T. Karaaslan et al., TRAUMATIC CHEST LESIONS IN PATIENTS WITH SEVERE HEAD TRAUMA - A COMPARATIVE-STUDY WITH COMPUTED-TOMOGRAPHY AND CONVENTIONAL CHEST ROENTGENOGRAMS, The journal of trauma, injury, infection, and critical care, 39(6), 1995, pp. 1081-1086
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.