Marts B, Durham R, Shapiro M, Mazuski J E, Zuckerman D, Sundaram M, Luchtefeld W B
Department of Surgery, St. Louis University Health Sciences Center, Missouri 63110-0250.
Am J Surg. 1994 Dec;168(6):688-92. doi: 10.1016/s0002-9610(05)80146-1.
Computed tomography (CT) is an important diagnostic modality in the evaluation of blunt head and abdominal injuries, but it has not been routinely used to evaluate blunt chest trauma.
One hundred seventy stable patients with blunt thoracic trauma were evaluated with chest x-ray (CXR), and subsequently by CT.
Of a total of 131 fractures, 53% were identified on initial CXR, 39% on CT, and 26% were not seen on either study. Twenty-one pneumothoraces were seen on CT but not on CXR. Chest tubes were placed in 8 patients and 12 patients were observed without incident. One hemothorax identified by CT scan alone required treatment. Four of 6 diaphragmatic injuries were seen on CT and 2 on CXR. Parenchymal abnormalities were apparent in 189 lung fields on CT and in 66 lung fields on CXR. Most represented atelectasis and did not require treatment. Altogether, CT scanning resulted in changes in management for 11 patients (6%).
Although CXR is less sensitive in detecting parenchymal and pleural injuries than CT, the majority of the injuries identified by CT alone are minor and require no treatment. CXR remains the primary modality for diagnostic evaluation of blunt thoracic trauma.
计算机断层扫描（CT）是评估钝性头部和腹部损伤的重要诊断方法，但尚未常规用于评估钝性胸部创伤。
对170例钝性胸部创伤稳定患者进行胸部X线（CXR）检查，随后进行CT检查。
在总共131处骨折中，53%在初次CXR检查中被发现，39%在CT检查中被发现，26%在两项检查中均未被发现。21例气胸在CT检查中可见，但在CXR检查中未见。8例患者放置了胸管，12例患者观察无异常。仅通过CT扫描发现的1例血胸需要治疗。6例膈肌损伤中有4例在CT检查中可见，2例在CXR检查中可见。CT检查发现189个肺野有实质异常，CXR检查发现66个肺野有实质异常。大多数表现为肺不张，无需治疗。总体而言，CT扫描导致11例患者（6%）的治疗方案发生改变。
尽管CXR在检测实质和胸膜损伤方面不如CT敏感，但仅通过CT发现的大多数损伤较轻，无需治疗。CXR仍然是钝性胸部创伤诊断评估的主要方法。
