, pancreas, breast, spleen in chest radiographs and liver, lungs, colon, stomach and ovaries, uterus (for girls) and prostate (for boys) in abdomen radiographs. The effective dosefor the chest was 0.49×10-2- 1.07×10-2 mSv, while for the abdomen 1.85×10-2- 3.02×10-2 mSv. The mean REID value was 1.254×10-5 for the abdomen and 0.645×10-5 for the chest.

  18. Organ dose and risk assessment in paediatric radiography using the PCXMC 2.0

    International Nuclear Information System (INIS)

    Ladia, A; Messaris, G; Delis, H; Panayiotakis, G

    2015-01-01

    Abdominal and chest radiographs are the most common examinations in paediatric radiology. X-ray examination of children attracts particular interest, mainly due to the increased risk for the expression of delayed radiogenic cancers as they have many years of expected life remaining. This study aims to calculate the organ dose and estimate the radiation Risk of Exposure Induced cancer Death (REID) to paediatric patients, using the PCXMC 2.0 Monte Carlo code.Patient data and exposure parameters were recorded during examinations of 240 patients, separated in four age groups undergoing chest or abdomen examinations.The organs received the highest dose in all patient groups were liver, lungs, stomach, thyroid, pancreas, breast, spleen in chest radiographs and liver, lungs, colon, stomach and ovaries, uterus (for girls) and prostate (for boys) in abdomen radiographs. The effective dosefor the chest was 0.49×10 -2 - 1.07×10 -2 mSv, while for the abdomen 1.85×10 -2 - 3.02×10 -2 mSv. The mean REID value was 1.254×10 -5 for the abdomen and 0.645×10 -5 for the chest. (paper)

  19. The presence of radiological features on chest radiographs: How well do clinicians agree?

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, M. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Lawson, Z. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Morris, S.; Evans, A.; Harrison, S.; Isaac, R. [Department of Paediatric Radiology, University Hospital of Wales, Cardiff (United Kingdom); Crocker, J. [Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Powell, C., E-mail: powellc7@cardiff.ac.uk [Department of Child Health, School of Medicine, Cardiff University (United Kingdom)

    2012-07-15

    Aim: To compare levels of agreement amongst paediatric clinicians with those amongst consultant paediatric radiologists when interpreting chest radiographs (CXRs). Materials and methods: Four paediatric radiologists used picture archiving and communication system (PACS) workstations to evaluate the presence of five radiological features of infection, independently in each of 30 CXRs. The radiographs were obtained over 1 year (2008) from children with fever and signs of respiratory distress, aged 6 months to <16 years. The same CXRs were interpreted a second time by the paediatric radiologists and by 21 clinicians with varying experience levels, using the Web 1000 viewing system and a projector. Intra- and interobserver agreement within groups, split by grade and specialty, were analysed using free-marginal multi-rater kappa. Results: Normal CXRs were identified consistently amongst all 25 participants. The four paediatric radiologists showed high levels of intraobserver agreement between methods (kappa scores between 0.53 and 1.00) and interobserver agreement for each method (kappa scores between 0.67 and 0.96 for PACS assessment). The 21 clinicians showed varying levels of agreement from 0.21 to 0.89. Conclusion: Paediatric radiologists showed high levels of agreement for all features. In general, the clinicians had lower levels of agreement than the radiologists. This study highlights the need for improved training in interpreting CXRs for clinicians and the timely reporting of CXRs by radiologists to allow appropriate patient management.

  20. The development of paediatric neuroradiology

    International Nuclear Information System (INIS)

    Harwood-Nash, D.C.

    1978-01-01

    The development of paediatric neuroradiology is a specific persuasion within neuroradiology and has increased in scope and significance throughout the last ten years. The emergence of computed tomography has altered the indications for types of neuroradiological procedures in infants and children. The sophistication, accuracy, and safety of standard neuroradiological procedures have been increased by the accuracy and safety of computed tomography, particularly in the premature infant. There is a growing need for education and instruction in paediatric neuroradiological techniques and paediatric neuroradiological diseases within the neuroradiological fraternity as a whole. (orig.) [de

  1. Radiographic features of paediatric pneumocystis pneumonia - a historical perspective

    International Nuclear Information System (INIS)

    Pitcher, R.D.; Zar, H.J.

    2008-01-01

    Aim: To determine differences between the plain radiographic features of paediatric pneumocystis pneumonia (PCP) recorded before the emergence of human immunodeficiency virus (HIV) in 1982 and those documented in the HIV era. To establish differences in the radiographic features of PCP documented in HIV-infected children in developed and developing countries. Method: A Medline search of articles was conducted from 1950 to 2006, using the terms 'pneumocystis pneumonia in children' and 'chest radiographic features' or 'bilateral opacification' or 'lobar consolidation' or 'asymmetrical opacification' or 'pneumatocoeles' or 'cavities' or 'pneumothorax' or 'pneumomediastinum' or 'pleural effusion' or 'mediastinal adenopathy' or 'nodules' or 'normal chest radiography'. Appropriate articles were retrieved, radiological data extracted, reference lists examined and hand searches of referenced articles conducted. Results: Diffuse bilateral 'ground-glass' or alveolar pulmonary opacification, which may show some asymmetry, has been consistently documented as the commonest radiographic finding in childhood PCP throughout the period under review. The less common radiological features of PCP in children are similar to those in adults. In developed countries, PCP-related pulmonary air cysts have been reported at an earlier age in HIV-infected children, compared with uninfected children. PCP-related air cysts, pneumothorax, and pneumomediastinum have been reported in children in developed but not in developing countries. Conclusion: The radiological features of paediatric PCP documented before the HIV epidemic are similar to those recorded in the HIV era. Further study of the determinants of the uncommon radiographic features in children is warranted

  2. Diagnostic modalities x-ray and CT chest differ in the management of thoracic injury

    Directory of Open Access Journals (Sweden)

    D Chapagain

    2015-06-01

    Full Text Available Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years. The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%, followed by fall injury (20.2%. X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1; 22-31

  3. Assessment of paediatric CT exposure in a Portuguese hospital

    International Nuclear Information System (INIS)

    Neves, A.; Nunes, A.; Rufino, M.; Madeira, P.; Vaz, P.; Pascoal, A.

    2012-01-01

    In this study, the characterisation of radiation exposure of paediatric patients in computerised tomography (CT) procedures was performed for a Portuguese hospital. Dosimetric data and technical parameters used for CT examinations were retrieved, compiled and analysed over a period of 1 y. Five paediatric age groups were considered, covering the age interval from 0 (newborn) to 18 y old and, for each age group, the relative frequency of the most frequent CT examinations (head, ears, sinuses, chest and abdomen examinations) is analysed. The exposure settings used (kilovolt and milli-ampere) were compared with the values established in the local (hospital) clinical protocols for consistency analysis. Average CT dose index vol and dose length product values, per age group, are presented as well as the corresponding estimated mean effective dose values. Results showed an evident need for a protocol review, in order to adjust practices to international guidelines for performing optimised paediatric CT examinations. Also, an increased awareness of staff to Radiological Protection principles in CT in particular, these of utmost importance, seems necessary. (authors)

  4. Paediatric x-ray examinations in Rio de Janeiro

    International Nuclear Information System (INIS)

    Azevedo, A C P; Osibote, O A; Boechat, M C B

    2006-01-01

    This work presents the results of a dose survey performed for paediatric patients and carried out in two large paediatric public hospitals in Rio de Janeiro city. The entrance surface dose (ESD) and the effective dose (ED) were evaluated for chest, skull, abdomen, lumbar spine, cervical spine and pelvis in antero-posterior (AP), postero-anterior (PA) and lateral (LAT) projections. For each examination, four age groups 0-1, 1-5, 5-10 and 10-15 years were studied. The DoseCal software was used to calculate these doses. Wide variations for the same type of examination and projection have been detected. These variations were evident, in Brazil, from previous work. In spite of the present results being still preliminary, they can give an idea of what paediatric ESDs are like in Brazil. Also, with respect to the entrance surface dose, some of the results are above the reference levels, which cause high ED, as well. On the other hand, the wide range of ESD reflects the disparity of radiographic techniques and demonstrates that the ALARA principle is not being applied in Brazilian hospitals and becomes a concern in terms of public health

  5. Geriatric trauma.

    Science.gov (United States)

    Adams, Sasha D; Holcomb, John B

    2015-12-01

    The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

  6. Abdominal trauma

    International Nuclear Information System (INIS)

    Giordany, B.R.

    1985-01-01

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  7. Intrathoracic lipoma masquerading as subclavian artery trauma.

    LENUS (Irish Health Repository)

    Munro, P T

    2012-02-03

    A 58 year old man was admitted to the accident and emergency department following an industrial accident in which he sustained a three part fracture dislocation of his right humerus. Chest radiography revealed a large mass in the right upper hemithorax and, when the patient became hypotensive, an emergency thoracotomy was performed. The mass was found to be a massive intrathoracic lipoma. This case shows how preexisting intrathoracic lesions may be mistaken for subclavian or great vessel trauma following violent shoulder girdle injury. The differential diagnosis of traumatic and non-traumatic intrathoracic mass lesions in chest radiography should be considered carefully.

  8. Cuffed endotracheal tubes in paediatrics

    African Journals Online (AJOL)

    cuffed endotracheal tubes (CETTs) in children who are younger than eight years old. Most paediatric ... the smallest functional part of the infant airway, because the ... During the 2003 severe acute respiratory syndrome (SARS) outbreak in ...

  9. Evaluation of effectiveness of a paediatric simulation course in procedural skills for paediatric residents - A pilot study.

    Science.gov (United States)

    AlShammari, Abdullah; Inayah, Aman; Afsar, Nasir Ali; Nurhussen, Akram; Siddiqui, Amna; Anwer, Muhammad Lucman; Obeidat, Sadek; Bakro, Mohammed Khaled; Abu Assale, Tawfik Samer; Almidani, Eyad; Alsonbul, Abdullah; Alhaider, Sami; Hussain, Ibrahim Bin; Khadawardi, Emad; Zafar, Muhammad

    2018-02-01

    To explore the effects of simulation training on paediatric residents' confidence and skills in managing advanced skills in critical care. The study was conducted at Alfaisal University, Riyadh, Saudi Arabia, from March to June 2016, and comprised junior residents in paediatrics. All paediatric residents (years 1 and 2) were recruited into two workshops, held one week apart. The first workshop covered lumbar puncture/ cerebrospinal fluid interpretation, oral intubation, bone marrow aspiration, and critical airway management. The second workshop covered chest tube insertion, pleural tap, insertion of central line, and arthrocentesis. The participants were surveyed using a 5-point Likert scale survey pre- and post-course, assessing their confidence. Their practical skills were assessed using a pre-objective structured clinical examination on the same day and post-course objective structured clinical examination a week later on selected skills. The outcome measures were: (1) pre-/post-course confidence rating, and (2) pre-/post-course objective structured clinical examination results. Data was analysed using SPSS 20. Of the 16 participants, 8(50%) were boys and 8(50%) girls. Besides, 13(81%) residents were in year-1 and 3(19%) in year-2. Median post-course confidence level ranks for all the skills were higher (pskills and confidence in performing critical tasks.

  10. Pancreatic trauma.

    Science.gov (United States)

    Lahiri, R; Bhattacharya, S

    2013-05-01

    Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: 'pancreatic trauma', 'pancreatic duct injury', 'radiology AND pancreas injury', 'diagnosis of pancreatic trauma', and 'management AND surgery'. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases

  11. Sandstorm in the chest?

    Directory of Open Access Journals (Sweden)

    Talluri MR

    2011-07-01

    Full Text Available A 32 year old female presented with dry cough and progressive breathlessness of one year duration. There was no history suggestive of collagen vascular disease, lung parenchymal infection or allergic airway disease. Clinical evaluation showed basal fine inspiratory crepitations. Radiographic examination of the chest revealed a black pleura line and lung parenchymal calcification. CT scan of the chest demonstrated nodular calcification of lung parenchyma with a “crazy pavement” pattern, which is suggestive of alveolar calcification. Pulmonary function test showed a severe restrictive defect. On transbronchial lung biopsy calcific spherules suggestive of the alveolar microlithiasis were seen. Diagnosis of pulmonary alveolar microlithiasis was made and symptomatic treatment was given, as there is no specific therapy available. The case illustrates an unusual cause of shortness of breath in a young female with striking radiographic features.

  12. Pediatric digital chest imaging.

    Science.gov (United States)

    Tarver, R D; Cohen, M; Broderick, N J; Conces, D J

    1990-01-01

    The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology.

  13. Pediatric digital chest imaging

    International Nuclear Information System (INIS)

    Tarver, R.D.; Cohen, M.; Broderick, N.J.; Conces, D.J. Jr.

    1990-01-01

    The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology

  14. Patient exposure in paediatric radiology

    International Nuclear Information System (INIS)

    Iacob, O.; Diaconescu, C.; Isac, R.

    2002-01-01

    Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study was to assess, in terms of effective dose, the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses delivered to patient

  15. Splenic Trauma

    International Nuclear Information System (INIS)

    Cortes Diaz, Fabio F; Buitrago Mejia, Francisco; Ulloa Guerrero, Luis Heber

    2001-01-01

    The spleen is the organ that is injured during the closed trauma with more frequency and it is the cause more common of foregone death in the patients with wounded abdominal. At the present time the complications of the splenic trauma are related with their severity, associate wounds, diagnostic fail or inadequate treatments. The lesions that are diagnosed in early form are managed quick and satisfactorily, but the forgotten wounds or the diagnoses and late treatments take for themselves high rates of morbid-mortality. The paper includes their phyto pathology, diagnoses, classification and treatment

  16. Ballistic trauma

    Directory of Open Access Journals (Sweden)

    Parvathi Devi Munishwar

    2016-01-01

    Full Text Available Gunshot injuries are rather serious but uncommon type of trauma in India. Radiologists can contribute substantially in the evaluation and treatment of patients with gunshot wounds. Foreign bodies that enter a patient as a result of trauma are contaminated and produce a range of symptoms. Oral and maxillofacial gunshot injuries are usually fatal due to close proximity with vital structures. Here, we report a case in which radiographic evidence of foreign bodies in the right orofacial region exposed a history of a gunshot injury. The patient did not have any major complaints except for reduced mouth opening. These foreign bodies were clinically silent for approximately 12 years.

  17. Paediatric retinal detachment: aetiology, characteristics and outcomes

    Directory of Open Access Journals (Sweden)

    Elizabeth McElnea

    2018-02-01

    Full Text Available AIM: To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. METHODS: A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. RESULTS: Twenty-eight eyes of 24 patients, 15 (62.5% of whom were male and 9 (37.5% of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0% cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3% cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6% cases which underwent surgical repair the retina was attached at last follow-up. CONCLUSION: Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.

  18. Paediatric retinal detachment: aetiology, characteristics and outcomes.

    Science.gov (United States)

    McElnea, Elizabeth; Stephenson, Kirk; Gilmore, Sarah; O'Keefe, Michael; Keegan, David

    2018-01-01

    To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. Twenty-eight eyes of 24 patients, 15 (62.5%) of whom were male and 9 (37.5%) of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6%) cases which underwent surgical repair the retina was attached at last follow-up. Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.

  19. Combined trauma in peaceful time

    Directory of Open Access Journals (Sweden)

    Chaika V.A.

    2014-06-01

    Full Text Available In the article epidemiological features of combined trauma (CT, characteristic for the industrial region were summarized. 486 cases of CT were analyzed for the period from 2010 to 2012. Male patients dominated. 267 (54.9% patients were the age from 25 to 44 years. Most often the damage occurred in 2 anatomic regions (AR - 224 (46.1%, 3 AR - 177 (36.4% and 4 or more - 85 (17.5%. Trau¬matic brain injury - 94.2%, skeletal trauma - 70.6%, the trauma of the chest and abdomen - 68.4% and 35.7%, respectively prevailed. Injury of the abdominal cavity as a dominant one - 148 (30.5% occupied the first place. In 17 (3.5% cases it was impossible to establish the dominant damage. Mortality rate was directly dependent on the type of the trauma and patient's age. Maximum values were found in the combined brain injury and that of abdominal organs - 28.6%, as well as in the group of patients older than 60 years - 35.1%. From 2010 to 2012 the overall mortality decreased by 3.5%.

  20. CT of the chest in suspected child abuse using submillisievert radiation dose

    International Nuclear Information System (INIS)

    Sanchez, Thomas R.; Seibert, J.A.; Stein-Wexler, Rebecca; Lee, Justin S.; Coulter, Kevin P.

    2015-01-01

    The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative. (orig.)