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Updated: Jun 6, 2026
Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition
Published on: September 22, 2023
Ability of a chest X-ray and an abdominal computed tomography scan to identify traumatic thoracic injury
Cristobal Barrios1, Jacqueline Pham, Darren Malinoski
1Division of Trauma, Critical Care, Burn and Acute Care Surgery, Department of Surgery, University of California Irvine Medical Center, CA, USA. cbarrios@uci.edu
Objective:
Our objective was to show that a chest X-ray (CXR) and an abdominal computed tomography (CT) scan are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering the thoracic CT scan useful in only a subset of patients.
Methods:
A retrospective study identified thoracic injuries in 374 trauma patients evaluated with a CXR, a thoracic CT scan, and an abdominal CT scan. Injuries seen on the initial CXR versus those seen on a CT scan only (occult) were identified and assessed for clinical relevance.
Results:
An abdominal CT scan identified 65% (15/23) of occult pneumothoraces, 100% (25/25) of occult hemothoraces, 64% (18/28) of occult pulmonary contusions, and 58% (18/31) of occult rib fractures. No occult pneumothoraces seen on the thoracic CT scan alone required tube thoracostomy.
Conclusions:
Our pilot study suggests that a CXR and an abdominal CT scan will identify most occult intrathoracic injuries. Reserving a thoracic CT scan for patients with an abnormal CXR or high-risk mechanism could safely reduce cost and radiation exposure while still diagnosing significant thoracic injuries.
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