الفهرس 
Chest wall injuriesOnly 14 pages are availabe for public view
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Abstract
Chest trauma is responsible for 25% of traumatic deaths. Rapid identification of blunt chest injuries through an organized approach and stabilization based on patient physiology can prevent untimely death and morbidity. The incorporation of FAST will greatly facilitate the diagnostic approach.
Portable chest radiography is the initial imaging method used at the emergency workup of the polytrauma patient, and it is useful for detecting serious life-threatening conditions, such as a tension or haemothorax, mediastinal haematoma, flail chest or malpositioned tubes. However, the superiority of CT over chest radiography has increased in recent years. CT detects significant disease in patients with normal initial radio- graphs and in 20% will reveal more extensive injuries compared with the abnormal initial radiographs, necessitating a change of management. CT is far more effective than chest radiography in detecting pulmonary contusion, thoracic aortic injury and osseous trauma, especially at the cervicorthoracic spine. MDCT has dramatically decreased imaging times and offers readily available multiplanar reformatted images or more sophisticated volume-rendered and MIP images. Therefore, it has been established as the gold standard for the imaging evaluation of blunt chest trauma and trauma in general.
Cardiac contusion is the most common in the blunt chest traumas. Diagnosis of is challenging because no gold standard is available. History, physical examination, and other diagnostic tests including ECG, cardiac enzymes, and echocardiogram complement each other and should be used in the context of the clinical picture. TTE is a sensitive tool for diagnosing cardiac contusion, but limited by technical difficulties in chest trauma patients. As a result, TEE seems to be the best tool for diagnosis and should be considered for patients with high clinical suspicion of cardiac contusion.
For aortic injuries, routine CT-scan screening in suspicious mechanisms of injury has now become a standard of care in most modern trauma centers. Diagnostic CT angiography has replaced diagnostic angiography and is the new standard. Delayed definitive repair of the aortic injury is now the preferred approach in most cases. Endovascular repair has largely replaced open repair and non-operative observational management is emerging as an acceptable alternative therapeutic modality in selected cases. All of these changes have resulted in major improvements in survival and reduction of procedure-related paraplegia.
VATS is a valuable and safe way to manage many problems in thoracic trauma. It may allow earlier diagnosis and treatment of post traumatic complications of chest injuries with less morbidity. The reduced pain and morbidity are attractive features compared with open thoracotomy. VATS continues to evolve in thoracic trauma, but unquestionably has proved value.
About 90% of chest injuries can be managed non-operatively. Tube thoracostomy, adequate analgesia, supplemental oxygen and aggressive respiratory therapy often suffice. Those patients requiring immediate surgeries are often haemodynamically unstable, have persistent bleeding, tracheal or esophageal injury. The appropriate incision, surgical exposure and attention to the anesthetic management are critical.