Kuhlman J E, Pozniak M A, Collins J, Knisely B L
Department of Radiology, University Hospital and Clinics, University of Wisconsin Medical School, Madison 53792-3252, USA.
Radiographics. 1998 Sep-Oct;18(5):1085-106; discussion 1107-8; quiz 1. doi: 10.1148/radiographics.18.5.9747609.
Increasingly, helical CT is being used to screen trauma patients for aortic injury. Most aortic injuries visible at CT occur at or near the level of the ligamentum arteriosus; these injuries manifest as mediastinal hematoma, aortic contour deformity, intimal flaps, intraluminal debris, pseudoaneurysm, and pseudocoarctation. In the process of searching for aortic injury, however, the radiologist should not overlook other serious and more common thoracic injuries. Tracheobronchial tears appear at CT and radiography with persistent pneumothorax, subcutaneous emphysema, "fallen lung" sign, and malposition of endotracheal tube. The ruptured diaphragm, which tears more often on the left, appears asymmetric, irregular, or discontinuous, with herniation of bowel or viscera into the chest. In esophageal rupture, CT and radiography demonstrate left pneumothorax, pneumomediastinum, subcutaneous emphysema, and pleural effusion and atelectasis on the left. CT is better than trauma radiography for depicting fractures of the thoracic vertebral bodies and ribs, as well as for revealing pulmonary contusions and lacerations. CT is also useful for demonstrating unsuspected injuries caused by seat belts. Observation of these injuries should prompt a search for other serious internal organ injuries.
螺旋CT越来越多地用于筛查创伤患者是否存在主动脉损伤。CT可见的大多数主动脉损伤发生在动脉韧带水平或其附近；这些损伤表现为纵隔血肿、主动脉轮廓畸形、内膜瓣、管腔内碎片、假性动脉瘤和假性缩窄。然而，在寻找主动脉损伤的过程中，放射科医生不应忽视其他严重且更常见的胸部损伤。气管支气管撕裂在CT和X线片上表现为持续气胸、皮下气肿、“肺坠落”征和气管内导管位置异常。膈肌破裂多发生在左侧，表现为不对称、不规则或不连续，伴有肠管或内脏疝入胸腔。食管破裂时，CT和X线片显示左侧气胸、纵隔气肿、皮下气肿以及左侧胸腔积液和肺不张。在显示胸椎和肋骨骨折以及揭示肺挫伤和撕裂伤方面，CT比创伤X线摄影更好。CT对于显示安全带造成的意外损伤也很有用。对这些损伤的观察应促使医生寻找其他严重的内脏损伤。
