Chest, Vol 100, 667-669, Copyright © 1991 by American College of Chest Physicians

ARTICLES

Routine initial computed tomography of the chest in blunt torso trauma

R Smejkal, KF O'Malley, E David, AC Cernaianu and SE Ross
Department of Surgery, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Cooper Hospital/University Medical Center, Camden.

Computer tomography (CT) is an effective technique in the initial evaluation of the abdomen and head following blunt trauma. To evaluate the role of CT of the thorax, a prospective study comparing routine early thoracic CT scanning with initial chest roentgenogram (CXR) was carried out on 73 patients with blunt torso trauma undergoing concomitant abdominal CT examination. Initial CXR and CT scans were interpreted independently by radiologists in a blinded fashion. CXR diagnosed more bony injuries than CT, while the CT identified pulmonary contusions and effusions more accurately. Only those contusions diagnosed by CXR proved clinically significant. Patient treatment was changed in one case based on CT findings. In the absence of CXR findings, chest CT scanning frequently identifies abnormalities with limited clinical significance. Although more sensitive, CT of the thorax has a limited role in the initial emergent evaluation of victims of blunt torso trauma.