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Emergency Radiology

E2572. Traumatic Chest Wall Injuries: A Pictorial Review

Marro A1,  Pannell D1,  Hosein M1,  Ditkofsky N.1,2 1. University of Toronto, Toronto, Canada ; 2. Sunnybrook Health Sciences Centre, Toronto, Canada

Address correspondence to A. Marro (alex.marro@mail.utoronto.ca)

Background Information: Chest injuries are the third most common injury found in trauma patients, after extremity and head injuries. Chest wall trauma comprises of a spectrum of injuries of the thoracic soft tissues and bones that range in severity. Although a high level of attention is paid to lung parenchymal injuries and vascular injuries, chest wall injuries deserve equal attention as altered mechanics of the chest wall can have a significant impact on a patient’s physiology. The morbidity and mortality for blunt chest wall trauma varies depending on the severity, with reported mortality ranging from 4 to 20%. Accurate identification and description of chest wall injuries are essential to guiding proper management

Educational Goals/Teaching Points: The goal of this exhibit is to provide an overview of the imaging techniques and protocol used for assessing chest wall trauma, the mechanisms commonly seen in chest wall trauma, and to illustrate the CT findings of chest wall trauma according to the American Association for the Surgery of Trauma (AAST) grading scale.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Chest wall injuries are the result of at least one of 4 main mechanisms of injury: direct impact, thoracic compression, rapid deceleration, and blast injury. This exhibit will review these mechanisms, as an understanding of the associated expected injuries can aid in their detection. For example, in motor vehicle collisions, soft tissue contusions that follow a seat belt pattern should alert the radiologist to possible aortic injury, cardiac contusion, or rib, sternal, and clavicular fractures. Fractures to the sternum, scapula, or 1st and 2nd ribs are an indication of a high-energy trauma and should alert the radiologist to look for associated injuries. In addition to reviewing the normal chest wall anatomy, this exhibit will present cases that cover the spectrum of chest wall injuries and discuss how these imaging findings correspond to the AAST grading system.

Conclusion: Chest wall injuries are a significant cause of mortality and morbidity in trauma patients. MDCT is a fast and accurate imaging modality to evaluate trauma patients for chest wall injuries. Accurate diagnosis of chest wall injuries is essential in guiding appropriate treatment.