Journal of thoracic imaging
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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.
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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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Sufficient trauma to the chest can result in injury to the bony thorax and soft tissues of the chest wall, increasing patient morbidity and mortality. Fractured ribs can lacerate the pleura, lung, or abdominal organs. Fractures to upper ribs, clavicle, and upper sternum can signal brachial plexus or vascular injury. ⋯ Sternal fractures, associated with clinically silent myocardial contusion, are best visualized on chest computed tomography (CT). Severe trauma to the chest wall can be associated with large chest wall hematomas or collections of air within the chest wall that can communicate with the intrathoracic space. CT scanning can easily distinguish chest wall from parenchymal or mediastinal injury, whereas this differentiation my not be possible with chest radiography.
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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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Screening for lung cancer has remained controversial since the completion, more than two decades ago, of the three large randomized controlled trials, sponsored by the National Cancer Institute, which led to the recommendation against screening by major medical organizations. Details of the controversy are given, which include concerns about the study design, implementation, and analysis. New evidence about the potential benefit of screening with chest radiography that has emerged since the completion of those trials is reviewed, as well as the results of studies of CT screening for lung cancer.