CT IN BLUNT CHEST TRAUMA - INDICATIONS AND LIMITATIONS

Computed tomography (CT) is the imaging modality of choice in the asse ssment of patients with clinical or radiographic findings suggestive o f aortic injury, bone fracture, or diaphragmatic tear following blunt chest trauma. Contrast material-enhanced spiral CT allows detection of both subtle and more obvious aortic tears. CT has overall greater sen sitivity than radiography in the detection of pulmonary lacerations an d pneumothoraces, CT may be indicated in cases of suspected tracheobro nchial injury. CT is of limited use in the assessment of rib fractures because such injuries are of limited clinical significance and can us ually be identified at radiography; however, CT provides optimal visua lization of thoracic spine fractures and superior assessment of suspec ted sternal fractures or sternoclavicular dislocation. Targeted spiral CT with sagittal and coronal reformatted images has increased sensiti vity and specificity over that provided by conventional axial CT in th e detection of diaphragmatic injury. Optimal CT assessment requires ca reful attention to technique, including the use of intravenously admin istered contrast material and multiplanar reconstructed images, as wel l as an awareness of potential pitfalls, Although in many cases diagno sis can be made with confidence on the basis of CT findings, further i nvestigation is often needed to confirm the diagnosis.