Preview

Medical Visualization

Advanced search

Multispiral computed tomography of the lungs with polytrauma in children

https://doi.org/10.24835/1607-0763-2020-1-96-104

Abstract

Introduction. MDCT is more sensitive in pulmonary, pleural and bone injuries detection in patients with polytrauma than chest radiography. High-quality multiplanar reconstructions brought additional information to the diagnostic capabilities of this method.

Purpose. Purpose of this publication was to analyze the data obtained during chest MDCT in children with polytrauma.

Material and methods. 147 children aged from 6 months to 17 years with polytrauma and chest injuries were studied. MDCT was performed on Philips Brilliance CT 16 and 64.

Results. We retrospectively evaluated CT and clinical data of 147 patients, the main reason of polytrauma were traffic accidents (n = 91 – 61.9%), the rest was caused by fall from a height (56 – 38.1%). In 80% of cases the injury was severe and complex with not only lungs and chest damage, but also with other parts of the body: the head, the stomach, the pelvis and the limbs. Among 147 patients, pulmonary parenchyma damages in the form of injuries, less gaps, were detected in 70% of cases, pneumothorax – in 30% of cases, hemothorax – in 15%.

Conclusion. MDCT significantly improves the detection of pulmonary damage in blunt thoracic trauma due to better visualization of bone, soft tissues and blood vessels damage and the possibility of obtaining multiplanar image reconstructions. MDCT allows to identify lung contusions and to differentiate areas of atelectasis and tears, to evaluate and calculate their volumes, and therefore should always be used as a primary imaging method in patients with polytrauma.

About the Authors

T. A. Akhadov
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

Doct. of Sci. (Med), Professor, head of radiology department

Phone: +7-495-633-58-03, +7-915-332-20-87

119180 Moscow, Bol’shaya Polyanka str, 22, Russian Federation







O. V. Karaseva
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

Doct. of Sci. (Med), Deputy Director for Science

Phone: +7-495-633-58-28

119180 Moscow, Bol’shaya Polyanka str, 22, Russian Federation 



I. A. Mel'nikov
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

Cand. of Sсi. (Med.), radiologist

Phone: +7-495-633-58-00 ad. 1689

119180 Moscow, Bol’shaya Polyanka str, 22, Russian Federation 



T. D. Kostikova
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

radiologist

Phone: +7-495-633-58-00 ad. 1488

119180 Moscow, Bol’shaya Polyanka str, 22, Russian Federation 



M. I. Akhlebinina
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

radiologist

Phone: +7-495-633-58-00 ad. 1746

119180 Moscow, Bol’shaya Polyanka str, 22, Russian Federation 



M. V. Ublinskiy
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma
Russian Federation

Cand. of Sсi. (Biol.), researcher

Phone: +7-929-620-21-77

119180 Moscow, Bol’shaya Polyanka str, 22, Russian Federation 



References

1. Sangster G.P., González-Beicos A., Carbo A.I., Heldmann M.G., Ibrahim H., Carrascosa P., Nazar M., D'Agostino H.B. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg. Radiol. 2007; 14 (5): 297–310. https://doi.org/10.1007/s10140-007-0651-8

2. Peters S., Nicolas V., Heyer C.M. Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients. Clin. Radiol. 2010; 65 (4): 333–338. https://doi.org/10.1016/j.crad.2009.12.008

3. Miller L.A. Chest wall, lung, and pleural space trauma. Radiol. Clin. N. Am. 2006; 44 (2): 213–224. https://doi.org/10.1016/j.rcl.2005.10.006

4. Scaglione M., Pinto A., Pedrosa I., Sparano A., Romano L. Multi-detector row computed tomography and blunt chest trauma. Eur. J. Radiol. 2008; 65: 377–388. https://doi.org/10.1016/j.ejrad.2007.09.023

5. Kaewlai R., Avery L.L., Asrani A.V., Novelline R.A. Multidetector CT of blunt thoracic trauma. Radiographics. 2008; 28: 1555–1570. https://doi.org/10.1148/rg.286085510

6. Rivas L.A., Fishman J.E., Múnera F., Bajayo D.E. Multislice CT in thoracic trauma. Radiol. Clin. N. Am. 2003; 41: 599–616. https://doi.org/10.1016/s0033-8389(03)00027-7

7. Oikonomou A., Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011; 2 (3): 281–295. https://doi.org/10.1007/s13244-011-0072-9

8. Exadaktylos A.K., Sclabas G., Schmid S.W., 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: 1173–1176. https://doi.org/10.1097/00005373-200112000-00025

9. Fanucci E., Fiaschetti V., Rotili A., Floris R., Simonetti G. Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure. Emerg. Radiol. 2007; 13: 251–257. https://doi.org/10.1007/s10140-006-0554-0

10. Holmes J. F., Sokolove P. E., Brant W.E., Kupperman N.A. A clinical decision rule identifying children with thoracic injuries blunt trauma. Ann. Emerg. Med. 2002; 39 (5); 492–499. https://doi.org/10.1067/mem.2002.122901

11. Shanmugathan K., Mirvis S.E. Imaging diagnosis of nonaortic thoracic injury. Radiol. Clin. N. Am. 1999; 37: 533–551. https://doi.org/10.1016/s0033-8389(05)70110-x

12. Mayberry J.C. Imaging in thoracic trauma: the trauma surgeon's perspective. J. Thorac. Imaging. 2000; 15: 76–86. https://doi.org/10.1097/00005382-200004000-00002

13. Banki F., Estrera A. L., Harrison R. G., Miller C.C., Leake S.S., Mitchell K.G., Khalil K., Safi H.J., Kaiser L.R. Pneumomediastinum: etiology and a guide to diagnosis and treatment. Am. J. Surg. 2013; 206 (6): 1001–1006. https://doi.org/10.1016/j.amjsurg.2013.08.009

14. Ganie F.A., Lone H., Lone G.N., Wani M.L., Singh S., Dar A.M., Wani N., Wani S., Nazeer N. Lung Contusion: A Clinico-Pathological Entity with Unpredictable Clinical Course. Bull. Emerg. Trauma. 2013; 1(1): 7–16.

15. Mirvis S.E. Imaging of acute thoracic injury: the advent of MDCT screening. Semin. Ultrasound CT MR. 2005; 26: 305–331. https://doi.org/10.1053/j.sult.2005.08.001

16. Ball C.G., Kirkpatrick A.W., Laupland K.B., Fox D.I., Nicolaou S., Anderson I.B., Hameed S.M., Kortbeek J.B., Mulloy R.R., Litvinchuk S., Boulanger B.R. Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J. Trauma. 2005; 59: 917–924. https://doi.org/10.1016/s0734-3299(08)70380-0

17. Miller D.L., Mansour K.A. Blunt traumatic lung injuries. Thorac. Surg. Clinics. 2007; 17 (1): 57–61. https://doi.org/10.1016/j.thorsurg.2007.03.017

18. Turkalj I., Petrović K., Stojanović S., Petrović D., Brakus A., Ristić J. Blunt chest trauma – an audit of injuries diagnosed by the MDCT examination. Vojnosanit. Pregl. 2014; 71(2): 161–166. https://doi.org/10.2298/vsp1402161t

19. Wirth S., Jahnsen S. Bony and thoracic chest wall injuries. In: Mariano Scagliono M., Linsenmaier U., Schueller G., Wirth S., editors. Bony and Thoracic Chest Wall Injuries. 1st ed. Switzerland: Springer; 2017: 25–59. https://doi.org/10.1007/174_2016_54

20. Ozmen C.A., Onat S., Aycicek D. Radiologic findings of thoracic trauma. Ther. Clin. Risk Manag. 2017; 13: 1085–1089. https://doi.org/10.2147/tcrm.s143845

21. Wanek S., Mayberry J.C. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit. Care Clin. 2004; 20: 71–81. https://doi.org/10.1016/s0749-0704(03)00098-8

22. Kim S.J., Bista A.B., Min Y.G., Kim E.U., Park K.J., Kang D.K., Sun J.S. Usefulness of low dose chest CT for initial evaluation of blunt chest trauma. Medicine (Baltimore). 2017; 96 (2): e5888. https://doi.org/10.1097/md.0000000000007234


Review

For citations:


Akhadov T.A., Karaseva O.V., Mel'nikov I.A., Kostikova T.D., Akhlebinina M.I., Ublinskiy M.V. Multispiral computed tomography of the lungs with polytrauma in children. Medical Visualization. 2020;24(1):96-104. (In Russ.) https://doi.org/10.24835/1607-0763-2020-1-96-104

Views: 916


ISSN 1607-0763 (Print)
ISSN 2408-9516 (Online)