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CT of blunt chest trauma in children
D Manson1, P S Babyn, S Palder
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pediatric chest CT scans reveal unique patterns of injury, with pulmonary contusions often posterior and nonsegmental. A full CT thorax scan is crucial for assessing blunt chest trauma in children, as initial X-rays may be insufficient.
Area of Science:
- Radiology
- Pediatric Imaging
- Trauma Imaging
Background:
- Trauma remains a leading cause of death in children.
- Pediatric chest injury CT findings are underrepresented in medical literature.
- Understanding imaging characteristics is vital for timely diagnosis and treatment.
Purpose of the Study:
- To investigate and describe the computed tomography (CT) appearances of blunt chest trauma in pediatric patients.
- To correlate CT findings with the extent of intrathoracic injury.
- To evaluate the adequacy of initial trauma imaging in children.
Main Methods:
- Retrospective review of CT scans from 44 pediatric patients with blunt chest trauma.
- Analysis of specific injury patterns, including pulmonary contusions, pneumothoraces, and mediastinal hematomas.
- Comparison of CT findings with initial radiographic assessments.
Main Results:
- Pulmonary contusions in children characteristically present as posterior, nonsegmental, and crescent-shaped.
- CT identified various thoracic injuries: pulmonary lacerations, pneumothoraces, mediastinal hematomas, aortic and tracheobronchial injuries, hemopericardium, and spinal injuries.
- Incidental findings crucial for therapy were also noted.
Conclusions:
- A single supine chest X-ray is inadequate for evaluating significant pediatric blunt chest trauma.
- A dynamically enhanced CT scan of the thorax is recommended for comprehensive assessment.
- CT findings can significantly alter patient management and therapeutic strategies.
Abstract:
While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy.