Abstract
Blunt thoracic trauma commonly causes lung contusions, pneumothorax, and pleural effusions, requiring an intensive treatment, often including mechanical ventilation.
Repeated lung diagnostic evaluations are needed in patients affected by blunt thoracic trauma, in order to follow up the clinical situation and monitoring the results of the therapeutic strategies.
Bedside radiography, clinical evaluation and serial measurements of respiratory variables are considered helpful but not sufficient; a daily chest X-ray is not more recommended, but only based on clinical indications or changing in clinical condition.
Nowadays, lung ultrasound is increasingly being incorporated in many stages, including follow-up, of trauma care, with accurate definition of indications.
computed tomography is actually considered the gold standard technique.
References
Miele V, Di Giampietro I (2014) Diagnostic imaging in emergency. Salute e Società (2EN):127–138. doi:10.3280/SES2014-002010EN.
Miele V, Di Giampietro I, Ianniello S, et al. Diagnostic imaging in pediatric polytrauma management. Radiol Med. 2015;120:33–49. doi:10.1007/s11547-014-0469-x.
Ianniello S, Di Giacomo V, Cuneo G, et al. Pediatric thoracic trauma. In: Miele V, Trinci M, editors. Imaging trauma and polytrauma in pediatric patients. Cham: Springer International Publishing; 2015. p. 43–64.
Ianniello S, Merola MG, Trinci M, et al. Priorità diagnostiche nel management del trauma maggiore: ruolo dell’E-FAST e della TCMD. Il Giornale Italiano di. Radiol Med. 2015;2:715–20. doi:10.17376/girm_2-4-07082015-19.
Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with Sonography for trauma (EFAST). J Trauma. 2004;57:288–95.
Ianniello S, Di Giacomo V, Sessa B, et al. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med. 2014;119:674–80. doi:10.1007/s11547-014-0384-1.
Volpicelli G, Elbarbabary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–91.
Croce MA, Fabian TC, Davis KA, et al. Early and late acute respiratory distress syndrome: two distinct clinical entities. J Trauma. 1999;46:361–8.
Antonelli M, Moro ML, Cappelli O, et al. Risk factors for early onset of pneumonia in trauma patients. Chest. 1994;105:224–8.
Hoff SJ, Shotts DS, Eddy VA, et al. Outcome of isolated pulmonary contusion in blunt trauma patients. Am Surg. 1994;60:138–42.
Daurat A, Millet I, Roustan JP, et al. Thoracic trauma severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 2015;47:147–53.
Strumwasser A, Chu E, Yeung L, et al. A novel CT Volume Index Score correlates with outcomes in polytrauma patients with pulmonary contusion. J Surg Res. 2011;170:280–5.
Ianniello S, Piccolo CL, Buquicchio GL, et al. First line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addiction to chest-X-ray (CXR) and its role in follow-up. Br J Radiol. 2016;89:20150998. doi:10.1259/bjr.20150998.
Miele V, Buquicchio GL, Piccolo CL, et al. Lung injuries. In: Scaglione M, Linsenmaier U, Scheller G, Berger F, Wirth S, editors. Emergency radiology of the chest and cardiovascular system. Heidelberg: Springer; 2017. p. 3–12.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–33. doi:10.1001/jama.2012.5669.
Wyncoll DL, Evans TW. Acute respiratory distress syndrome. Lancet. 1999;354:497–50.
Weinberger SE, Drazen JM. Disturbances of respiratory function. In: Braunwald E, Fauci AS, Kaspar DL, Hauser SL, Longo DL, editors. Harrison’s principles of internal medicine. 15th ed. New York: McGraw-Hill; 2001. p. 1454.
Lichtenstein D. Lung ultrasound in the intensive care unit. Recent Res Dev Resp Crit Care Med. 2001;1:83–93.
Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest. 2001;120:400S–24S.
Covelli HD, Nessan VJ, Tuttle WK 3rd, et al. Oxygen derived in acute respiratory, failure. Crit Care Med. 1983;11:646–9.
Nieszkowska A, Lu Q, Vieira S, et al. Incidence and regional distribution of lung overinflation during mechanical ventilation with positive end-expiratory pressure. Crit Care Med. 2004;32:1496–503.
Scialpi M, Cappabianca S, Rotondo A, et al. Pulmonary congenital cystic disease in adults. Spiral computed tomography findings with pathologic correlation and management. Radiol Med. 2010;115:539–50. doi:10.1007/s11547-010-0467-6.
Gattinoni L, Presenti A, Torresin A, et al. Adult respiratory distress syndrome profiles by computed tomography. J Thorac Imaging. 1986;1:25–30.
Desai SR, Wells AU, Rubens MB, et al. Acute respiratory distress syndrome: computed tomography abnormalities at long-term follow-up. Radiology. 1999;210:29–35.
MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British thoracic society pleural disease guide-line. Thorax. 2010;65:ii18–31. doi:10.1136/thx.2010.136986.
Lomoschitz FM, Eisenhuber E, Linnau KF, et al. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms. Eur J Radiol. 2003;48:61–70.
Weissberg D, Refaely Y. Pneumothorax: experience with 1,199 patients. Chest. 2000;117:1279–85.
Miele V, Buquicchio GL, Piccolo CL, et al. Injuries of the pleural spaces. In: Scaglione M, Linsenmaier U, Scheller G, Berger F, Wirth S, editors. Emergency radiology of the chest and cardiovascular system. Heidelberg: Springer; 2017. p. 13–23.
Chaturvedi A, Lee S, Klionsky N, et al. Demystifying the persistent pneumothorax: role of imaging. Insights Imaging. 2016;7:411–29.
Rhea JT, van Sonnenberg E, McLoud TC. Basilar pneumothorax in the supine adult. Radiology. 1979;133:593–5.
Tocino IM, Miller MH, Fairfax WR. Distribution of pneumothorax in the supine and semirecumbent critically ill adult. AJR Am J Roentgenol. 1985;144:901–5.
Collins JA, Samra GS. Failure of chest X-rays to diagnose pneumothoraces after blunt trauma. Anaesthesia. 1998;53:74–8.
Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin N Am. 2006;44:213–24.
Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12:844–9.
Soldati G, Testa A, Sher S, et al. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest. 2008;133:204–11.
Lichtenstein DA, Mezière G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33:1231–8.
Toombs BD, Sandler CM, Lester RG. Computed tomography of chest trauma. Radiology. 1981;140:733–8.
Trupka A, Waydhas C, Hallfeldt KK, et al. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43:405–11.
Paspatis GA, Dumonceau JM, Barthet M, et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2014;46:693–711.
Gayer G, Rozenman J, Hoffmann C, et al. CT diagnosis of malpositioned chest tubes. Br J Radiol. 2000;73:786–90.
Peters S, Wolter D, Schultz JH. Dangers and risks of thoracic drainage at the accident site. Unfallchirurg. 1996;99:953–7.
Laws D, Neville E, Duffy J. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society BTS guidelines for the insertion of a chest drain. Thorax. 2003;58:ii53–9.
Tomlinson MA, Treasure T. Insertion of a chest drain: how to do it. Br J Hosp Med. 1997;58:248–52.
Harris A, O’Driscoll BR, Turkington PM. Survey of major complications of intercostal chest drain insertion in the UK. Postgrad Med J. 2010;86:68–72.
Heim P, Maas R, Tesch C, et al. Pleural drainage in acute thoracic trauma. Comparison of the radiologic image and computer tomography. Aktuelle Radiol. 1998;8:163–8.
Stern EJ, Sun H, Haramati LB. Peripheral bronchopleural fistulas: CT imaging features. AJR Am J Roentgenol. 1996;167:117–20.
Seo H, Kim TJ, Jin KN, et al. Multi-detector row computed tomography evaluation of bronchopleural fistula: correlation with clinical, bronchoscopic, and surgical findings. J Comput Assist Tomogr. 2010;34:13–8.
Ricci ZJ, Haramati LB, Rosenbaum AT, et al. Role of computed tomography in guiding the management of peripheral bronchopleural fistula. J Thorac Imaging. 2002;17:214–8.
Sarkar P, Chandak T, Shah R, et al. Diagnosis and management bronchopleural stula. Indian J Chest Dis Allied Sci. 2010;52:97–104.
Takanami I. Closure of a bronchopleural fistula using a fibrin-glue coated collagen patch. Interact Cardiovasc Thorac Surg. 2003;2(3):2387–8.
Uchida S, Igaki H, Izumo T, et al. Effective treatment of empyema with bronchopleural fistula after esophagectomy by endobronchial embolization using endobronchial Watanabe Spigots. Int J Surg Case Rep. 2017;33:1–3.
Giddings O, Kuhn J, Akulian J. Endobronchial valve placement for the treatment of bronchopleural fistula: a review of the current literature. Curr Opin Pulm Med. 2014;20:347–51.
Díaz-Agero Álvarez PJ, Bellido-Reyes YA, Sánchez-Girón JG, et al. Novel bronchoscopic treatment for bronchopleural fistula using adipose-derived stromal cells. Cytotherapy. 2016;18:36–40.
Villa MT, Chang DW. Muscle and omental flaps for chest wall reconstruction. Thorac Surg Clin. 2010;20:543–50.
Sangster GP, Gonzalez-Beicos A, Carbo AI, et al. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol. 2007;14:297–310.
Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Semin Ultrasound CT MRI. 2005;26:305–31.
Shanmuganathan K, Mirvis SE. Imaging diagnosis of nonaortic thoracic injury. Radiol Clin N Am. 1999;37:533–51.
Mayberry JC. Imaging in thoracic trauma: the trauma surgeon’s perspective. J Thorac Imaging. 2000;15:76–86.
Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. 2007;17:47–55.
Kaewlai R, Avery LL, Asrani AV, et al. Multidetector CT of blunt thoracic trauma. Radiographics. 2008;28:1555–70. doi:10.1148/rg.286085510.
Broderick SR. Hemothorax etiology, diagnosis, and management. Thorac Surg Clin. 2013;23:89–96. doi:10.1016/j.thorsurg.2012.10.003.
Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol. 2009;192:599–612. doi:10.2214/AJR.07.3324.
Thoongsuwan N, Kanne JP, Stern EJ (2004) Imaging of blunt chest trauma. RSNA Syllabus 71–79.
Brooks A, Davies B, Sethhurst M, et al. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004;21:44–6.
Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29:312–5.
Villegas MI, Hennessey RA, Morales CH, et al. Risk factors associated with the development of post-traumatic retained hemothorax. Eur J Trauma Emerg Surg. 2011;37:583–9. doi:10.1007/s00068-010-0064-3.
DuBose J, Inaba K, Demetriades D, et al. Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. J Trauma Acute Care Surg. 2012;72:11–22.
American College of Surgeons. Committee on trauma. ATLS: advanced trauma life support for doctors. 8th ed. Chicago: American College of Surgeons; 2008.
Inaba K, Lustenberger T, Recinos G, et al. Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. J Trauma. 2012;72:422–7.
Gonzalez RP, Holevar MR. Role of prophylactic antibiotics for tube thoracostomy in chest trauma. Am Surg. 1998;64:617–20.
Wilson RF, Nichols RL. The EAST practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: a commentary. J Trauma. 2000;48:758–9.
Luchette FA, Barrie PS, Oswanski MF, et al. Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: the EAST practice management guidelines work group. J Trauma. 2000;48:753–7.
Kimbrell BJ, Yamzon J, Petrone P, et al. Intrapleural thrombolysis for the management of undrained traumatic hemothorax: a prospective observational study. J Trauma. 2007;62:1175–8.
Skeete DA, Rutherford EJ, Schlidt SA, et al. Intrapleural tissue plasminogen activator for complicated pleural effusions. J Trauma. 2004;57:1178–83.
Ciraulo DL, Elliott D, Mitchell KA, et al. Flail chest as a marker for significant injuries. J Am Coll Surg. 1994;178:466–70.
Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin. 2004;20:71–81.
Collins J. Chest wall trauma. J Thorac Imaging. 2000;15:112–9.
Besson A, Segesser F. Blunt trauma of the chest wall. A colour atlas of chest trauma and associated injuries, vol. 1. Weert, Netherlands: Wolfe Medical Publications Ltd; 1982. p. 153–98.
Majercik S, Pieracci FM. Chest wall trauma. Thorac Surg Clin. 2017;27:113–21.
Zink KA, Mayberry JC, Peck EG, et al. Lidocaine patches reduce pain in patients with rib fractures. Am Surg. 2011;77:438–42.
Britt T, Sturm R, Ricardi R, et al. Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review. Local Reg Anesth. 2015;8:79–84.
Schweiger JW, Downs JB, Smith RA. Chest wall disruption with and without acute lung injury: effects of continuous positive airway pressure therapy on ventilation and perfusion relationships. Crit Care Med. 2003;31:2364–70.
Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73:s351–61. doi:10.1097/TA.0b013e31827019fd.
Fowler TT, Taylor BC, Bellino MJ, et al. Surgical treatment of flail chest and rib fractures. J Am Acad Orthop Surg. 2014;22:751–60. doi:10.5435/JAAOS-22-12-751.
Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216:302–11.e1.
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Ianniello, S., Merola, M.G., Pignatelli, M., Ferrari, R., Trinci, M., Miele, V. (2018). The Follow-Up of Patients with Thoracic Injuries. In: Miele, V., Trinci, M. (eds) Diagnostic Imaging in Polytrauma Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-62054-1_23
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