Tupa trauma grudnog koša – pregled povreda dijagnostikovanih MDCT pregledom

  • Ivan Turkalj Center of Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Kosta Petrović Center of Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Sanja Stojanović Center of Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Djorđe Petrović Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Alma Brakus Center of Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
  • Jelena Ristić Center of Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
DOI: https://doi.org/10.2298/1994
Ključne reči: wounds, nonpenetrating||, ||povrede, zatvorene, thorax||, ||toraks, diagnosis||, ||dijagnoza, tomography, x-ray computed||, ||tomografija, kompjuterizovana, redgenska, multiple trauma||, multiple, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod/ Cilj. Multidetektorska kompjuterizovana tomografija (MDCT) koja se odlikuje brzinom i preciznošću sve više se koristi u odeljenjima urgentne medicine. Cilj istraživanja bio je da se utvrde najčešće povrede grudnog koša, udružene vantorakalne povrede, kao i da se ustanovi ishod lečenja. Metode. Ova prospektivna studija obuhvatila je 61 bolesnika sa tupom traumom. Svakom bolesniku urađen je CT grudnog koša, kao deo inicijalne dijagnostike. Procenjen je broj povreda po organima i organskim sistemima grudnog koša. Evidentiran je uzrok povrede, dužina i ishod lečenja, kao i prisustvo povreda u drugim regijama. Rezultati. Povreda grudnog koša bila je udružena sa drugim regijama kod 80,3% bolesnika i to najčeće sa povredama ekstremiteta ili kostiju karlice kod 54.1% bolesnika, potom sa povredama glave kod 39,3% bolesnika. Kod 90,9% bolesnika sa smrtnim ishodom postojale su pridružene povrede grudnog koša. Lezije plućnog parenhima, pleuralni izlivi i frakture rebara bile su najčešće povrede kod 77,1%, 65,6% i 63,9% bolesnika, respektivno. Zaključak. Tupa trauma grudnog koša je značajan problem prevashodno kod muškarca u četrdesetim godinama i obično je uzrokovana saobraćajnim nezgodama. U slučaju pneumomedijastinuma ili medijastinalnog hematoma, savetuje se korišćenje 3D rekonstrukcija u postavljanju dijagnoze potencijalne traheobronhijalne povrede i povrede grudne aorte. Povećana rezolucija CT skenera dala je veliki broj nalaza koji su teško vidljivi na radiografiji, naročito u slučaju povrede plućnog parenhima i pleure. Trebalo bi imati na umu međutim, da nijedna tehnika snimanja ne može da bude jedini faktor pri odlučivanju o hirurškom lečenju.

 

Reference

Scaglione M, Pinto A, Pedrosa I, Sparano A, Romano L. Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol 2008; 65(3): 377−88.

Traub M, Stevenson M, McEvoy S, Briggs G, Lo SK, Leibman S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury 2007; 38(1): 43−7.

Westaby S, Brayley N. ABC of major trauma. Thoracic trauma-I. BMJ 1990; 300(6740): 1639−43.

Primack SL, Collins J. Blunt nonaortic chest trauma: radio-graphic and CT findings. Emerg Radiol 2002; 9(1): 5−12.

Gavelli G, Canini R, Bertaccini P, Battista G, Bnà C, Fattori R. Traumatic injuries: imaging of thoracic injuries. Eur Radiol 2002; 12(6): 1273−94.

Sampson MA, Colquhoun KB, Hennessy NL. Computed tomogra-phy whole body imaging in multi-trauma: 7 years experience. Clin Radiol 2006; 61(4): 365−9.

Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computer-ized tomography in blunt chest trauma. Am Surg 2001; 67(7): 660−4.

Ho ML, Gutierrez FR. Chest radiography in thoracic poly-trauma. AJR Am J Roentgenol 2009; 192(3): 599−612.

Elmali M, Baydin A, Nural MS, Arslan B, Ceyhan M, Gürmen N. Lung parenchymal injury and its frequency in blunt thoracic trauma: the diagnostic value of chest radiography and thoracic CT. Diagn Interv Radiol 2007; 13(4): 179−82.

Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin North Am 2006; 44(2): 213−24.

Mirvis SE. Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR 2004; 25(2): 156−79.

Wicky S, Wintermark M, Schnyder P, Capasso P, Denys A. Imaging of blunt chest trauma. Eur Radiol 2000; 10(10): 1524−38.

Vergnion M, Lambert JL. A protocol of trauma care in the emergency service including MDCT imaging. Acta Anaesthe-siol Belg 2006; 57(3): 249−52.

Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest in-jury due to blunt trauma. Eur J Cardiothorac Surg 2003; 23(3): 374−8.

Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg 1987; 206(2): 200−5.

Wagner RB, Crawford WO Jr, Schimpf PP. Classification of paren-chymal injuries of the lung. Radiology 1988; 167(1): 77−82.

Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 1997; 43(3): 405−11.

Weyant MJ, Fullerton DA. Blunt thoracic trauma. Semin Thorac Cardiovasc Surg 2008; 20(1): 26−30.

Shirley PJ. Trauma and critical care III: chest trauma. Trauma 2005; 7(3): 133−42.

Sangster GP, González-Beicos A, Carbo AI, Heldmann MG, Ibrahim H, Carrascosa P, et al. Blunt traumatic injuries of the lung pa-renchyma, pleura, thoracic wall, and intrathoracic airways: mul-tidetector computer tomography imaging findings. Emerg Ra-diol 2007; 14(5): 297−310.

Pal JM, Mulder DS, Brown RA, Fleiszer DM. Assessing multiple trauma: is the cervical spine enough? J Trauma 1988; 28(8): 1282−4.

Petrović K, Stojanović S, Till V, Vučaj-Ćirilović V, Nikolić O, Nići-forović D. Blunt injuries of the lungs, pleura and chest bone structures: Computed Tomography contribution. Med Pregl 2008; 61(1−2): 83−6. (Serbian)

Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging 2011; 2(3): 281-95.

Milia DJ, Brasel K. Current Use of CT in the Evaluation and Management of Injured Patients. Surg Clin North Am 2011; 91(1): 233−48.

Wintermark M, Schnyder P. The Macklin effect: a frequent etiol-ogy for pneumomediastinum in severe blunt chest trauma. Chest 2001; 120(2): 543−7.

Assenza M, Passafiume F, Valesini L, Centonze L, Romeo V, Modini C. Pneumomediastinum and pneumoperitoneum after blunt chest trauma: the Macklin effect. J Trauma Treatment 2012; 1(1): 1−5.

Young CA, Menias CO, Bhalla S, Prasad SR. CT features of eso-phageal emergencies. Radiographics 2008; 28(6): 1541−53.

Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radio-graphics 2012; 32(2): 477−98.

Objavljeno
2015/04/21
Broj časopisa
Vol. 71 Br. 2 (2014)
Rubrika
Originalni članak