Imaging in pediatric blunt thoracic trauma

Thoracic trauma is an important cause of mortality in pediatric trauma, and most thoracic trauma in pediatrics is blunt trauma. Pediatric patients have important anatomic and physiologic differences from adults that must be considered in the setting of blunt thoracic trauma. Some of the more significant differences are related to chest wall structure, laxity of mediastinal fixation points, and increased sensitivity to ionizing radiation. When imaging pediatric blunt thoracic trauma, a chest radiograph is the initial test of choice. Further imaging is often not needed, especially if the initial chest radiograph is normal, and additional findings on computed tomography (CT) often do not impact management. Factors which have been found to increase the utility of chest CT in pediatric blunt thoracic trauma include age 15 years or older, abnormal chest auscultation, tachycardia, chest pain, abnormal chest radiograph - especially mediastinal contour abnormality - and severe mechanism. Common injuries in pediatric blunt thoracic trauma include pulmonary contusion, pulmonary laceration, pneumothorax, hemothorax, and rib fractures. Rare but important injuries include cardiac and great vessel injuries, tracheobronchial injuries, esophageal injuries, and diaphragmatic injuries.