Medicina

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EMERGENCY CHEST IMAGING
Volume 44 • Number 2 • March 2006

Contents

Preface

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Stuart E. Mirvis and Kathirkamanathan Shanmuganathan
Chest Pain: A Clinical Assessment

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Kenneth H. Butler and Sharon A. Swencki
Chest pain is one of the most common presentations in emergency medicine. The initial
evaluation should always consider life-threatening causes such as aorticdissection, pulmonary embolism, pneumothorax, pneumomediastinum, pericarditis, and esophageal
perforation. Radiographic imaging is performed in tandem with the initial clinical assessment and stabilization of the patient. Radiologic findings are key to diagnosis and management of this entity.
Thoracic Vascular Injury

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Stuart E. Mirvis
This article emphasizes multirow detector CT (MDCT)technique, the spectrum of findings for diagnosing major thoracic vascular injuries, and the challenges and potential
errors that might be encountered. In particular, the role of MDCT data after processing to
enhance diagnostic accuracy and convey appropriate and required diagnostic information
to the doctors who are managing these vascular injuries are discussed.
Imaging of Diaphragm InjuriesClint W. Sliker
Diaphragm injuries are uncommon consequences of blunt and penetrating trauma.
Early diagnosis and repair prevent potentially devastating complications that typically
result from visceral herniation through the posttraumatic diaphragm defect. Although
clinical and radiographic manifestations frequently are nonspecific, the stalwarts of
trauma imaging—chest radiography andCT—typically demonstrate these injuries. To
render the appropriate diagnosis, the radiologist must be familiar with the varied imaging manifestations of injury, and maintain a high index of suspicion within the appropriate clinical setting.

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Contents

Chest Wall, Lung, and Pleural Space Trauma

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Lisa A. Miller
Chest radiographs frequently underestimate the severity andextent of chest trauma
and, in some cases, fail to detect the presence of injury. CT is more sensitive than
chest radiography in the detection of pulmonary, pleural, and osseous abnormalities
in the patient who has chest trauma. With the advent of multidetector CT (MDCT),
high-quality multiplanar reformations are obtained easily and add to the diagnostic
capabilities of MDCT. This article reviewsthe radiographic and CT findings of chest
wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.
Imaging of Penetrating Chest Trauma

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Kathirkamanathan Shanmuganathan and Junichi Matsumoto
This article discusses the role of imaging in evaluating patients who are admitted with
penetrating injuries to the chest. Emphasis is placedon the role of multidetector row CT,
which has been introduced in the past 5 years into the arena of care for trauma victims.
It is important to take full advantage of this new CT technology with its capability to produce high-resolution multiplanar and volumetric images to diagnose penetrating chest
injuries. This article emphasizes detection of active bleeding and assessment of the mediastinumfor penetrating injury.
Thoracic Angiography and Intervention in Trauma

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Patrick C. Malloy and Howard Marks Richard III
Interventional radiologists are involved less often in the initial diagnostic evaluation of
patients who have acute chest trauma today than in the past. Patients are cleared of significant injury by CT, or, when a significant injury is present, they are triagedappropriately to
open surgery or endovascular intervention. Significant advances in catheter-based technology, such as stent grafts and embolization coils, allow definitive repair of thoracic aortic
and branch vessel injury. The opportunity to treat these types of injury with minimally
invasive techniques has reinforced a continuing need for the maintenance and continued
development of skills...