2. Chest Injuries

3. Main Causes of Chest Trauma Blunt Trauma- Blunt (direct) force to chest. Penetrating Trauma- Projectile that enters chest causing small or large hole. Compression Injury- Chest is caught between two objects and chest is compressed.

4. Chest wall injuries Rib fractures Flail chest Open pneumothorax

5. Rib fractures Most common thoracic injury which characterized by Localised pain, tenderness. Upper ribs (mainly three pairs), clavicle, sternal or scapula fracture indicate sever trauma and may be associated with spinal injury or vascular damage. With lower rib fractures, abdominal visceral injury, such as liver, spleen or kidney, may occur. Sternal fracture. Fracture of the left first rib. This injury is associated with an increased incidence of neurovascular injury, in the subclavian vein.

6. Open Pneumothorax Opening in chest cavity that allows air to enter pleural cavity. A common complication of chest trauma (15–40%). Causes the lung to collapse due to increased pressure in pleural cavity Can be life threatening Signs and symptoms Dyspnoea Sudden sharp pain Subcutaneous Emphysema Decreased lung sounds on affected side Simple pneumothorax: the edge of the right lung is clearly seen (arrows) devoid of peripheral lung markings. No mediastinal shift occurs.

7. Flail chest  A condition of multiple rib fractures produce a mobile fragment which moves paradoxically with respiration  Usually traumatic with two or more ribs fractured in two or more places..  Always consider underlying lung injury (pulmonary contusion).  Underlying lung contusion are likely to contribute to the patient’s hypoxia.  The main Clinical features are: Dyspnoea, Tachycardia, hypoxia, Cyanosis and Hypotension

8. Haemothorax Occurs when pleural space fills with blood Usually occurs due to lacerated blood vessel in thorax As blood increases, it puts pressure on heart and other vessels in chest cavity General increased opacification of the hemithorax is seen on a supine film Ruptured major airway : This should be suspected in the presence of any of the following : haemoptysis, collapse of the lung or lobe, Pneumothorax with major air leak. Rupture diaphragm : This is more characterized with a bowel or stomach shadow in the thoracic cavity or an ill defined hemi diaphragm.

9. Diaphragm Rupture A tear in the Diaphragm that allows the abdominal organs enter the chest cavity The opacification of the left hemithorax is du to a haemothorax. Haemo-thorax

10. Chronic obstructive pulmonary disease ● General term of conditions including chronic bronchitis and emphysema. ● Characterised by chronic airflow reduction resulting from resistance to expiratory airflow, infection, mucosal oedema, bronchospasm and bronchoconstriction. ● Causative factors include smoking, chronic asthma and chronic infection CXRs In the emergency setting, useful for assessing complications, such as pneumonia, heart failure, pneumothorax or rib fractures. – Radiographic features include hyper-expanded (enlarged) lungs associated with flattening of both hemidiaphragms The lungs are hyper-inflated with flattening of both hemi-diaphragms

11. Aortic rupture Usually blunt trauma involving Chest; especially RTAs or fall from a height ~80-90% die within minutes clinical suspicion, CXR, aortography and contrast CT are done  An aortic rupture should be suspected from the mechanism of injury.  Chest or inter-scapular pain will be present. Traumatic aortic rupture: tracheal deviation to the right; left haemothorax, blurring of the outline of the aortic arch. Rib fractures and a traumatic left diaphragmatic hernia are also noted.

12. Radiographic projections of the chest Postero anterior : It is used commonly for all cases unless the patient requires ongoing assessment, resuscitation, treatment, or monitoring. Anteroposterior : This view is usually requested for seriously ill patients with a life threatening condition that requires assessment, monitoring, or treatment in a resuscitation area. Lateral chest film: The lateral chest radiography is rarely helpful in acute conditions. However, it can localize abnormalities seen in the postero anterior view. Lateral decubitus film: It can identify a small pleural effusion and differentiate this from pleural thickening. A sub- pulmonary haemothorax may become apparent with this view when the only abnormality seen in the postero anterior film is a raised hemi diaphragm. PA )patient with pericadial effusion Lateral ) patient with air filled mass

13. Expiration film:  To show a small pneumothorax,  Expiration films are occasionally requested to help establish a diagnosis of inhaled foreign body. Routine Radiographic projections of the chest ● inhaled foreign body. Usually seen in children. ● Considered an emergency as it may result in complete upper airway obstruction. If the child is coughing they should be encouraged. ● the chest may be normal. Radiological features ● A radio-opaque foreign body may or may not be seen. ● secondary signs, such as, segmental collapse, consolidation or hyperinflation, as the foreign body acts as a ball valve.

14. Imaging Findings: These three images show a hydropneumothorax in three different views. The PA, lateral, and right decubitus The right decubitus film demonstrates a right hydropneumothorax.