Chest injuries - what is new?

This article reviews new aspects about the significance, diagnosis and treatment of different chest injuries.

Age and Injury Severity Score were risk factors for pneumonia and mortality in patients with rib fractures or flail chest. Occult pneumothoraces were detected in 14.5% and occult hemothoraces in 21.4% using computed tomography, whereas lung contusions were detected two times more frequently with computed tomography compared with chest X-ray. The current treatment of acute respiratory distress syndrome has been ameliorated by extracorporeal membrane oxygenation and pumpless extracorporeal lung assist system. Endovascular repair of thoracic aortic injuries has reduced mortality and morbidity compared with open repairs. Increased serum levels of troponin are related to the degree of overall injury severity and physiologic parameters but not to mechanical chest impact. The mortality of penetrating cardiac injuries is still very high (15.6% for stab wounds, 81% for gunshot wounds).

Faster and more detailed diagnosis of thoracic injuries has been achieved by multislice computed tomography. The modern management of thoracic injuries is complex. Minimally invasive techniques (thoracoscopic surgery, endovascular repair) and recent developments in lung supportive therapies reduce mortality and morbidity. However, emergency thoracotomy is still an important and valuable approach for life-saving or damage-control procedures.