Manson D, Babyn P S, Palder S, Bergman K
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Radiol. 1993;23(1):1-5. doi: 10.1007/BF02020209.
While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy.
尽管创伤仍是儿童年龄段死亡的主要原因,但令人惊讶的是,儿科胸部损伤的CT表现很少在文献中得到研究。我们回顾了44例因要求进行胸部CT检查以探究胸内损伤程度的儿童钝性胸部创伤的CT表现。我们注意到肺挫伤倾向于位于后部或后内侧,且在解剖学上非节段性,呈新月形。这可能归因于儿童相对顺应性较好的前胸壁。本文还描述了其他主要胸部损伤的CT表现,包括肺撕裂伤、气胸、胸管位置不当、纵隔血肿、主动脉损伤、气管支气管损伤、心包积血以及伴有椎旁液体积聚的脊柱损伤。本文还展示了一些患儿,他们虽有与实际损伤无关但对后续治疗很重要的检查结果。我们得出结论,在发生具有临床意义的钝性胸部创伤时,创伤室中的单次仰卧位胸部检查不足以充分识别胸内损伤的程度。除了怀疑有主动脉损伤需行主动脉造影外,应进行胸部动态增强CT扫描,因为具有临床意义的检查结果可能会改变治疗方案。