| 1. Bernardin B, Troquet JM. Initial management and resuscitation of severe chest trauma. Emerg Med Clin North Am. 2012;30(2):377-400, viii-ix. |
Review/Other-Dx |
N/A |
To provide a review of major thoracic injuries and to provide guidance in the initial management and resuscitation of victims of severe chest trauma. |
The incorporation of E-FAST will greatly facilitate the diagnostic approach. Therapeutic gestures such as tube thoracostomy and intubation play an important role in the initial stabilization of these patients. Further imaging with CT scanning allows for better definition of the majority of the injuries and has become the diagnostic modality of choice for aortic injuries. The majority of occult injuries (to CXR) can be easily observed. More than 80% of chest injuries may be managed nonoperatively, with supportive treatment. |
4 |
| 2. Karmy-Jones R, Jurkovich GJ, Nathens AB, et al. Timing of urgent thoracotomy for hemorrhage after trauma: a multicenter study. Arch Surg. 2001;136(5):513-518. |
Observational-Tx |
157 patients |
Study hypothesized that it is possible to quantify an amount of thoracic hemorrhage, after blunt and penetrating injury, at which delay of thoracotomy is associated with increased mortality. |
Mortality correlated with mean (+/- SD) Injury Severity Score (38 +/- 19 vs 22 +/- 12.6 for survivors; P<.01) and mechanism (24 [67%] for blunt vs 21 [17%] for penetrating injuries; P<.01). Mortality increased as total chest blood loss increased, with the risk for death at blood loss of 1500 mL being 3 times greater than at 500 mL. Blunt-injured patients waited a significantly longer time to thoracotomy than penetrating-injured patients (4.4 +/- 9.0 h vs 1.6 +/- 3.0 h; P =.02) and also had a greater total chest tube output before thoracotomy (2220 +/- 1235 mL vs 1438 +/- 747 mL; P =.001). |
2 |
| 3. Hasler RM, Srivastava D, Aghayev E, Keel MJ, Exadaktylos AK, Schnuriger B. First results from a Swiss level I trauma centre participating in the UK Trauma Audit and Research Network (TARN): prospective cohort study. Swiss Medical Weekly. 144:w13910, 2014 Feb 13. |
Review/Other-Dx |
458 patients |
To identify predictors for mortality in Swiss trauma patients. |
Of 458 patients 71% were male. The median age was 50.5 years (inter-quartile range [IQR] 32.2–67.7), median Injury Severity Score (ISS) was 14 (IQR 9–20) and median Glasgow Coma Score (GCS) was 15 (IQR 14–15). The ISS was >15 for 47%, and 14% had an ISS >25. A total of 17 patients (3.7%) died within 30 days of trauma. All deaths were in patients with ISS >15. Most injuries were due to falls <2 m (35%) or road traffic accidents (29%). Injuries to the head (39%) were followed by injuries to the lower limbs (33%), spine (28%) and chest (27%). The time of admission peaked between 12:00 and 22:00, with a second peak between 00:00 and 02:00. A total of 64% of patients were admitted directly to our trauma centre. The median time to CT was 30 min (IQR 18–54 min). Using multivariable regression analysis, the predictors of mortality were older age, higher ISS and lower GCS. |
4 |
| 4. Watson J, Slaiby J, Garcia Toca M, Marcaccio EJ Jr, Chong TT. A 14-year experience with blunt thoracic aortic injury. Journal of Vascular Surgery. 58(2):380-5, 2013 Aug. |
Observational-Tx |
129 patients |
To review the natural history of blunt thoracic aortic trauma (BTAT) over a 14-year period at a level 1 trauma center and to compare open vs endovascular treatment. |
We identified 129 patients with BTAT. Of these, 32 (25%) were dead on arrival, 38 (29%) underwent a resuscitative thoracotomy and died, 33 (26%) underwent open repair, 14 (11%) underwent endovascular repair, 9 (7%) underwent simultaneous procedures, and 3 (2%) were managed nonoperatively. Mean Injury Severity Scores and Revised Trauma Scores were similar (P [ .484, P [ .551) between the open repair group (n [ 36) and the endovascular repair group (n [ 14). In the open repair group, there were 14 deaths (42%) #30 days of injury, 3 strokes (9%), 2 patients (6%) with paralysis, 2 myocardial infarctions (MIs; 6%), and 3 patients (9%) who required hemodialysis. In the endovascular group, there was 1 death (7%) #30 days of injury, 1 (7%) stroke, and 1 (7%) stent collapse. No paralysis, MI, or renal failure requiring hemodialysis was noted in the endovascular group. The average length of stay was 15 days for patients treated with endovascular repair vs 24 days for those treated with open repair (P [ .003). Conclusions: The incidence of BTAT is low but the mortality associated with it is significant. During the 14-year period studied, there was a clear change in management preference from open repair to endovascular repair at our level 1 trauma center. Outcomes, including stroke, MI, renal failure, paralysis, length of stay, and death, appear to be reduced in the endovascular group. |
2 |
| 5. American College of Radiology. ACR Appropriateness Criteria®: Major Blunt Trauma. Available at: https://acsearch.acr.org/docs/3102405/Narrative/. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No abstract available. |
4 |
| 6. Akar I, Ince I, Aslan C, Ceber M, Kaya I. Left atrial rupture due to blunt thoracic trauma. Ulus Travma Acil Cerrahi Derg. 21(4):303-5, 2015 Jul. |
Review/Other-Dx |
1 male |
To report the case of 33-year-old man with a rupture of the left atrium-right superior pulmonary vein connection after blunt thoracic trauma. |
After midline sternotomy and pericardial incision, 400 ml fibrin blood gushed out. On the examination of the heart, left atrial rupture was detected at the pulmonary vein-atrial junction (Fig. 2). Under partial cardiopulmonary bypass, the defect was sutured with a pledgeted 4–0 polypropylene suture. After opening the right pleura, approximately 1200 ml blood was aspirated. There was no bleeding source at the right hemithorax. After weaning from the cardiopulmonary bypass, transeusophageal echocardiography was performed and no defect was seen at interatrial and interventricular septum. The postoperative period was uneventful, and the patient was discharged on the postoperative six day without any complications. |
4 |
| 7. Huis In 't Veld MA, Craft CA, Hood RE. Blunt Cardiac Trauma Review. [Review]. Cardiol Clin. 36(1):183-191, 2018 Feb. |
Review/Other-Dx |
N/A |
To discuss the various types of cardiac injuries and their presentations. |
No results stated in the abstract. |
4 |
| 8. Wilbring M, Tugtekin SM, Daubner D, Ouda A, Kappert U, Matschke K. Protective effect of previous cardiac operation: survival of contained right ventricular rupture. Annals of Thoracic Surgery. 95(4):1445-7, 2013 Apr.Ann Thorac Surg. 95(4):1445-7, 2013 Apr. |
Review/Other-Dx |
1 male |
To report the case of a 66-year old male with a history of prior cardiac operation who survived a contained rupture of the right ventricle; and six months later, presented with a false aneurysm of the right ventricular outflow tract. |
The patient underwent a cardiac operation and the aneurysm was successfully resected. |
4 |
| 9. Getz BS, Davies E, Steinberg SM, Beaver BL, Koenig FA. Blunt cardiac trauma resulting in right atrial rupture. JAMA. 255(6):761-3, 1986 Feb 14. |
Review/Other-Dx |
5 patients |
To report the cases of five patients with atrial ruptures in the Columbus, Ohio metropolitan area. |
No results stated in the abstract. |
4 |
| 10. Bock JS, Benitez RM. Blunt cardiac injury. [Review]. Cardiol Clin. 30(4):545-55, 2012 Nov. |
Review/Other-Dx |
N/A |
To review some of the most common patterns of blunt cardiac injury (BCI). |
Blunt chest trauma represents a spectrum of injuries to the heart and aorta that vary markedly in character and severity. The setting, signs, and symptoms of chest trauma are often nonspecific, which represents a challenge to emergency providers. Individuals with suspected blunt chest trauma who have only mild or no symptoms, a normal electrocardiogram (ECG), and are hemodynamically stable typically have a benign course and rarely require further diagnostic testing or long periods of close observation. Individuals with pain, ECG abnormalities, or hemodynamic instability may require rapid evaluation of the heart by echocardiography and the great vessels by advanced imaging. |
4 |
| 11. Hall MK, Omer T, Moore CL, Taylor RA. Cost-effectiveness of the Cardiac Component of the Focused Assessment of Sonography in Trauma Examination in Blunt Trauma. Acad Emerg Med. 23(4):415-23, 2016 Apr. |
Review/Other-Dx |
N/A |
To determine through decision analysis whether performing the cFAST exam is cost-effective in the evaluation of hypotensive and normotensive blunt trauma patients. |
In hypotensive patients, for the base case scenario of a 34-year-old with blunt trauma, the cFAST strategy had a cost of $42,882.70 and an effectiveness of 25.3597 QALYs, whereas the no cFAST strategy had a cost of $42,753.52 and an effectiveness of 25.3532 QALYs. The incremental costeffectiveness ratio (ICER) was $19,918/QALY. For normotensive patients the cFAST strategy had a cost of $18,331.03 and an effectiveness of 23.2817 QALYs, whereas the no cFAST strategy had a cost of $18,207.58 and an effectiveness of 23.2814 QALYs. The ICER was $465,867/QALY. In the sensitivity analyses, age, probability of death from sBCI with prompt treatment, and probability of sBCI were the main drivers of variability in the model outcomes. |
4 |
| 12. Rojas CA, Cruite DM, Chung JH. Traumatic ventricular septal defect: characterization with electrocardiogram-gated cardiac computed tomography angiography. J Thorac Imaging. 2012;27(6):W174-176. |
Review/Other-Dx |
N/A |
To report a case in which a ventricular septal defect caused by blunt chest trauma was characterized with electrocardiogram-gated computed tomography angiography and to review the current literature and theories of injury mechanism. |
No results stated in abstract. |
4 |
| 13. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 14. Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A. Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT. American Journal of Emergency Medicine. 36(6):1014-1017, 2018 Jun.Am J Emerg Med. 36(6):1014-1017, 2018 Jun. |
Observational-Dx |
140 patients |
To compare the diagnostic accuracy of the E-FAST exam performed by EM residents with the results of CT scan as a gold standard. |
A total of 140 patients were recruited from eligible 144 patients. The final study population was 132 for abdominal and 130 for thorax examinations. In this study, AUC of E-FAST was 0.71 for abdominal free fluid, 0.87 for pneumothorax and 1.00 for pleural effusion. The sensitivity was 42.9% and specificity was 98.4%. The +LR for abdominal free fluid was 26.8 and -LR was 0.58. |
2 |
| 15. Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Is the FAST exam reliable in severely injured patients?. Injury. 41(5):479-83, 2010 May. |
Observational-Dx |
3181 patients |
To determine whether the FAST exam is reliable in severely injured patients. |
3181 patients with blunt abdominal trauma included into the study were divided into the three groups according to the ISS. The mean ISS was 7.9+/-3.97, 19.6+/-2.48 and 41.3+/-11.95 in Groups 1, 2 and 3, respectively. The accuracy of ultrasound was 90.6% in the group of patients with the highest ISS (>or=25) compared with 97.5 and 97.1 for Groups 1 and 2 (p<0.001). Similarly, ultrasound had a significantly lower sensitivity, specificity, PPV and NPV for patients in Group 3 compared with the first two groups (p<0.001). There was a significantly lower sensitivity in Group 2 compared with Group 1 (p<0.001), but no differences in specificity, accuracy, PPV or NPV were demonstrated. |
3 |
| 16. Laselle BT, Byyny RL, Haukoos JS, et al. False-negative FAST examination: associations with injury characteristics and patient outcomes. Ann Emerg Med. 60(3):326-34.e3, 2012 Sep. |
Observational-Dx |
332 patients |
To estimate associations between false-negative Focused assessment with sonography in trauma (FAST) results and patient characteristics, specific abdominalorgan injuries, and patient outcomes. |
During the study period, 332 patients met inclusion criteria. Median age was 32 years (interquartile range 23 to 45 years), 67% were male patients, the median Injury Severity Score was 27 (interquartile range 17 to 41), and 162 (49%) had a false-negative FAST result. Head injury was positively associated with false negative FAST result (odds ratio [OR] 4.9; 95% confidence interval [CI] 1.5 to 15.7), whereas severe abdominal injury was negatively associated (OR 0.3; 95% CI 0.1 to 0.5). Injuries to the spleen (OR 0.4; 95% CI 0.24 to 0.66), liver (OR 0.36; 95% CI 0.21 to 0.61), and abdominal vasculature (OR 0.17; 95% CI 0.07 to 0.38) were also negatively associated with false-negative FAST result. False-negative FAST result was not associated with mortality (OR 0.89; 95% CI 0.42 to 1.9), prolonged ICU length of stay (relative risk 0.88; 95% CI 0.69 to 1.12), or total hospital length of stay (relative risk 0.92; 95% CI 0.76 to 1.12). However, patients with false-negative FAST results were substantially less likely to require therapeutic laparotomy (OR 0.31; 95% CI 0.19 to 0.52). |
2 |
| 17. Kim YJ, Kim JS, Cho SH, et al. Characteristics of computed tomography in hemodynamically unstable blunt trauma patients: Experience at a tertiary care center. Medicine. 96(49):e9168, 2017 Dec. |
Observational-Dx |
1723 patients |
To describe the bleeding site and hospital course of severe blunt trauma patients with hemoperitoneum diagnosed by computed tomography (CT) scan. |
Among 1723 severe blunt trauma patients, 136 patients with hemoperitoneum were included. Of these, 98 (72.1%) patients had documented intraperitoneal injury, and the liver (60.2%) was most frequently damaged site, followed by spleen (23.5%) and mesentery (23.5%). The rate of intraperitoneal organ injury did not differ between hemodynamically stable (n=107) and unstable (n= 29) groups (69.2% vs 82.8%, P=.15), while the documented active internal bleeding was high in the unstable group (29.9% vs 69.0%, P<.001). In the unstable group, 14 (48.3%) patients underwent emergent operation, while 3 patients underwent embolization, and the others were treated in a conservative manner. |
3 |
| 18. Alborzi Z, Zangouri V, Paydar S, et al. Diagnosing Myocardial Contusion after Blunt Chest Trauma. [Review]. The Journal of Tehran Heart Center. 11(2):49-54, 2016 Apr 13. |
Review/Other-Dx |
N/A |
To provide the appropriate diagnostic algorithm and the steps to eliminating many of the uncertainties in dealing with blunt chest trauma patients. |
No results stated in abstract. |
4 |
| 19. Velmahos GC, Karaiskakis M, Salim A, et al. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. Journal of Trauma-Injury Infection & Critical Care. 54(1):45-50; discussion 50-1, 2003 Jan. |
Observational-Dx |
333 patients |
To examine whether the combination of two simple tests, electrocardiography (ECG) and serum troponin I (TnI) level, may serve as reliable predictors of blunt cardiac injury (BCI) or the absence of it. |
SigBCI was diagnosed in 44 patients (13%). Of 80 patients with abnormal ECG and TnI, 27 (34%) developed SigBCI. Of 131 with normal serial ECG and TnI, none developed SigBCI. Of patients with abnormal ECG only or TnI only, 22% and 7%, respectively, developed SigBCI. The positive and negative predictive values were 29% and 98% for ECG, 21% and 94% for TnI, and 34% and 100% for the combination of ECG and TnI. The admission ECG or TnI was abnormal in 43 of 44 patients with Sig- BCI. Only one patient had initially normal ECG and TnI and developed abnormalities 8 hours after admission. Forty-one patients without other significant injuries stayed 1 to 3 days in the hospital only to rule out SigBCI and could have been discharged earlier. Besides ECG and TnI, other independent risk factors of SigBCI were an Injury Severity Score > 15, the presence of significant skeletal trauma, and history of cardiac disease. |
3 |
| 20. Abi-Chaker AM, Jones KM, Sanchez P, Sasson J, Li X, Rey J. Successful Revascularization of Aortic Arch in a 39-Year-Old Blunt Trauma Patient with Acute Diffuse Axonal Injury without the Use of Systemic Anticoagulation. Ann Vasc Surg. 44:418.e1-418.e5, 2017 Oct. |
Review/Other-Dx |
1 male |
To report the case of a 39-year-old otherwise healthy Hispanic male following a motor vehicle collision and found to have multiple intracranial hemorrhages and a large aortic pseudoaneurysm of the distal ascending aorta. |
In lieu of standard cardiopulmonary bypass, a hybrid approach was utilized. Cranial blood flow was maintained using a temporary extra-anatomical left femoral to bilateral carotid bypass during endovascular coverage of the aortic arch. Aortic arch revascularization was then achieved by means of in situ laser fenestration of the innominate artery followed by a right-to-left carotid-carotid-subclavian bypass. This case demonstrates the viability of a hybrid vascular repair of a complex aortic disruption without the use of systemic anticoagulation in the setting of contraindicated or unknown risk of systemic anticoagulation. |
4 |
| 21. Iacobellis F, Ierardi AM, Mazzei MA, et al. Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications. [Review]. British Journal of Radiology. 89(1061):20150952, 2016. |
Review/Other-Dx |
N/A |
To illustrate the value of dual-phased MDCT protocol in the identification and characterization of acute vascular injuries in the chest and abdomen in patients with high-energy trauma. |
No results stated in the abstract. |
4 |
| 22. Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. [Review] [50 refs]. Radiographics. 28(6):1555-70, 2008 Oct. |
Review/Other-Dx |
N/A |
To review and illustrate a spectrum of abnormalities encountered in blunt thoracic trauma at multidetector CT with multiplanar (two-dimensional) and volumetric (three-dimensional [3D]) reformation. |
Multidetector CT can quickly and accurately help diagnose a variety of thoracic injuries in trauma patients. These injuries can be clearly displayed with multiplanar and volumetric reformation. |
4 |
| 23. Tillou A, Gupta M, Baraff LJ, et al. Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. Journal of Trauma-Injury Infection & Critical Care. 67(4):779-87, 2009 Oct. |
Observational-Dx |
284 patients |
To determine whether a more selective approach could be justified in use the pan-CT scan for the evaluation of blunt trauma. |
Of the 284 patients, 48 (17%) had injuries on 52 unsupported CT scans. An immediate intervention was required in 2 of the 48 patients (4%). Injuries that would have been missed included 5 of 62 unsupported head scans (8%), 2 of 50 neck scans (4%), 33 of 116 chest scans (28%), and 12 of 83 abdominal scans (14%). These missed injuries represent 5 of the 61 patients with closed head injuries (8%) in the series, 2 of the 23 with C-spine injuries (9%), 33 of the 112 with chest injuries (29%), and 12 of the 86 with abdominal injuries (14%). In 19 patients, none of the four CT scans was supported; nine of these had an injury identified, and six were admitted to the hospital (1 to the intensive care unit). Injuries that would have been missed included intraventricular and intracerebral hemorrhage (4), subarachnoid hemorrhage (2), cerebral contusion (1), C1 fracture (1), spinous and transverse process fractures (3), vertebral fracture (6), lung lacerations (1), lung contusions (14), small pneumothoraces (7), grade II–III liver and splenic lacerations (6), and perinephric or mesenteric hematomas (2). |
4 |
| 24. Audette JS, Emond M, Scott H, Lortie G. Investigation of myocardial contusion with sternal fracture in the emergency department: multicentre review. Canadian Family Physician. 60(2):e126-30, 2014 Feb. |
Observational-Dx |
54 trauma patients |
To describe the use of initial electrocardiogram (ECG), follow-up ECG or equivalent monitoring, and tropinin I in patients presenting with sternal fracture who are assessed in emergency departments or by front-line physicians. |
Thirty-nine patients (72%) were assessed initially with ECGs; after 6 hours in the emergency department, 18 of these patients (33%) had follow-up ECGs or equivalent cardiac monitoring. Sixteen patients (30%) were assessed by means of troponin I dosage. Two patients (4%) presented with ECG abnormalities and only 1 patient (2%) presented with an elevated troponin I level. |
3 |
| 25. Bu'Lock FA, Prothero A, Shaw C, et al. Cardiac involvement in seatbelt-related and direct sternal trauma: a prospective study and management implications. European Heart Journal. 15(12):1621-7, 1994 Dec. |
Observational-Dx |
60 patients |
To assess the incidence and consequences of pericardial and myocardial involvement in seatbelt-related sternal injury. |
The study showed that 25% of 32 patients with seatbelt-related chest injury and 30% of 10 patients with multiple injuries had clinically unsuspected pericardial effusions detected by echocardiography. Pericardial effusion was not associated with an adverse outcome in the seatbelt-related injuries. Abnormalities of ECG or CK-MB isoenzyme levels were non-specific and did not correlate with the presence of pericardial effusion. |
2 |
| 26. Chen SW, Huang YK, Liao CH, Wang SY. Right massive haemothorax as the presentation of blunt cardiac rupture: the pitfall of coexisting pericardial laceration. Interactive Cardiovascular & Thoracic Surgery. 18(2):245-6, 2014 Feb.Interact Cardiovasc Thorac Surg. 18(2):245-6, 2014 Feb. |
Review/Other-Dx |
1 female |
To report the case of a 74-year-old female with blunt chest trauma where a chest X-ray and computed tomography (CT) revealed right haemothorax and little pericardial effusion. |
There were three 1-cm lacerations actively bleeding from the right atrium and inferior vena cava junction, which were repaired successfully. Furthermore, we identified a 10 cm laceration in the right-side pleuropericardium and a communication existing between the pericardial space and the right pleural space. No other injuries of the right thoracic cavity were noted after all blood clot was evacuated. This patient’s bleeding subsided and vital sign was stabilized after the operation and blood transfusions of packed red blood cell 6 units, fresh frozen plasma 6 units and Platelet 12 units. However, she suffered from renal failure, hepatic failure and respiratory failure because of perioperative profound shock. This patient’s multiorgan dysfunction gradually receded and the patient was discharged from the hospital on postoperative day 69. |
4 |
| 27. Saar S, Lomp A, Laos J, et al. Population-Based Autopsy Study of Traumatic Fatalities. World J Surg. 41(7):1790-1795, 2017 07. |
Review/Other-Dx |
1344 autopsies |
To study all consecutive autopsies on traumatic fatalities performed in a 5-year time segment in Estonia to determine predominant causes of death. |
Overall, 1344 autopsies were included. 75.7% of deaths were following blunt trauma. Mean age was 50.4 +/- 18.5 years, and 77.1% were male. A total of 71.8% of deaths occurred in the prehospital setting. Accidents, assaults, and suicides constituted 64.4, 20.5, and 15.2% of deaths, respectively. A total of 51.1% of injury fatalities had a positive blood alcohol level (BAL). Mean injury severity score was 39.7 +/- 23.9. Most common cause of death was due to head injuries at 50.5% followed by hemorrhage at 30.4%. Cardiac and aortic injuries were the predominant cause of hemorrhage-related fatalities. |
4 |
| 28. Harris DG, Huffner ME, Croal-Abrahams L, et al. Thoracic Endovascular Repair of Blunt Thoracic Aortic Injury in the Setting of an Aberrant Right Subclavian Artery. Ann Vasc Surg. 42:302.e15-302.e20, 2017 Jul. |
Review/Other-Dx |
3 patients |
To describe three patients with ARSA who underwent TEVAR for BTAI, and discuss critical management and technical issues in these patients. |
All patients underwent TEVAR on hospital day 2. Patient 1 was discharged on hospital day 49 after recovering from concurrent injuries. A CT angiogram obtained 6 months after repair demonstrated exclusion of the pseudoaneurysm and stable KD. At latest follow-up 5 years after surgery, the patient was doing well. Patient 2 was discharged on day 5. Embolization was not performedbecause the ARSA had no aneurysmal degeneration and did not communicate with the aortic injury. The patient lost his right radial and ulnar pulses, but had biphasic Doppler waveforms and no symptoms of ischemia. A postoperative CT angiogram demonstrated exclusion of traumatic pseudoaneurysm and collateral filling of the ARSA. Upon follow-up 1 month after injury he regained his right radial and ulnar pulses. Patient 3 had right finger digital pressures of 65 mm Hg versus 135 on the left but had no symptoms of extremity or vertebrobasilar ischemia. |
4 |
| 29. Ryu DW, Lee SY, Lee MK. Rupture of the left atrial roof due to blunt trauma. Interactive Cardiovascular & Thoracic Surgery. 17(5):912-3, 2013 Nov.Interact Cardiovasc Thorac Surg. 17(5):912-3, 2013 Nov. |
Review/Other-Dx |
1 male |
To report the first case of a 61-year-old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury. |
We diagnosed the patient with right-sided heart rupture and performed an emergency operation. After median sternotomy, we performed surgery under partial cardiopulmonary bypass. Immediately after pericardial excision, about 200 ml of stagnated blood gushed out and the blood pressure normalized. Continuous flow of small amounts of fresh blood without any lesion was found on the right side of the heart. After careful inspection, a laceration wound about 1.5 cm in size was found on the roof of the left atrium (Fig. 2). We sutured the wound with a 4-0 pledgeted polypropylene suture. The patient was discharged after 10 days, without any complications. |
4 |
| 30. Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT. [Review] [69 refs]. Radiographics. 27(6):1595-610, 2007 Nov-Dec. |
Review/Other-Dx |
N/A |
To review the anatomy, pathophysiology, and clinical manifestations of cardiac tamponade, with a particular focus on the CT findings of this life-threatening condition. |
No results stated in the abstract. |
4 |
| 31. Wall MJ Jr, Mattox KL, Wolf DA. The cardiac pendulum: blunt rupture of the pericardium with strangulation of the heart. [Review] [47 refs]. J Trauma. 59(1):136-41; discussion 141-2, 2005 Jul. |
Review/Other-Dx |
10 patients |
To report on a rare clinical injury, the blunt injury of the pericardium with strangulation of the heart. |
Ten cases of blunt injury to the pericardium were identified. All weresecondary to blunt trauma. Nine of the 10 cases had associated chest wall injuries and 5 of the 10 cases had cardiac strangulation. |
4 |
| 32. Restrepo CS, Gutierrez FR, Marmol-Velez JA, Ocazionez D, Martinez-Jimenez S. Imaging patients with cardiac trauma.[Erratum appears in Radiographics. 2012 Jul-Aug;32(4):1258]. Radiographics. 32(3):633-49, 2012 May-Jun. |
Review/Other-Dx |
N/A |
To discuss the pathophysiology and classification of cardiac trauma and the triage of patients with cardiac trauma, with emphasis on timely diagnostic imaging in patients who are hemodynamically stable. |
No results stated in the abstract. |
4 |
| 33. Schir F, Thony F, Chavanon O, Perez-Moreira I, Blin D, Coulomb M. Blunt traumatic rupture of the pericardium with cardiac herniation: two cases diagnosed using computed tomography. Eur Radiol. 11(6):995-9, 2001. |
Review/Other-Dx |
2 males |
To report on to cases of traumatic herniation of the heart for which a CT scan brought a major contribution for diagnosis. |
No results stated in the abstract. |
4 |
| 34. Kamiyoshihara M, Nagashima T, Baba S, Shimizu K, Takeyoshi I. Serial chest films are needed after a diagnosis of pneumopericardium because of risk of cardiac herniation. Ann Thorac Surg. 90(5):1705-7, 2010 Nov. |
Review/Other-Dx |
1 patient |
To present a case report which highlights the importance of reviewing the initial computed tomography (CT) scan, and not solely relying on latest CT findings. |
No results stated in abstract. |
4 |
| 35. Park MR, Min MK, Ryu JH, Lee DS, Lee KH. Extension of a coronary intramural hematoma after blunt chest trauma. Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES. 24(1):78-81, 2018 Jan.Ulus Travma Acil Cerrahi Derg. 24(1):78-81, 2018 Jan. |
Review/Other-Dx |
1 male |
To report the case of a 31-year-old man who had worsening left chest pain due to blunt chest trauma. |
Bedside echocardiography showed akinesis of the left ventricular apex and anterior wall as well as hypokinesis of the mid-to-basal anteroseptal wall and mid-to-basal lateral and posterior walls of the left ventricle. Computed tomography coronary angiography revealed intramural hematoma in the left main (LM) coronary and proximal left anterior descending (LAD) arteries. Percutaneous coronary intervention, with bare metal stent implantation from the LM coronary artery to the proximal LAD artery, was performed to treat the occlusion caused by the hematoma. After stenting, the hematoma that compressed the LM coronary artery shifted the left circumflex (LCX) artery, and the intramural hematoma developed and extended to the LCX artery. To resolve this occlusion, a drug-eluting stent was successfully implanted in the LCX artery. The patient was discharged without complications. At 2-month follow-up, he remained asymptomatic, with no recurrence of cardiovascular symptoms. |
4 |
| 36. Nabeel M, Williams KA Sr. A broken heart: right ventricular rupture after blunt cardiac injury. Journal of cardiovascular computed tomography. 7(2):133-5, 2013 Mar-Apr.J Cardiovasc Comput Tomogr. 7(2):133-5, 2013 Mar-Apr. |
Review/Other-Dx |
1 woman. |
To present the case of a 68-year-old woman who was a restrained driver that was brought to a hospital after sustaining a sever motor vehicle accident. |
CT of the chest showed multiple injuries to bone and soft tissue, in addition to contrast extravasation from the apical portion of the right ventricle into the pericardial space (Fig. 2). A 2-dimensional echocardiogram showed an left ventricular ejection fraction of 40%e45% and a small pericardial effusion but no clear evidence of myocardial rupture (Fig. 3). The patient was immediately taken to the operating room because of deteriorating respiratory status. Bilateral chest tubes were placed; an exploratory laparotomy was done for Roux-en-Y hepatojejunostomy and duodenal repair. After surgery, the patient developed frequent episodes of premature atrial and ventricular contractions and runs of nonsustained ventricular tachycardia, and she became hypotensive, requiring phenylephrine support. Her troponin level increased to 6.4 ng/mL over the next 48 hours. Repeat echocardiography showed mild-to-moderate sized loculated pericardial effusion (Fig.3) without any physiologic evidence for cardiac tamponade, leading to conservative management. After a prolonged hospital course, the patient ultimately died of hepatic failure and sepsis after multiple abdominal and orthopedic operations |
4 |
| 37. Maenza RL, Seaberg D, D'Amico F. A meta-analysis of blunt cardiac trauma: ending myocardial confusion. Am J Emerg Med. 1996;14(3):237-241. |
Meta-analysis |
41 studies |
To use a meta-analysis of the current literature to identify which patients with blunt cardiac trauma develop complications. |
Results of the three meta-analyses were similar. Abnormal ECG and abnormal CPK-MB were found to correlate directly with complications requiring treatment. Conversely, normal ECG and CPK-MB correlated with the lack of clinically significant complications. Radionuclide scans did not correlate with complications. The results for echocardiogram were not congruent between the prospective and retrospective studies. The data support the use of ECG and CPK-MB in the diagnosis of clinically significant myocardial contusion. Radionuclide scanning is not useful in the evaluation of patients with blunt cardiac trauma. Further studies need to define the role of echocardiography. |
Inadequate |
| 38. Sadr-Ameli MA, Amiri E, Pouraliakbar H, Heidarali M. Left anterior descending coronary artery dissection after blunt chest trauma. Archives of Iranian Medicine. 17(1):86-90, 2014 Jan.Arch Iran Med. 17(1):86-90, 2014 Jan. |
Review/Other-Tx |
1 female |
To report the case of a left anterior descending (LAD) coronary artery dissection in a health 38-year old female caused by blunt chest trauma. |
The patient was referred to our hospital with a complaint of chest pain. Electrocardiography showed T-wave inversion, echocardiography a revealed circumferential pericardial effusion, and the coronary angiogram demonstrated a thrombotic dissection of the LAD. Troponin I was the only biomarker with elevated level. CT coronary angiography was performed using the subtotal occlusion of the LAD and illustrated a relatively good LAD runoff, and thallium scintigraphy displayed viable myocardium in this territory. Despite the total occlusion of the LAD in our case, myocardial |
4 |
| 39. Nhan NH, Anh PT, Trung TM, Pezzella AT. Blunt traumatic left atrial appendage rupture and cardiac herniation. [Review]. Asian Cardiovascular & Thoracic Annals. 22(5):598-600, 2014 Jun.Asian Cardiovasc Thorac Ann. 22(5):598-600, 2014 Jun. |
Review/Other-Tx |
1 man |
To report the case of a 42-year-old man who sustained blunt thoracic trauma after a motor vehicle accident. |
He underwent an urgent operation. Operative findings included a large hematoma, a 4-cm tear in the left atrial appendage, and a long pleuropericardial rupture along the right phrenic nerve. We repaired the left atrial appendage without cardiopulmonary bypass, and closed the pericardial defect primarily. The patient recovered fully and was discharged on the 6th postoperative day. |
4 |
| 40. Malbranque G, Serfaty JM, Himbert D, Steg PG, Laissy JP. Myocardial infarction after blunt chest trauma: usefulness of cardiac ECG-gated CT and MRI for positive and aetiologic diagnosis. Emerg Radiol. 2011;18(3):271-274. |
Review/Other-Dx |
2 patients |
To determine usefulnes of cardiac ECG-gated CT and MRI for diagnosis of myocardial infarction after blunt chest trauma. |
Cardiac CT and MRI were useful to noninvasively explore these lesions. |
4 |
| 41. Evora PRB, Romano MMD, Tannus de Souza GB, Wada DT, Schmidt A, Rodrigues AJ. Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome. Tex Heart Inst J. 44(3):214-218, 2017 Jun. |
Review/Other-Dx |
1 male |
To report the 14-year outcome of a patient with acute myocardial infarction secondary to a left anterior descending coronary artery injury sustained in a motorcycle accident. |
Eleven months after the accident, the patient presented to us with clinical conditions and laboratory results that indicated the need for intervention. In view of his thoracic pain and effort symptoms, we performed myocardial scintigraphy, which revealed anterior ischemia. Coronary angiograms showed an extensive, isolated proximal LAD lesion, with no apparent evidence of atherosclerotic coronary artery disease.We therefore chose to treat the patient by means of surgical revascularization. After an absence of 12 years, our former patient lost his medical insurance and returned to our public institution, asymptomatic, as a “new case.” We gathered samples for a study of his blood chemistry, and we performed chest radiography, conventional ECG, myocardial scintigraphy, dobutamine stress echocardiography, and 64-slice multidetector computed tomography (CT). The ECG registered sinus rhythm and advanced right bundle branch block, with right ventricular (RV) overload. The two ECG records showed that, in 10 years, there had been no change in either pattern (Fig. 2). In addition, the 2015 chest radiograph showed normal results (Fig. 3). A stress echocardiogram with dobutamine showed no evidence of myocardial ischemia or ventricular dysfunction. Contrast echocardiograms confirmed good LV function. |
4 |
| 42. Kang T, Kang MJ, Kim JH. Spontaneous obliteration of right ventricular pseudoaneurysm after blunt chest trauma: diagnosis and follow-up with multidetector CT. Korean Journal of Radiology. 15(3):330-3, 2014 May-Jun.Korean J Radiol. 15(3):330-3, 2014 May-Jun. |
Review/Other-Dx |
1 patient |
To report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. |
On the eighth day of admission, echocardiography was performed to evaluate cardiac function and identify RV pseudoaneurysm. The echocardiography failed to identify a pseudoaneurysm, and cardiac function was normal. Consequently, the patient underwent an electrocardiography (ECG)-gated cardiac CT scan for final diagnosis on the fifteenth day of admission. The ECG-gated cardiac CT scan demonstrated a 15 x 6 mm round high attenuation-collection (i.e., pseudoaneurysm) connected to the RV by the neck. On the twentieth day of admission, the patient underwent a follow-up CT scan to evaluate the stability of the aneurysm. On follow-up CT scan, the size of pseudoaneurysm had increased to 17 x 7 mm (Fig. 1B, C), but surgery was deferred due to the critical condition of the patient. The patient received medical treatment with close monitoring. Follow-up CT scan obtained one month later indicated interval decrease of the pseudoaneurysm. Final CT obtained two months later demonstrated spontaneous obliteration of the RV pseudoaneurysm (Fig. 1D). |
4 |
| 43. Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with "normal" chest radiograph? J Trauma. 2001;51(6):1173-1176. |
Observational-Dx |
93 patients |
To evaluate the role of routine computed tomographic (CT) scan. |
68 patients (73.1%) showed at least one pathologic sign on chest radiograph, and 25 patients (26.9%) had normal chest radiograph. In 13 (52.0%) of these 25 patients, the CT scan showed multiple injuries; among these were two aortic lacerations, three pleural effusions, and one pericardial effusion. |
3 |
| 44. Ozdogan O, Karacelik M, Ekmekci C, Ozbek C. Management of acute myocardial infarction after a blunt chest trauma. Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES. 19(2):173-6, 2013 Mar.Ulus Travma Acil Cerrahi Derg. 19(2):173-6, 2013 Mar. |
Review/Other-Dx |
1 patient |
To present the case of a 46-year-old with a hyperacute anterior wall myocardial infarction (MI) after blunt chest trauma. |
Diagnostic coronary angiography showed total occlusion of the left anterior descending coronary artery (LAD) starting at the takeoff of the vessel from the left main (Fig. 3). Other coronary arteries were free of coronary artery disease, without significant stenosis. After coronary angiography, a bare-metal stent was immediately deployed at the proximal LAD and TIMI 3 flow was achieved; however post-procedural (Fig. 4a,b) images revealed no satisfactory results. A proximaldissection and intraluminal thrombus extending to left main coronary artery was observed. Because of the proximity of the lesion to the left main coronary artery, re-intervention was considered to be risky and urgent coronary artery bypass grafting was planned. At surgery he underwent a single bypass graft as follows: left internal mammary artery to LAD. The operative course was uneventful. Respiratory support was required for 42 days after the operation due to the contusion. |
4 |
| 45. Patil RR, Mane D, Jariwala P. Acute myocardial infarction following blunt chest trauma with intracranial bleed: a rare case report. Indian Heart Journal. 65(3):311-4, 2013 May-Jun.Indian Heart J. 65(3):311-4, 2013 May-Jun. |
Review/Other-Dx |
1 patient |
To report the case of a young male following a road traffic accident (RTA) with head injury and parietal bleed who was diagnosed with STEMI based on ECG findings. |
Coronary angiography showed thrombotic ostial occlusion of LAD. Successful primary angioplasty using thrombo-aspiration was done, in difficult clinical scenario. The case was challenging in terms of use of anticoagulation and antiplatelet strategy in a rare etiology of acute myocardial infarction following road traffic accident. |
4 |
| 46. Tepe SM, Glockner JF, Julsrud P. MRI demonstration of acute myocardial infarction due to posttraumatic coronary artery dissection. Int J Cardiovasc Imaging. 2006;22(1):97-100. |
Review/Other-Dx |
1 patient |
To review MR imaging of myocardial infarction. |
No results stated in abstract. |
4 |
| 47. Pai M. Diagnosis of myocardial contusion after blunt chest trauma using 18F-FDG positron emission tomography. Br J Radiol. 2006;79(939):264-265. |
Review/Other-Dx |
1 case |
To report a case of acute myocardial infarction without coronary artery injuries after a blunt chest trauma, in which myocardial viability status was evaluated by FDG PET combined with 201Tl perfusion SPECT. |
FDG PET helped to identify the contused myocardium as a result of perfusion-metabolism matching defect suggesting non-viable infarcted myocardium. FDG PET may be useful in early decision making for patients with blunt chest trauma in a case with indistinct laboratory and imaging findings. |
4 |
| 48. Sohn JH, Song JW, Seo JB, et al. Case report: pericardial rupture and cardiac herniation after blunt trauma: a case diagnosed using cardiac MRI. Br J Radiol. 2005;78(929):447-449. |
Review/Other-Dx |
N/A |
To report a case of traumatic herniation of the heart for which a CT scan and MRI made a major contribution to the diagnosis is reported. |
No results stated in abstract. |
4 |
| 49. Holness R, Waxman K. Diagnosis of traumatic cardiac contusion utilizing single photon-emission computed tomography. Crit Care Med. 18(1):1-3, 1990 Jan. |
Observational-Dx |
125 patients |
To determine whether SPECT scan is useful in screening patients at risk of developing arrhythmias from cardiac contusion. |
Seventy-five patients had positive scans and 48 had negative. Two studies could not be completed. Eleven patients with positive studies developed serious arrhythmias (multiple premature ventricular beats or atrial fibrillation). None of these patients had a prior history of cardiac disease. While three patients with negative SPECT scans had arrhythmias, each had a prior history of cardiac disease and two were on chronic antiarrhythmia therapy. Neither ECG findings, creatinine phosphokinase (CPK), nor CPK-isoenzymes distinguished between those patients who did and did not develop arrhythmias. |
4 |
| 50. Karalis DG, Victor MF, Davis GA, et al. The role of echocardiography in blunt chest trauma: a transthoracic and transesophageal echocardiographic study. J Trauma. 1994;36(1):53-58. |
Observational-Dx |
105 patients |
To provide complete echocardiographic assessment of cardiac structure and function in patients with severe blunt chest trauma. |
Myocardial contusion was diagnosed in 31 patients (30%), 22 by TTE and nine by TEE. Cardiac complications developed in 8 of 31 patients (26%) with myocardial contusion compared with 2 of 74 patients (3%) with normal echocardiographic findings (p = 0.001). Cardiac complications required treatment in only four patients. Echocardiography was of value in detecting severe right ventricular dysfunction as the cause of hypotension in two patients with suspected cardiac tamponade. Four patients with myocardial contusion died compared with two patients with normal echocardiographic findings (p = NS). No death was related to the cardiac status. In addition, TEE detected aortic injury in five patients, four with focal intimal tears and one with an aortic transection |
2 |
| 51. Hatani Y, Tanaka H, Kajiura A, et al. Sudden Onset of Platypnea-Orthodeoxia Syndrome Caused by Traumatic Tricuspid Regurgitation With Ruptured Chordae Tendineae After Blunt Chest Trauma. Canadian Journal of Cardiology. 34(8):1088.e11-1088.e13, 2018 08. |
Review/Other-Dx |
1 |
To report a case of a very rare occurrence of sudden-onset platypnea-orthodeoxia syndrome (POS) in a patient with a moderate-sized patent foramen ovale (PFO) and severe tricuspid regurgitation (TR) caused by papillary muscle and chordae tendinae rupture after blunt chest trauma. |
Transesophageal echocardiography showed severe tricuspid regurgitation (TR) caused by anterior papillary muscle rupture. Furthermore, right-to-left shunt with TR through a patent foramen ovale (PFO) was observed. The diagnosis was therefore platypnea-orthodeoxia syndrome with right-to-left shunt through PFO with shunting exacerbated by acute severe TR after blunt chest trauma. |
4 |
| 52. Harel Y, Szeinberg A, Scott WA, et al. Ruptured interventricular septum after blunt chest trauma: ultrasonographic diagnosis. [Review] [38 refs]. Pediatr Cardiol. 16(3):127-30, 1995 May-Jun. |
Review/Other-Dx |
1 patient |
To report the case of a 6-year-old child found under a heavy bookcase that compressed her chest. |
On admission to the emergency room she was found to be dyspneic with a systolic murmur and complete atrioventricular (A-V) block. Her condition deteriorated rapidly, leading to cardiogenic shock and loss of consciousness. Echocardiographic Doppler evaluation demonstrated a large ventricular septal defect and tricuspid insufficiency. A pericardial patch was put over the tear in the septum, and torn chordae tendinae were reimplanted to the papillary muscles. A pacemaker was inserted. Her situation improved, but on the third day cardiogenic shock and right ventricular dysfunction ensued and the patient expired. |
4 |
| 53. Rollins MD, Koehler RP, Stevens MH, et al. Traumatic ventricular septal defect: case report and review of the English literature since 1970. J Trauma. 2005;58(1):175-180. |
Review/Other-Dx |
1 |
To report a case for a traumatic ventricular septal defect. |
No abstract available. |
4 |
| 54. Tenzer ML.. The spectrum of myocardial contusion: a review. [Review] [47 refs]. J Trauma. 25(7):620-7, 1985 Jul. |
Review/Other-Dx |
N/A |
To review the pathophysiology, clinical presentation, and critical evaluation of the diagnostic tests used in the confirmation of myocardial contusion and how to approach the evaluation and management of these patients. |
No results stated in the abstract. |
4 |
| 55. Ishikawa N, Watanabe G, Tarui T, et al. Robotic mitral valve plasty for mitral regurgitation after blunt chest trauma in Barlow's disease. Asian j. endosc. surg.. 11(1):35-38, 2018 Feb. |
Review/Other-Dx |
1 male |
To report the case of a 71-year-old man that was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. |
Preoperative examination revealed wide chordae tendineae rupture and myxomatous changes to the bileaflets. Neo-chordae reconstruction of the anterior mitral leaflet using loop technique, triangular resection of the posteriormitral leaflet, and ring annuloplasty was performed via surgical robot. Robotic mitral valve plasty for severe mitral regurgitation due to chest trauma in Barlow’s disease was achieved safely with good clinical and excellent cosmetic results. |
4 |
| 56. Parsaee M, Saedi S, Porkia R. Peri-mitral ventriculoatrial fistula after blunt thoracic trauma. Echocardiography. 35(6):895-897, 2018 06. |
Review/Other-Dx |
1 patient |
To present a patient with history of blunt chest trauma and incidental finding of posttraumatic severe mitral regurgitation. |
No results stated in the abstract. |
4 |
| 57. Saric P, Ravaee BD, Patel TR, Hoit BD. Acute severe mitral regurgitation after blunt chest trauma. Echocardiography. 35(2):272-274, 2018 Feb. |
Review/Other-Dx |
1 patient |
To report a case of acute severe mitral regurgitation due to ruptured chordae tendinae requiring surgical repair following a motor vehicle accident. |
No results stated in the abstract. |
4 |
| 58. Kikuchi C, Motohashi S, Takahashi Y, Nakazawa S, Kanazawa H. A successful treatment for concomitant injury of the coronary artery and tricuspid valve after blunt chest trauma. General Thoracic & Cardiovascular Surgery. 63(11):616-9, 2015 Nov.Gen Thorac Cardiovasc Surg. 63(11):616-9, 2015 Nov. |
Review/Other-Dx |
1 patient. |
To report the case of a 63-year-old woman involved in an automobile accident with thoracic injury sustained by the impact of her vehicle's steering wheel. |
Cardiac auscultation revealed a grade III/VI systolic murmur and the electrocardiogram showed ST elevation in leads 2, 3 and aVF. A 2D echocardiogram revealed severe tricuspid regurgitation and a hypokinetic right ventricle. Coronary angiography revealed dissection of the proximal right coronary artery (RCA) with 90 % stenosis. Urgent CABG for the RCA and tricuspid valvuloplasty were performed, as the anterior leaflet of the tricuspid valve had prolapsed as a result of chordal rupture. Blunt thoracic trauma causing both tricuspid insufficiency and coronary artery dissection is a very rare and life-threatening situation. Prompt diagnosis and timely surgery enabled us to save this patient's life. |
4 |
| 59. Link MS, Wang PJ, VanderBrink BA, et al. Selective activation of the K(+)(ATP) channel is a mechanism by which sudden death is produced by low-energy chest-wall impact (Commotio cordis). Circulation. 100(4):413-8, 1999 Jul 27. |
Experimental-Dx |
26 juvenile swine |
To determine whether selective K(+)(ATP) channel activation may be a pivotal mechanism in sudden death resulting from low-energy chest-wall trauma in young people during sporting activities. |
In the initial experiment, 6 juvenile swine were given 0.5 mg/kg IV glibenclamide, a selective inhibitor of the K(+)(ATP) channel, and chest impact was given on the QRS. The results of these strikes were compared with animals in which no glibenclamide was given. In the second phase, 20 swine were randomized to receive glibenclamide or a control vehicle (in a double-blind fashion), with chest impact delivered just before the T-wave peak. With QRS impacts, the maximal ST elevation was significantly less in those animals given glibenclamide (0.16+/-0.10 mV) than in controls (0.35+/-0.20 mV; P=0.004). With T-wave impacts, the animals that received glibenclamide had significantly fewer occurrences of ventricular fibrillation (1 episode in 27 impacts; 4%) than controls (6 episodes in 18 impacts; 33%; P=0.01). |
3 |
| 60. Ungar TC, Wolf SJ, Haukoos JS, Dyer DS, Moore EE. Derivation of a clinical decision rule to exclude thoracic aortic imaging in patients with blunt chest trauma after motor vehicle collisions. Journal of Trauma-Injury Infection & Critical Care. 61(5):1150-5, 2006 Nov.J Trauma. 61(5):1150-5, 2006 Nov. |
Observational-Dx |
1,096 patients |
To assess which patients with blunt chest trauma do not need aortic imaging. This article talks about a clinical decision rule. |
The decision rule incorporates findings on the CXR: sensitivity of 86% (95% CI, 65% to 97%), a specificity of 77% (95% CI, 75% to 80%), a PPV of 7% (95% CI, 4% to 11%), a NPV of 99.6% (95% CI, 99.0% to 99.9%), a positive likelihood ratio of 3.8 (95% CI, 1.1-12.9), and a negative likelihood ratio of 0.18 (95% CI, 0.05-0.61). This would potentially reduce aortic imaging by 76% (95% CI, 74% to 79%). This study is a more recent example in the literature showing the continued importance of the CXR in the initial evaluation of this group of patients. |
3 |
| 61. Yap D, Ng M, Chaudhury M, Mbakada N. Longest delayed hemothorax reported after blunt chest injury. American Journal of Emergency Medicine. 36(1):171.e1-171.e3, 2018 Jan.Am J Emerg Med. 36(1):171.e1-171.e3, 2018 Jan. |
Review/Other-Dx |
1 male |
To present a case of 55-year-old male with 44-day delay in hemothorax which has not been previously reported in current literature. |
The patient's initial X-ray showed fractures of the right 7th and 8th ribs without hemothorax or pneumothorax. He returned 30 days after the initial consultation (44 days post-trauma) having increasing shortness of breath. A chest X-ray this time revealed a large right hemothorax and 1850 ml of blood drained from his chest. There was a complete resolution of the hemothorax within 48 h and the patient was discharged after a 6-week follow-up with chest physicians. |
4 |
| 62. Liang HM, Chen QL, Zhang EY, Hu J. Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma. Am J Emerg Med. 34(4):758.e1-3, 2016 Apr. |
Review/Other-Dx |
1 patient. |
To report the case of a 58-year-old male who had delayed cardiac tamponade 17 days after a severe blunt chest trauma. |
A 58-year-old man, without other medical problems, was admitted with chest pain and dyspnea. Cardiac tamponade was established; arrangements were made toperforma median sternotomy. No visible puncture wound on the pulmonary artery or interpericardial sac was found. The patient was weaned from mechanical ventilatory support the next day. Pericardial fluid drainage decreased from 300 mL the first postoperative day to 25mLon the third postoperative day.We removedthe pericardial drain at that time. The patient fully recovered without complication and was discharged after 7 days. |
4 |
| 63. Brun PM, Bessereau J, Levy D, Billeres X, Fournier N, Kerbaul F. Prehospital ultrasound thoracic examination to improve decision making, triage, and care in blunt trauma. American Journal of Emergency Medicine. 32(7):817.e1-2, 2014 Jul.Am J Emerg Med. 32(7):817.e1-2, 2014 Jul. |
Review/Other-Dx |
1 patient |
To report the case of a a 44-year-old worked who had a sharp chest pain currently after using a jackhammer. |
First clinical examination suspected a left tension pneumothorax but ruled out by sliding sign in left hemithorax ultrasound (US) examination. The right upper thoracic scan showed a well-defined lung point, a “hepatization” appearance with static air bronchograms, a diaphragm elevation and a dextrocardia in B mode, and a pseudobarcode with no lung pulse in Time Motion (TM) mode. A “rip’s organ absent sign” excluded the hypothesis of an acute diaphragmatic rupture. An atelectasis was at once suspected and confirmed at hospital by tomodensitometry. |
4 |
| 64. Aguilera AL, Volokhina YV, Fisher KL. Radiography of cardiac conduction devices: a comprehensive review. [Review]. Radiographics. 31(6):1669-82, 2011 Oct. |
Review/Other-Dx |
N/A |
To provide basic information about cardiac conduction devices (CCDs) to familiarize radiologists with their normal and abnormal radiographic appearances. |
No results stated in abstract. |
4 |
| 65. Barakat AF, Cross B, Wertz J, Saba S, Kancharla K. Cardiac implantable electronic device malfunction after deceleration injury without obvious chest trauma. HeartRhythm Case Reports 2019:[E-pub ahead of print]. |
Review/Other-Dx |
1 patient |
To describe a case of trauma-related device malfunction and present a stepwise approach for clinical problem solving. |
No abstract available. |
4 |
| 66. Ball CG, Kirkpatrick AW, Laupland KB, et al. Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J Trauma. 2005;59(4):917-924; discussion 924-915. |
Observational-Dx |
761 patients |
To define the incidence, predictors, and outcomes for occult posttraumatic pneumothoraces (OPTXs) after trauma. |
Paired CXRs and CT scans were available for 338 of 761 (44%) patients (98.5% blunt trauma). One hundred three PTXs were present in 89 patients, 57 (55%) of which were occult; 6 (11%) were seen only on thoracic CT scan. Age, sex, length of stay, and survival were similar between all groups. OPTXs and PTXs were similar in comparative size index and number of images. Subcutaneous emphysema, pulmonary contusion, rib fracture(s), and female sex were independent predictors of OPTXs. Seventeen (35%) patients with OPTXs were ventilated, of whom 13 (76%) underwent thoracostomy. No complications resulted from observation, although 23% of patients with thoracostomy had tube-related complications or required repositioning. |
3 |
| 67. Bridges KG, Welch G, Silver M, Schinco MA, Esposito B. CT detection of occult pneumothorax in multiple trauma patients. J Emerg Med. 1993;11(2):179-186. |
Review/Other-Dx |
90 trauma patients |
To assess the prevalence, initial detection, and management of trauma patients with occult pneumothoraces. |
In 35 cases (38.8%), initial supine chest x-ray study failed to detect a pneumothorax, and the diagnosis was made on CT scan of the chest or abdomen performed within 2 hours of admission. In 15 of these cases (42.8%), identification of the pneumothorax on CT scan resulted in alterations in management, including chest tube placement in 10 patients and intensified monitoring in 5 patients. |
4 |
| 68. Brink M, Deunk J, Dekker HM, et al. Added value of routine chest MDCT after blunt trauma: evaluation of additional findings and impact on patient management. AJR. 2008;190(6):1591-1598. |
Observational-Dx |
464 patients |
To evaluate the added value of a low-threshold routine thoracic MDCT algorithm compared with a selective MDCT algorithm in adult blunt trauma patients. |
Of all 464 patients within the routine MDCT group, 164 patients underwent selective MDCT, which resulted in detection of additional diagnoses compared with conventional radiography in 97 (59%) patients. The routine MDCT algorithm detected additional diagnoses compared with conventional radiography in 201 of 464 patients (43%). Compared with the selective MDCT algorithm, this was an absolute increase of 104 of 464 (22%) extra patients, resulting in a change in patient management in 34 (7%; 95% CI, 5-9.7%), mostly because of additional findings of pulmonary and mediastinal injury. |
3 |
| 69. Lopes JA, Frankel HL, Bokhari SJ, Bank M, Tandon M, Rabinovici R. The trauma bay chest radiograph in stable blunt-trauma patients: do we really need it? Am Surg. 2006;72(1):31-34. |
Observational-Dx |
157 patients |
To evaluate the need for trauma bay chest radiographs (CXR) in stable blunt-trauma patients who are scheduled for chest computed tomography (CCT). |
Among 95 patients with a "normal" CXR, 38 patients (40%) were found on CCT to have traumatic injuries. Among 62 patients with an "abnormal" CXR, 18 (29%) were found to be normal on CCT. Of the remaining 44 patients, 34 had additional findings on CCT. In 32 patients, CCT led to changes in management. CCT was more sensitive in diagnosing thoracic injuries and led to significant changes in management. |
3 |
| 70. McGonigal MD, Schwab CW, Kauder DR, Miller WT, Grumbach K. Supplemental emergent chest computed tomography in the management of blunt torso trauma. J Trauma. 1990;30(12):1431-1434; discussion 1434-1435. |
Observational-Dx |
50 patients |
To examine the efficacy of conventional chest X-ray (CXR) in comparison to chest computed tomography (CCT) in acutely injured blunt trauma patients. |
Hemo- and/or pneumothorax (HPTX) was noted in 12 patients (five by CXR, 12 by CCT). Pulmonary contusion (PC) was identified in 10 patients (four by CXR, ten by CCT). Three additional false positive PC were diagnosed by CXR. Therapy changes based upon CCT findings occurred in seven of seven HPTX and five of six PC. The two imaging techniques were complementary in detecting fractures. Atelectasis was a common CCT finding (58% incidence). Chest X-ray is less sensitive than chest CT in the detection of HPTX (42% vs. 100%) and PC (40% vs. 100%). Emergent chest CT is recommended in stable patients with: 1) blunt high-energy torso trauma, 2) "cross-body" injury pattern, and/or 3) a mechanism of injury suggestive of chest trauma. |
3 |
| 71. Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg. 2001;67(7):660-664. |
Observational-Dx |
169 patients; 110 enrolled in CTL group |
To determine whether thoracic CT provides additional information to routine CXR findings, whether the additional information results in a management change, and whether thoracic CT is more useful in patients with particular mechanisms of injury. |
Thoracic CT identified injuries not seen on CXR in 66 per cent of the Control (CTL) group and 39 per cent of the mechanism (MECH) group. Identification of these injuries resulted in a highly significant (P < 0.001) change in clinical management in 20 per cent of the CTL group and 5 per cent of the MECH group. TCT appears to be most helpful in the acute evaluation of trauma patients when roentgenographic evidence of chest injury exists and provides additional information impacting on the care of the patient 20 per cent of the time. In patients with severe mechanisms of injury and normal CXRs TCT expeditiously identifies occult chest injuries that require treatment in 5 per cent of this population. |
3 |
| 72. Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surgery. 148(10):940-6, 2013 Oct. |
Observational-Dx |
9005 patients |
To validate our previously derived decision instrument (NEXUS Chest) for identification of blunt trauma patients with very low risk of thoracic injury seen on chest imaging (TICI).We hypothesized that NEXUS Chest would have high sensitivity (>98%) for the prediction of TICI and TICI with major clinical significance. |
Of 9905 enrolled patients, 43.1% had 1 CXR, 42.0% had CXR and chest CT, 6.7%hadCXRand abdominal CT (without chest CT), 5.5%had multiple CXRs without CT, and 2.6%had chest CT without CXR in the ED. Their mean age was 46 years (interquartile range, 29-60 years) and 62.8%were male. The most common trauma mechanisms were motorized vehicle crash (43.9%), fall (27.5%), pedestrian struck by motorized vehicle (10.7%), bicycle crash (6.3%), and struck by blunt object, fists, or kicked (5.8%). Of the 5173 (52.2%) admitted patients, 4877 (94.3%) survived to hospital discharge. Thoracic injury seen on chest imaging was seen in 1478 (14.9%) patients with 363 (24.6%) of these having major clinical significance, 1079 (73.0%) minor clinical significance, and 36 (2.4%) no clinical significance. The most common diagnoses were multiple rib fractures, pulmonary contusion or laceration, and pneumothorax seen in 67.4% 39.9%, and 35.7% of patients with TICI, respectively. Table 1 summarizes all TICI diagnoses. Evaluating for workup bias, we obtained follow-up on 212 blunt trauma patients with negative ED chest imaging and 221 blunt trauma patients who did not receive ED chest imaging. None of these patients were diagnosed with injuries that would have been considered TICI. The NEXUS Chest DI had a sensitivity of 98.8% (95% CI, 98.1%-99.3%), an NPV of 98.5% (95%CI, 97.6%-99.1%), and a specificity of 13.3% (95%CI, 12.6%-14.1%) for the prediction of TICI. Of the 17 missed (false-negative) TICI patients, 1 had clinically major injury (hemopneumothorax with chest tube placement), 14 had clinically minor injury, and 2 had no clinically significant injury (Table 2). The sensitivity and NPV for clinically major TICI were 99.7% (95%CI, 98.2%-100.0%) and 99.9% (95%CI, 99.4%-100.0%), respectively, and the sensitivity and NPV for clinically major or minor TICI were 99.0% (95% CI, 98.2%-99.4%) and 98.7% (95% CI, 98.1%-99.3%), respectively. Table 3 summarizes NEXUS Chest screening performance characteristics. Thirteen of the 17 missed TICI occurred at 1 site. The sensitivity for TICI at this site was 97.1%, while the sensitivity at the other 8 sites was 99.6%. |
2 |
| 73. Traub M, Stevenson M, McEvoy S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38(1):43-47. |
Observational-Dx |
141 patients |
To identify the clinical features associated with further diagnostic information obtained on a CT chest scan compared with a routine chest X-ray in patients sustaining blunt trauma to the chest. |
The CT chest scan is significantly more likely to provide further diagnostic information for the management of blunt trauma compared to a chest X-ray in patients with chest wall tenderness (OR = 6.73, 95% CI = 2.56, 17.70, p < 0.001), reduced airentry (OR = 4.48, 95% CI = 1.33, 15.02, p = 0.015) and/or abnormal respiratory effort (OR = 4.05, 95% CI = 1.28, 12.66, p = 0.017). CT scan was significantly more effective than routine chest X-ray in detecting lung contusions, pneumothoraces, mediastinal haematomas, as well as fractured ribs, scapulas, sternums and vertebrae. |
3 |
| 74. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
