TRAUMATIC CHEST LESIONS IN PATIENTS WITH SEVERE HEAD TRAUMA - A COMPARATIVE-STUDY WITH COMPUTED-TOMOGRAPHY AND CONVENTIONAL CHEST ROENTGENOGRAMS

In patients with severe craniocerebral trauma, who need a continuous p ositive-pressure breathing, the detection of pulmonary and mediastinal traumatic lesions, especially pneumothorax, may alter the management, The aim of this study is to evaluate the efficiency and accuracy of c onventional supine chest roentgenograms to detect the associated traum atic chest lesions in severe craniocerebral trauma and to compare thei r value as a diagnostic method for the identification of unsuspected l esions with a limited chest computed tomographic (CT) examination, For ty-seven consecutive patients with severe craniocerebral trauma underw ent head CT and a prospective limited CT examination of the thorax in the same session, Nine patients (19.1%) presented a pneumothorax, bila teral in one case, Six pneumothoraces (60%) were identified both on co nventional chest roentgenograms and CT, whereas in four cases (40%), t he lesion was only detectable on CT, The CT study also showed 31 areas of pulmonary parenchymal contusions in 19 subjects (40%), whereas the conventional chest roentgenograms demonstrated 17 areas of contusions in 11 (23%) subjects, One thoracic aorta and one right diaphragm rupt ure were detected on CT study, On the conventional chest roentgenogram s the mediastinal vascular injury was overlooked, whereas the right di aphragmatic rupture was highly suspected, The limited chest CT examina tion supplied additional information in 30% of patients, In 12.7% of p atients, this information was clinically significant enough to alter t he management, In patients with severe craniocerebral trauma evaluatio n of associated chest trauma by a supplementary limited chest CT, exam ination provides more and precise information about the size and sever ity of mediastinal and pulmonary lesions with a superior detectability of pneumothorax.