Chest Injuries

Main Causes of Chest TraumaBlunt Trauma- Blunt (direct) force to

chest.

Penetrating Trauma- Projectile that enters chest causing small or large hole.

Compression Injury- Chest is caught between two objects and chest is compressed.

Chest wall injuries

Rib fractures

Flail chest

Open pneumothorax

Rib fractures Most common thoracic injury which characterized by

Localised pain, tenderness. Upper ribs (mainly three pairs), clavicle , sternal or scapula

fracture indicate sever trauma and may be associated with spinal injury or vascular damage .

With lower rib fractures, abdominal visceral injury, such as liver, spleen or

kidney, may occur.

Sternal fracture. Fracture of the left first rib. This injury is associated with an increased incidence of neurovascular injury, in the subclavian vein.

Open Pneumothorax Opening in chest cavity that allows air

to enter pleural cavity. A common complication of chest

trauma (15–40%).

Causes the lung to collapse due to increased pressure in pleural cavity

Can be life threatening

Signs and symptomsDyspnoeaSudden sharp painSubcutaneous EmphysemaDecreased lung sounds on

affected side

Simple pneumothorax: the edge ofthe right lung is clearly seen(arrows) devoid of peripheral lungmarkings. No mediastinal shiftoccurs.

Flail chest A condition of multiple rib fractures produce a mobile fragment which moves

paradoxically with respiration Usually traumatic with two or more ribs fractured in two or more places.. Always consider underlying lung injury (pulmonary contusion). Underlying lung contusion are likely to contribute to the patient’s hypoxia. The main Clinical features are: Dyspnoea, Tachycardia, hypoxia ,Cyanosis and

Hypotension

Haemothorax

Occurs when pleural space fills with blood Usually occurs due to lacerated blood vessel in thorax As blood increases, it puts pressure on heart and other

vessels in chest cavityGeneral increased opacification of the hemithorax is

seen on a supine filmRuptured major airway:This should be suspected in the presence of any of the following :• haemoptysis , • collapse of the lung or lobe, • Pneumothorax with major air leak.Rupture diaphragm:This is more characterized with a bowel or stomach shadow in the thoracic cavity or an ill defined hemi diaphragm.

Diaphragm

Rupture

A tear in the Diaphragm that allows the abdominal organs enter the chest cavity

The opacification of the left hemithorax is du to a haemothorax.

Haemo-thorax

Chronic obstructive pulmonary disease

● General term of conditions including chronic bronchitis and emphysema.● Characterised by chronic airflow reduction resulting from resistance toexpiratory airflow, infection, mucosal oedema , bronchospasm and bronchoconstriction .● Causative factors include smoking, chronic asthma and chronic infectionCXRs In the emergency setting, useful for assessing complications, such as pneumonia, heart failure, pneumothorax or rib fractures.– Radiographic features include hyper-expanded (enlarged) lungs associated with flattening of both hemidiaphragms

The lungs are hyper-inflated with flattening of both hemi-diaphragms

Aortic rupture Usually blunt trauma involving Chest;

especially RTAs or fall from a height ~80-90% die within minutes

clinical suspicion, CXR, aortography and contrast CT are done

An aortic rupture should be suspected from the mechanism of injury.

Chest or inter-scapular pain will be present.

Traumatic aortic rupture: tracheal deviation to the right; left haemothorax, blurring of the outline of the aortic arch. Rib fractures and a traumatic left diaphragmatic hernia are also noted.

Radiographic projections of the chest

Postero anterior :It is used commonly for all cases unless the patient requires ongoing assessment , resuscitation , treatment , or monitoring.Anteroposterior :This view is usually requested for seriously ill patients with a life threatening condition that requires assessment , monitoring , or treatment in a resuscitation area.Lateral chest film:The lateral chest radiography is rarely helpful in acute conditions. However , it can localize abnormalities seen in the postero anterior view.

Lateral decubitus film:It can identify a small pleural effusion and differentiate this from pleural thickening . A sub-pulmonary haemothorax may become apparent with this view when the only abnormality seen in the postero anterior film is a raised hemi diaphragm.

PA )patient with pericadial effusion

Lateral ) patient with air filled mass

Expiration film: To show a small pneumothorax , Expiration films are occasionally requested

to help establish a diagnosis of inhaled foreign body.

Routine Radiographic projections of the chest

● inhaled foreign body.Usually seen in children.● Considered an emergency as it may result in complete upper airway obstruction.• If the child is coughing they should be

encouraged.● the chest may be normal. Radiological features● A radio-opaque foreign body may or may not be seen.● secondary signs, such as, segmental collapse, consolidation or hyperinflation, as the foreign body acts as a ball valve.

Imaging Findings:

These three images show a hydropneumothorax in three different views. The PA, lateral, and right decubitus The right decubitus film demonstrates a right hydropneumothorax.