Van Hise M L, Primack S L, Israel R S, Müller N L
Department of Radiology, Oregon Health Sciences University, Portland 97201, USA.
Radiographics. 1998 Sep-Oct;18(5):1071-84. doi: 10.1148/radiographics.18.5.9747608.
Computed tomography (CT) is the imaging modality of choice in the assessment of patients with clinical or radiographic findings suggestive of aortic injury, bone fracture, or diaphragmatic tear following blunt chest trauma. Contrast material-enhanced spiral CT allows detection of both subtle and more obvious aortic tears. CT has overall greater sensitivity than radiography in the detection of pulmonary lacerations and pneumothoraces. CT may be indicated in cases of suspected tracheobronchial injury. CT is of limited use in the assessment of rib fractures because such injuries are of limited clinical significance and can usually be identified at radiography; however, CT provides optimal visualization of thoracic spine fractures and superior assessment of suspected sternal fractures or sternoclavicular dislocation. Targeted spiral CT with sagittal and coronal reformatted images has increased sensitivity and specificity over that provided by conventional axial CT in the detection of diaphragmatic injury. Optimal CT assessment requires careful attention to technique, including the use of intravenously administered contrast material and multiplanar reconstructed images, as well as an awareness of potential pitfalls. Although in many cases diagnosis can be made with confidence on the basis of CT findings, further investigation is often needed to confirm the diagnosis.
计算机断层扫描（CT）是评估钝性胸部创伤后出现提示主动脉损伤、骨折或膈肌撕裂的临床或影像学表现患者的首选成像方式。对比剂增强螺旋CT能够检测出细微和较明显的主动脉撕裂。在检测肺撕裂伤和气胸方面，CT总体上比X线摄影具有更高的敏感性。对于疑似气管支气管损伤的病例，可能需要进行CT检查。CT在评估肋骨骨折方面作用有限，因为此类损伤临床意义不大，通常可通过X线摄影识别；然而，CT能最佳地显示胸椎骨折，并能更好地评估疑似胸骨骨折或胸锁关节脱位。与传统轴向CT相比，具有矢状面和冠状面重组图像的靶向螺旋CT在检测膈肌损伤方面具有更高的敏感性和特异性。最佳的CT评估需要仔细关注技术，包括使用静脉注射对比剂和多平面重建图像，以及了解潜在的陷阱。尽管在许多情况下可根据CT结果自信地做出诊断，但往往需要进一步检查以确诊。
