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KEYWORDS Trauma series / Chest radiograph / Thoracic trauma / Advanced Trauma Life Sup
The chest radiograph is used as a screening test to exclude significant thoracic injuries in cases of major trauma. A systematic approach to reviewing chest radiographs is necessary for accurate interpretation. Radiographic findings should be considered together with clinical assessment.
In this series of papers we review the radiographs performed as part of the Advanced Trauma Life Support (ATLS) trauma series; this paper deals with chest radiographs.
Thoracic trauma is a significant cause of morbidity and mortality (Gavelli et al 2002, Peters et al 2010). A portable chest radiograph may be carried out in the resuscitation room and is the first-line radiological investigation used to diagnose thoracic injuries. Chest radiography is indicated for all major trauma patients as part of the ATLS protocol. It is a useful screening test that facilitates prompt detection of potentially life-threatening injuries that may require rapid intervention. In the case of critically ill patients, the chest radiograph may be the only investigation that may be performed without the risk of further decompensation (Ho & Gutierrez 2009).
The review of the chest radiograph should be guided by findings from the clinical examination. In turn, the radiographic findings may then be used to focus further clinical examination and to direct decisions regarding the need for further investigations such as thoracic computed tomography (CT), arteriography or echocardiography. Clinical re-evaluation and repeat chest radiographs may be required if the patient's clinical status changes (ATLS 2004).
Mechanisms of thoracic injury
Most thoracic injuries may be classified as blunt or penetrating injuries. Blunt trauma refers to a closed injury that may be due to direct impact from moving solid objects, sudden deceleration, or compressive or shear forces. Most blunt thoracic injuries in the developed world are caused by road traffic accidents (Mayberry 2000, Zinck & Primack 2000). Falls, physical attacks and crush injuries are other causes of blunt trauma. Penetrating injuries occur when the skin and tissues are pierced by items such as knives, glass, bullets. These items enter the body and may damage organs and vascular structures. Less common mechanisms include burns, radiation and blast injuries (Ho & Gutierrez 2009, Ursic & Curtis 2010).
Thoracic anatomy
A clear understanding of...