Rahmouni A, Margenet-Baudry A, Guerrini P, Anglade M C, Golli M, Vasile N
Service de Radiologie et Imagerie Médicale, CHU Henri-Mondor, Créteil.
J Radiol. 1992 Dec;73(12):657-62.
On chest radiographs, the precise assessment of thoracic injuries consecutive to blunt trauma is often compromised by the nonspecific appearance of many lesions. Furthermore, significant injuries are frequently overlooked. However, the management of the patients with chest trauma is still often based primarily upon clinical and radiographic findings and Computed Tomography (CT) is often performed secondarily on the basis of unexplained clinical signs or suspected radiographic abnormality. Some authors have reported that CT was a highly sensitive method for detecting thoracic lesions frequently not seen or underestimated on conventional supine chest radiographs. However, the value that these new CT findings could have in the therapeutic management of these patients, have not been systematically investigated to our knowledge, except in a limited series suggesting that the course of critically ill patients could be substantially altered after thoracic CT. In order to estimate the role of early CT in the management of patient care, we report the therapeutic consequences of CT findings in forty patients who we report the therapeutic consequences of CT findings in forty patients who had a thoracic CT within few hours following a chest injury. We showed that early thoracic CT scan in patients with blunt trauma detected significantly more lesions than did chest X-Ray and appreciably modified the treatment modalities in 70% of our patients. We then recommend that all the patients admitted in ICU after chest trauma undergo a thoracic CT scan as soon as possible in order to optimize their treatment modalities.
在胸部X光片上，钝性创伤后胸部损伤的精确评估常常因许多损伤的非特异性表现而受到影响。此外，严重损伤经常被忽视。然而，胸部创伤患者的治疗通常仍主要基于临床和影像学检查结果，计算机断层扫描（CT）往往是在出现无法解释的临床体征或怀疑有影像学异常时才作为次要检查进行。一些作者报告称，CT是检测传统仰卧位胸部X光片上经常看不到或被低估的胸部损伤的高灵敏度方法。然而，据我们所知，除了在一个有限的系列研究中表明胸部CT后重症患者的病程可能会发生实质性改变外，这些新的CT检查结果在这些患者治疗管理中的价值尚未得到系统研究。为了评估早期CT在患者治疗管理中的作用，我们报告了40例胸部受伤后数小时内接受胸部CT检查患者的CT检查结果对治疗的影响。我们发现，钝性创伤患者早期胸部CT扫描检测到的损伤明显多于胸部X光检查，并且在70%的患者中显著改变了治疗方式。我们因此建议，所有胸部创伤后入住重症监护病房的患者应尽快接受胸部CT扫描，以优化其治疗方式。
