Journal of thoracic imaging
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In addition to traumatic aortic injuries (TAI), blunt chest trauma may damage other structures in the mediastinum, including the tracheobronchial tree, the heart and pericardium, and rarely the esophagus. Tracheobronchial injuries may be difficult to separate radiographically from accompanying parenchymal lung injuries. Experience with diagnosis by computed tomography (CT) is still limited. ⋯ Some patients, usually those with chamber ruptures of the right heart, survive long enough to receive a chest CT, at which time hemopericardium can be detected. Upper esophageal injuries may occur in conjunction with lower cervical or upper thoracic spine injures. Distal esophageal injuries are rarely caused by blunt trauma.
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Comparative Study
The normal CT appearances of the second carina and bronchial stump after left upper lobectomy.
We retrospectively evaluated the computed tomography (CT) appearance of the bronchial stump and second carina (left upper lobe spur) after left upper lobectomy. There were 69 CT examinations in 38 patients; all were free of recurrent or metastatic disease. The spur was graded as a) sharp (wedge-shaped tip configuration with <90 degrees angulation), b) lobulated (bulbous tip with <90 degrees angulation), or c) widened (>90 degrees angulation regardless of tip configuration). ⋯ No changes occur over time. Interval change, widening of the spur, or soft tissue at the bronchial stump may suggest abnormality. Knowledge of normal and potentially abnormal appearances is essential to proper CT interpretation, particularly in the setting of postoperative surveillance for recurrent or metastatic disease.
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The thoracic aorta and great vessels are at risk of injury by both blunt and penetrating trauma. High-speed deceleration injury, predominately caused by motor vehicle accidents, is the primary cause of blunt traumatic aortic injury (TAI). ⋯ Radiologic imaging plays a key role in the evaluation of TAI, and this review focuses on the relative roles of chest radiography, computed tomography (CT) (particularly helical CT), and aortography in the diagnostic algorithm for TAI. Other aortic imaging methods have been used in the setting of TAI, such as transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound; although these techniques may play a complementary role in TAI evaluation, they are unlikely to have as significant an impact on routine radiologic practice as will CT.
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Multiple imaging modalities are available for the preoperative diagnosis of diaphragmatic injury. Chest radiographs are the initial and most commonly performed imaging study to evaluate the diaphragm after trauma. When chest radiography is indeterminate, spiral computed tomography (CT) with thin sections and reformatted images is the next study of choice, particularly because most hemodynamically stable patients with blunt diaphragm injury will require an admission CT examination to evaluate the extent and anatomical sites of coexisting thoracoabdominal injuries. Magnetic resonance imaging is used to evaluate the diaphragm for patients with clinical suspicion but an indeterminate diagnosis after chest radiography and spiral CT.
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Injuries of the thorax are a major cause of morbidity and mortality in blunt trauma patients. Radiologic imaging plays an important role in the workup of the patient with thoracic trauma. ⋯ The primary role of chest CT has been to assess for aortic injuries, but CT has been shown to be useful for the evaluation of pulmonary, airway, skeletal, and diaphragmatic injuries as well. Magnetic resonance imaging (MRI) has a limited role in the initial evaluation of the trauma patient, but may be of use for the evaluation of the spine and diaphragm in patients who are hemodynamically stable.