Computed Tomography Scan of the Chest Is a Reliable Screening Investigation for Structural Cardiac and Pericardial...

Background The objective of this study was to assess the efficacy of a computed tomography (CT) scan of the chest in detecting structural cardiac and pericardial injuries. Methods We retrospectively analyzed data from a data registry at a trauma center between January 2015 and June 2022. This study included individuals with severe chest trauma (defined as an Abbreviated Injury Scale score of ≥3 for the chest). The assessment of cardiac injury from chest CT scans relied on the information provided in the official radiological reports. Definitive diagnoses of structural cardiac injury were confirmed on the basis of surgical findings or the diagnosis upon discharge. Results The chest CT scans revealed 11 cases of pericardial abnormalities: 10 (90.9%) cases of pericardial effusion in patients with blunt trauma and one (9.1%) case of pneumopericardium in a patient with a stab wound. Among these 11 cases, surgical exploration identified four structural cardiac and pericardial injuries, and three died during hospitalization. The remaining seven cases underwent nonsurgical intervention, and none exhibited any cardiac and pericardial abnormalities. The chest CT for traumatic structural cardiac and pericardial injuries had a sensitivity of 4/4 (100.0%), a specificity of 402/411 (97.8%), a positive predictive value of 4/11 (36.4%), and a negative predictive value of 404/404 (100.0%). Conclusion This study highlighted a high mortality rate among patients diagnosed with structural cardiac injuries, underscoring the critical importance of accurate and timely diagnostic investigations in such cases. Our findings confirmed that chest CT is a reliable screening tool for detecting structural cardiac injuries in patients with both blunt and penetrating chest trauma. However, given the relatively low positive predictive value of chest CT for structural cardiac injuries, additional diagnostic imaging or prompt surgical intervention may be necessary in cases where pericardial abnormalities are identified on chest CT to address potential occult cardiac injuries.