Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography(TCT)in evaluating chest trauma have not yet been clarified at present.The current study was undertaken to determine the value of chest X-ray(CXR)in detecting chest injuries in patients with blunt trauma.METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department(ED)in the period of 2009–2013 were retrospectively reviewed.The patients met inclusion criteria(age>8 years,blunt injury to the chest,hemodynamically stable,and neurologically intact)and underwent both TCT and upright CXR in the ED.Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS:Of the 447 patients,309(69.1%)were male.The mean age of the 447 patients was 39.5±19.2(range 9 and 87 years).158(35.3%)patients were injured in motor vehicle accidents(MVA).CXR showed the highest sensitivity in detecting clavicle fractures[95%CI 78.3(63.6–89)]but the lowest in pneuomediastinum[95%CI 11.8(1.5–36.4)].The specificity of CXR was close to 100%in detecting a wide array of entities.CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma.Moreover,stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

螺旋CT平扫早期诊断肠和肠系膜钝性伤的临床价值

目的探讨螺旋CT平扫对肠及肠系膜钝性伤的早期诊断价值。方法回顾性分析32例经手术证实的急性肠及肠系膜钝性伤的CT表现和临床资料,所有病例均行CT平扫及增强检查,总结其CT征象的临床意义,并对CT平扫及增强检查结果进行对比分析。结果螺旋CT平扫及CT增强在腹腔积液或血肿、腹腔游离气体、肠系膜渗出及血肿、肠壁肿胀、肠管破裂、肠管扩张伴积液方面,诊断率无显著性差异。结论螺旋CT平扫对早期诊断急性肠和肠系膜钝性伤有较大临床价值,增强检查可作为CT平扫的重要补充。

闭合性腹部肠道及系膜损伤CT诊断

目的：探讨闭合性腹部肠道及系膜损伤的CT表现特征。材料与方法：回顾性研究闭合性腹部肠道及系膜损伤CT表现对例，全部经手术证实。结果：21例中，腹腔积气10例，主要呈小泡状、裂隙状，分布于肝脾胃周等；肠道管壁增厚2例；系膜增厚及血肿4例；腹腔及肠袢间积液13例；肠道扩张2例。结论：腹腔积气是肠道损伤的直接征象，肠道管壁及系膜增厚与血肿为肠道损伤的提示性征象，来源不明的腹腔积液，应考虑肠道损伤的可能性。肠道损伤的CT表现特征，对临床诊治和预后评估等具有重要价值。

螺旋CT在闭合性肠及肠系膜损伤中的诊断价值

目的探讨腹部闭合损伤致肠及肠系膜损伤的CT表现,分析其临床应用价值。方法回顾性分析手术证实的24例肠及肠系膜闭合性损伤患者的CT表现。结果腹腔游离气体共10例,占41.7%;肠壁增厚和(或)肠壁内血肿17例,占70.8%;肠系膜水肿15例,占62.5%;肠系膜血肿11例,占45.8%;腹腔和肠间隙积液、积血共24例,占100.0%。结论闭合性肠及肠系膜损伤具有特征性CT表现,CT对肠及肠系膜闭合损伤具有重要诊断价值,对临床早期诊治具有重要意义。

Clinical value of bedside abdominal sonography performed by certified sonographer in emergency evaluation of blunt abdominal trauma

Purpose:To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma.Methods:The study was carried out from 2017 to 2019.Findings in operations or on computed tomography(CT)were used as references to evaluate the accuracy of bedside abdominal ultrasonography.The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application.Results:Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma,of which 71 critical patients received surgery.The overall diagnostic accordance rate was 88.68%.The diagnostic accordance rate for liver injury,spleen injury,kidney injury,gut perforation,retroperitoneal hematoma and multiple abdominal organ injury were 100%,94.73%,94.12%,20.00%,100%and 81.48%,respectively.Among the 71 critical patients,the diagnostic accordance rate was 94.37%,in which the diagnostic accordance rate for liver injury,spleen injury,kidney injury,gut perforation and multiple abdominal organ injury were 100%,100%,100%,20.00%and 100%.The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan(4.45±1.63 vs.2.38±1.19)min;however,the mean waiting time before examination(7.37±2.01 vs.16.42±6.37)min,the time to make a diagnostic report(6.42±3.35 vs.36.26±13.33)min,and the overall time(17.24±2.33 vs.55.06±6.96)min were shorter for bedside abdominal ultrasonography than for CT scan.Conclusion:Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma.Especially for patients with free peritoneal effusion and critical patients,bedside ultrasonography has been proved obvious advantageous.However,for negative bedside ultrasonography patients with blunt abdominal trauma,we recommend further abdominal CT scan or serial ultrasonography scans subsequently.

消化道空腔器官钝性损伤的多层螺旋CT诊断

目的:探讨多层螺旋CT(MSCT)增强扫描检查对腹部胃肠道和肠系膜损伤的诊断价值。方法:回顾性分析27例经手术证实为腹部钝性损伤患者的平扫及增强CT表现征象,并比较分析各种征象的诊断价值。结果:27例中,腹腔和(或)腹膜后积液23例,气腹19例,肠管水肿增厚18例,肠系膜血肿15例,肠系膜增厚与周边脂肪界面模糊不清或周边脂肪内有斑点状改变22例。结论:MSCT增强扫描对判断有无肠和肠系膜损伤及其程度都有重要作用,有助于及时诊治。

肠系膜损伤的MSCT表现

目的探讨肠系膜损伤的CT表现特征。资料与方法回顾18例经手术证实肠系膜损伤患者的CT检查结果,采用多窗技术分析其CT征象。结果18例患者的CT图像均显示有腹膜腔内游离积液/积血及肠系膜脂肪内渗出,其中14例可见肠系膜内血肿,13例可见肠壁增厚及增强后异常强化,7例合并肠管损伤可见肠腔外游离气体,2例可见血管内对比剂外溢。CT表现均与手术结果一致。结论肠系膜损伤可出现多种CT表现,采用多窗技术分析并正确认识其CT征象有助于避免漏诊和误诊。