From the Department of Radiology, University of Washington School of Medicine, 325 9th Ave, Box 359728, Seattle, WA 98104.
Radiographics. 2014 Nov-Dec;34(7):1824-41. doi: 10.1148/rg.347130022.
Penetrating transmediastinal injuries (TMIs) are injuries that traverse the mediastinum. These injuries are most commonly caused by firearms and knives. The investigation and management algorithms for TMI have undergone changes in recent years due to increasing evidence that computed tomography (CT) in useful in the evaluation of hemodynamically stable TMI patients. Initial investigation of TMI patients depends on the question of hemodynamic stability. In unstable patients, imaging (if any) should be limited to bedside radiography and focused ultrasonography. In hemodynamically stable patients in whom a mediastinal trajectory of injury is suspected, the primary imaging modality after radiography should be multidetector CT. CT is invaluable in the assessment of TMI due to its capacity to depict the injury track as well as demonstrate both direct and indirect signs of organ injury. On the basis of the suspected trajectory and specific findings, radiologists can play an essential role in determining future patient management and investigations for each mediastinal organ, thereby expediting appropriate investigation and treatment and avoiding unnecessary and sometimes invasive tests or surgery. The authors provide an up-to-date and evidence-based approach for the management of hemodynamically unstable and stable patients with suspected TMI, discuss management algorithms and CT protocols, and highlight common and uncommon imaging findings and diagnostic pitfalls associated with vascular, cardiac, esophageal, tracheobronchial, pleural, and pulmonary injuries. Online supplemental material is available for this article.
穿透性纵膈伤（TMIs）是指贯穿纵膈的损伤。这些损伤最常见于由火器和刀引起。由于越来越多的证据表明计算机断层扫描（CT）在评估血流动力学稳定的 TMI 患者方面很有用，因此 TMI 的调查和管理算法近年来发生了变化。TMI 患者的初始调查取决于血流动力学是否稳定的问题。对于不稳定的患者，影像学（如有）应仅限于床边 X 线摄影和焦点超声检查。对于血流动力学稳定且怀疑有纵膈伤轨迹的患者，在 X 线摄影后，主要的成像方式应为多排 CT。CT 由于能够描绘损伤轨迹以及显示直接和间接的器官损伤迹象，因此在评估 TMI 方面非常有价值。根据可疑的轨迹和具体发现，放射科医生可以在确定每个纵膈器官的未来患者管理和检查方面发挥重要作用，从而加快适当的检查和治疗，并避免不必要且有时是侵入性的检查或手术。作者提供了一种最新的、基于证据的方法来管理血流动力学不稳定和血流动力学稳定的疑似 TMI 患者，讨论了管理算法和 CT 方案，并强调了与血管、心脏、食管、气管支气管、胸膜和肺损伤相关的常见和不常见的影像学表现和诊断陷阱。本文提供了在线补充材料。
