The imaging of paediatric thoracic trauma

Area of Science:

• Pediatric Radiology
• Trauma Imaging
• Emergency Medicine

Background:

• Major chest trauma in children presents unique injury patterns due to distinct pediatric anatomy and physiology.
• It is often associated with multisystem injuries following high-energy incidents, such as motor vehicle accidents.
• Common injuries include pulmonary contusion, pneumothorax, hemothorax, and rib fractures, while more severe injuries like tracheobronchial tears are rare.

Purpose of the Study:

• To outline an appropriate imaging algorithm for pediatric chest trauma.
• To emphasize the role of initial imaging modalities and the judicious use of advanced techniques.
• To guide clinicians in selecting the most effective and safest imaging strategies for pediatric patients.

Main Methods:

• Chest radiography is established as the primary imaging tool for initial assessment.
• Ultrasonography (US) and Computed Tomography (CT) are recommended as supplementary tools based on clinical indication.
• Multidetector CT is highlighted for accurate diagnosis but advised for selected cases only to mitigate radiation risks.

Main Results:

• Chest radiography is the cornerstone of initial evaluation in pediatric chest trauma.
• Advanced imaging like multidetector CT offers high diagnostic accuracy for various injuries.
• Routine CT use in all pediatric patients is discouraged due to excessive radiation exposure without clear clinical benefit.

Conclusions:

• An individualized imaging approach, guided by trauma mechanism and clinical status, is crucial for pediatric chest trauma.
• Chest radiography should be the first-line investigation, supplemented by US and CT as needed.
• CT utilization must be selective, employing dose-reduction strategies to minimize radiation exposure in children.