COMPUTED-TOMOGRAPHY SCREENS STABLE PATIENTS AT RISK FOR PENETRATING CARDIAC INJURY

Objective: To determine the accuracy of CT of the chest in diagnosing the presence of cardiac injury in stable patients with penetrating che st injuries. Methods: A retrospective chart review of a convenience sa mple of stable patients with penetrating thoracic wounds evaluated for hemopericardium using chest CT al an urban level I trauma center. Res ults: 60 stable patients with penetrating wounds in proximity to the h eart underwent CT, Three patients had radiographic evidence of pericar dial fluid, and 1 had an equivocal study, These 4 patients underwent s ubxiphoid pericardial window exploration: 2 had only clear fluid prese nt, the other 2 had hemopericardium. The latter patients had a total o f 3 cardiac and 1 diaphragmatic injuries, which were repaired at subse quent sternotomy. None of the 56 patients who had negative CTs had fur ther clinical evidence of cardiac injury, The sensitivity, specificity , and accuracy of CT in this setting for hemopericardium are 100% (95% CI 18-100%), 96.6% (95% CI 88-100%), and 96.7% (95% CI 89-100%), resp ectively. Conclusion: Chest CT may be a useful test for diagnosing the presence of hemopericardium in the setting of penetrating thoracic in jury. With the caveat that the patient must be removed from a closely monitored environment, the authors advocate the use of CT in stable pa tients with penetrating chest wounds whenever echocardiography is unav ailable.