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British Journal of Healthcare and Medical Research - Vol. 10, No. 2

Publication Date: April 25, 2023

DOI:10.14738/jbemi.102.14346.

Hilendarov, A., Georgiev, A., & Cherenkov, L. (2023). Multidetector Computed Tomography in Cases with Chest Trauma. British

Journal of Healthcare and Medical Research, Vol - 10(2). 242-253.

Services for Science and Education – United Kingdom

Multidetector Computed Tomography in Cases with Chest

Trauma

Atanas Hilendarov

MU Plovdiv, Dept. Of Diagnostic Imaging Plovdiv, Bulgaria

Georgiev, A.

MU Plovdiv, Dept. Of Diagnostic Imaging Plovdiv, Bulgaria

Cherenkov, L.

MU Plovdiv, Dept. Of Diagnostic Imaging Plovdiv, Bulgaria

ABSTRACT

Introduction: Chesttraumas are a significant cause of mortality and morbidity. They

commonly occur in the younger population and are the most common cause of

death in people between 25 and 40 years of age. Purpose: This article summarizes

the place of MDCT in the diagnosis, examination technique and findings in injuries

of the chest trauma patients. Methods: Multidetector computed tomography

(MDCT) is considered to be the most effective imaging method in this field. Its

advantages include especially high speed and high geometric resolution at any

plane. The method allows us to view large parts of the body with minimal motion

artifacts and to create accurate multiplanar and three dimensional (3D)

reformations. Results: MDCT allows us to view diagnosis significantly more

accurate. One hundred and twelve patients are examined at the Emergency

department. The injuries of the chest and intrathoracic organs are found. In 56

(50%) of all 112 patients included in our study, fractures of the ribs are the most

common traumas. Also fracture of the scapula, sternum, extra pleural hematomas,

pneumothorax, hemothorax, pulmonary contusions, laceration of trachea and

bronchi, rupture of esophagus, diaphragmatic rupture and injuries of blood vessels

are established. Conclusion: Because of its advantages MDCT has become the first- choice method in emergency chest trauma patients.

Keywords: Multidetector computed tomography, Blunt trauma, Penetrating trauma

INTRODUCTION

In recent years has been observed major chest injuries withch represent a significant

socioeconomic problem. They commonly occur in the younger population and are the most

common cause of death in people between 25 and 40 years of age. Chest injuries occur in about

20 % of all trauma patients. In up to 80 % of cases they are associated with injuries of other

body parts such as the head (69%), abdomen and pelvis (43%) and extremities (52%) [1, 2].

Diagnostic imaging plays a key role in deciding the therapeutic procedure [3]. Multidetector

computed tomography (MDCT) considered to be the most effective imaging method in this field

and therefore should be a part of the emergency department [4]. We trying to evaluate the place

of MDCT in the diagnostic algorithm in major trauma patients.

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Hilendarov, A., Georgiev, A., & Cherenkov, L. (2023). Multidetector Computed Tomography in Cases with Chest Trauma. British Journal of Healthcare

and Medical Research, Vol - 10(2). 242-253.

URL: http://dx.doi.org/10.14738/jbemi.102.14346.

METHODS AND MATERIALS

Clinical symptoms of chest trauma are diverse and often do not correlate with their severity.

This is the reason why diagnostic imaging are the first procedures performed after admission

to a emergency department. The simplest and fastest methods include chest radiography and

ultrasound. They can provide important information about the presence of serious injuries

requiring an emergency intervention, such as tension pneumothorax, large hemothorax,

hemoperitoneum and injuries of the abdominal organs. It is also very unreliable in detecting

injuries of the heart and great vessels [5–8]. Compared to this, MDCT enables sufficiently

accurate assessment of all compartments of the chest and reveals changes that are not

detectable by other methods (Fig. 1).

Fig. 1 a, b Patient with laceration of the aorta. a Topogram (analogical to chest radiograph)

shows normal mediastinal width. b MDCT reveals rupture of the aorta with small hematoma

(arrow)

Excellent spatial and temporal resolution is the main benefit. Because of the isotropic data field,

it allows performing two-dimensional (2D) and three dimensional (3D) reformations in any

plane and angle of view without loss of geometric resolution.

The choice of a diagnostic procedure depends on the patient’s condition and traumatic

mechanism. In stable patients with no need of emergency intervention, the MDCT examination

can be performed directly after admission to emergency department and primary clinical

examination. In the case of circulatory instability the chest X-ray in supine position is usually

performed as well as ultrasound examination to exclude findings that require an immediate

intervention. If MDCT is a part of the emergency department it can be used as the primary

imaging method.

Generally speaking, in order to minimize motion artifacts high examination speed should be

used in traumas, and because of the need value can be reduced to 80–100, and the mAs value

can be decreased to 30–80 (Fig. 2) [6].to perform reformations in other planes the highest

resolution in the Z-axis should be used as well. Dose reduction is achieved the kilovolt value can

be reduced to 80–100, and the mAs value can be decreased to 30–80 (Fig. 2) [6]