The ABC’s of Thoracic Trauma Imaging

The approach to thoracic trauma will be divided into two major categories in this article: parenchymal and extraparenchymal injuries. The radiographic and CT appearance of pulmonary edema, aspiration, atelectasis, and contusion will be reviewed. The extraparenchymal injuries will revolve around the ABC approach outlined by Dr Jud Gurney. 1 Review of common presentations as well as evolving diagnostic and pathological etiologies will be discussed in the article. The morbidity and mortality of trauma in the United States is substantial. Trauma is the third leading cause of death overall and most frequent cause for those less than 35 years of age. Thoracic injuries account for 25 to 35% of trauma-related deaths. 2 Mortality from blunt chest trauma is usually due to aortic or great vessel injury. While great vessel injuries account for much of the mortality, they occur in only 1% of victims suffering blunt chest trauma. Pulmonary parenchymal injuries such as contusion and laceration are more common, occurring in 30 to 70% of blunt thoracic trauma victims. Currently, the supine chest radiograph is obtained as a screening examination for the vast majority of trauma patients and remains an excellent tool for early detection of life-threatening thoracic injuries. In the emergency setting, a “quick read” assists the primary team in patient triage. Though chest CT scans along with CT scans of the abdomen and pelvis are obtained with increased frequency in blunt trauma patients, radiographs are not obsolete and maintain an important role in early diagnosis and patient triage. The evaluation of the radiographs will be divided in this article by common parenchymal and extraparenchymal injuries. Parenchymal injuries include aspiration, atelectasis, contusion, and edema. In the evaluation of extraparenchymal injuries we describe an algorithm set forth by Dr Jud Gurney (www.chestx-ray.com) modeled after the ABC’s of clinical management, which addresses the mechanical disruption of thoracic anatomy and its physiologic consequences.