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[Computed tomography in injuries to the respiratory system in children. The correlation with adults]
V Coppola1, D Verrengia, M Coppola
1Istituto di Scienze Radiologiche, Università degli Studi di Federico II, Napoli.
Insights
Pediatric chest trauma is often severe and difficult to diagnose with standard X-rays. Emergency computed tomography (CT) offers a more accurate assessment of injuries in children, improving diagnosis and treatment.
Area of Science:
- Medical Imaging
- Pediatric Emergency Medicine
- Trauma Surgery
Background:
- Diagnostic imaging in emergency rooms can be delayed and inadequate for pediatric chest trauma.
- Chest traumas in children are often more severe and challenging to treat due to these limitations.
Purpose of the Study:
- To assess differences in major chest trauma involving the respiratory tract between adults and children.
- To evaluate the role of emergency computed tomography (CT) in diagnosing pediatric chest trauma.
Main Methods:
- Retrospective study of fourteen children admitted to the emergency department for major chest trauma.
- Chest radiography was performed in 11/14 (78.6%) patients; CT was performed in 3/14 (21.4%) patients.
Main Results:
- Pediatric trauma involved multiple organs (78.6%) with lung involvement frequently associated with contusion (100%), pneumothorax (78.6%), and hemothorax (71.4%).
- CT corrected or supplemented radiographic findings in 67% for contusions and 63.6% for pneumothorax, revealing injuries missed by conventional imaging.
Conclusions:
- Pediatric chest injuries, including tracheobronchial ruptures, are more severe than in adults due to anatomical and biomechanical factors.
- Spiral CT is recommended as the primary imaging modality in emergency departments for pediatric chest trauma, facilitating accurate diagnosis and management.
Introduction:
Diagnostic imaging in emergency rooms may be inadequate and delayed, which makes chest traumas in children more severe and difficult to treat. We carried out a retrospective study on adults and children who had survived major chest traumas involving the respiratory tract to assess the differences between the two age groups and the role of emergency CT.
Material And Methods:
Our series consisted of fourteen children admitted to the emergency department for various accidents. Home accidents prevailed (9/14 = 64.3%). On admission, chest radiography was performed in most cases (11/14 = 78.6%); CT was carried out in 21.4% (3/14 patients).
Results:
Trauma involved more organs in pediatric patients (11/14 = 78.6%) and lung involvement was always associated with other types of injury, namely contusion (14/14 = 100%), pneumothorax (11/14 = 78.6%), hemothorax (10/14 = 71.4%), tear (4/14 = 28.6%). CT corrected or integrated the radiographic findings of contusion focus in 67% (8/14) and that of pneumothorax in 63.6%; both patterns cannot be demonstrated otherwise.
Discussion:
Mixed and multiple posterior parenchymal injuries with no rib fractures prevail in young subjects because their bones and ligaments are more elastic, which may lead to trauma underestimation. Tracheobronchial ruptures and pneumomediastinum are much more severe in children than in adults. Chest plain film is often the only diagnostic tool used, despite its major technical and interpretative limitations, also because skull and abdomen are the most investigated regions. Executive limitations are stronger in childhood, increasing the margin of error and the risk of delayed treatment. CT is as cost-effective as radiography and shows even the injuries missed or poorly depicted on conventional images; CT also gives accurate information on damage severity and nature.
Conclusions:
Traumatic injuries are more severe in pediatric patients due to their build and to biomechanical, clinical and management factors. Spiral CT should be considered the examination of choice to be performed in the emergency department equipped also for pediatric re-animation.