Multiple Radiologic Findings in a Simple Blunt Thoracic Trauma

Authors

  • Prijo Sidipratomo Department of Radiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Referral General Hospital, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec., Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta 10430 http://orcid.org/0000-0002-6953-5025
  • Jacob Pandelaki Departemen Radiologi, Fakultas Kedokteran, Universitas Indonesia
  • Samuel Widjaja Departemen Radiologi, Fakultas Kedokteran, Universitas Indonesia
  • Jason Jason Departemen Radiologi, Fakultas Kedokteran, Universitas Indonesia

DOI:

https://doi.org/10.33533/jpm.v17i1.5123

Keywords:

Blunt Trauma, CT scan, Chest radiograph, Lungs, Thoracic Trauma

Abstract

Blunt thoracic trauma is one of the main contributors to trauma-related deaths, with the broad possibility of pathological chest injury. Imaging plays an important role in detecting most of internal organ injuries. Here we presented a 56-years-old male with progressive chest pain following blunt chest trauma several days prior without any early intervention. Chest radiograph showed rib fractures, pneumothorax, atelectasis, and raised left hemidiaphragm. Further CT scan evaluation identified additional hemothorax, subcutaneous emphysema and confirming the fourth to tenth rib fractures, pneumothorax, and unilateral hemidiaphragm elevation. As seen in our case, chest radiograph is crucial in initial evaluation of chest injury, usually through identification of pathological landmark. While chest radiograph is limited to one projection, CT scan provide a global evaluation of a region with a high sensitivity and specificity in detecting and confirming most of the injuries. Thus, one must not overlook any lightly appeared blunt thoracic trauma while optimizing the use of radiography and CT scan for the evaluation of injuries.

Author Biography

Prijo Sidipratomo, Department of Radiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Referral General Hospital, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec., Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta 10430

Prijo Sidipratomo, MD is a senior interventional radiology consultant and a primary expert clinical educator doctor (Dokter Pendidik Klinis Ahli Utama) in Cipto Mangunkusumo National General Hospital

References

WHO. Road Traffic Injuries [Internet]. Geneva: World Health Organization; 2022 [cited 2022 Oct 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries.

Benhamed A, Ndiaye A, Emond M, Lieutaud T, Boucher V, Gossiome A, et al. Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality—A multicenter observational study. PLOS ONE. 2022 May 6;17(5):e0268202.

Akgul Ozmen C, Onat S, Aycicek D. Radiologic findings of thoracic trauma. Ther Clin Risk Manag. 2017 Aug 26;13:1085-1089.

Polireddy K, Hoff C, Kinger NP, Tran A, Maddu K. Blunt thoracic trauma: role of chest radiography and comparison with CT — findings and literature review. Emerg Radiol. 2022 Aug 1;29(4):743–55.

Lewis BT, Herr KD, Hamlin SA, Henry T, Little BP, Naeger DM, Hanna TN. Imaging Manifestations of Chest Trauma. Radiographics. 2021 Sep-Oct;41(5):1321-1334.

Uberoi R, Chakraverty S. Standards of practice and guidance for trauma radiology in severely injured patients. 2nd ed. London: The Royal College of Radiologists; 2021.

Unsworth A, Curtis K, Asha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand J Trauma Resusc Emerg Med. 2015 Feb 8;23:17.

Mergan İliklerden D, Çobanoğlu U, Sayır F, İliklerden ÜH. Late complications due to thoracic traumas. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES. 2022 Mar;28(3):328–35.

Kumar H M, Mishra K, Jain A, Sharma N. Ginkgo leaf sign and subcutaneous emphysema. BMJ Case Rep. 2018 Dec 3;11(1):bcr2018227770.

Aghajanzadeh M, Dehnadi A, Ebrahimi H, Fallah Karkan M, Khajeh Jahromi S, Amir Maafi A, Aghajanzadeh G. Classification and Management of Subcutaneous Emphysema: a 10-Year Experience. Indian J Surg. 2015 Dec;77(Suppl 2):673-7.

Rendeki S, Molnár TF. Pulmonary contusion. J Thorac Dis. 2019 Feb;11(Suppl 2):S141-S151.

Talbot BS, Gange CP Jr, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics. 2017 Mar-Apr;37(2):628-651.

Henry TS, Donnelly EF, Boiselle PM, Crabtree TD, Iannettoni MD, Johnson GB, et al. ACR Appropriateness Criteria® Rib Fractures. J Am Coll Radiol. 2019 May;16(5):S227–34.

Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020 Jun;23(3):125-138.

Zeiler J, Idell S, Norwood S, Cook A. Hemothorax: A Review of the Literature. Clin Pulm Med. 2020 Jan;27(1):1–12.

Rodriguez RM, Canseco K, Baumann BM, Mower WR, Langdorf MI, Medak AJ, et al. Pneumothorax and Hemothorax in the Era of Frequent Chest Computed Tomography for the Evaluation of Adult Patients With Blunt Trauma. Ann Emerg Med. 2019;73(1):58–65.

Liu F, Huang YC, Ng YB, Liang JH. Differentiate pleural effusion from hemothorax after blunt chest trauma; comparison of computed tomography attenuation values. J Acute Med. 2016 Mar 1;6(1):1–6.

Dubé BP, Dres M. Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies. J Clin Med. 2016 Dec 5;5(12):113.

Lakranbi M, Harmouchi H, Belliraj L, Ammor F, Issoufou I, Ouadnouni Y, et al. Phrenic Paralysis after Chest Trauma: About 3 Cases. J Emerg Clin Care. 2108;1(1):1–4.

Gothi D, Patro M, Agarwal M, Vaidya S. A mysterious case of an elevated dome of the right diaphragm. Breathe. 2020 Jun;16(2):190334.

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Published

2023-05-03

How to Cite

Sidipratomo, P., Pandelaki, J., Widjaja, S., & Jason, J. (2023). Multiple Radiologic Findings in a Simple Blunt Thoracic Trauma. Jurnal Profesi Medika : Jurnal Kedokteran Dan Kesehatan, 17(1). https://doi.org/10.33533/jpm.v17i1.5123