الفهرس 
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Abstract
Trauma is the leading cause of death for persons 32 years or younger and is also the largest contributor to years of potential life lost. Studies of missed injuries from the literature showed an incidence ranging from 0.6 % to 0.65 % of trauma patients. The incidence of thoracic missed injuries was about 19.1 % of all missed injuries. Thoracic trauma may account for 25 % of all trauma deaths. Pleural abnormalities after chest trauma are the most frequent complications. Pneumothorax is the most common chest injury after rib fracture. Even a small, occult pneumothorax, defined as a pneumothorax that is missed at clinical examination and an initial chest radiograph, may become life threatening after the administration of general anesthesia or mechanical ventilation. To safeguard against this occurrence, it is necessary to identify the diagnostic tests that are useful in detecting occult injuries. This study was performed with the aim of: to determine the incidence of missed non manifest thoracic injuries namely pleural injuries (haemothorax and pneumothorax), lung contusions and myocardial contusions among patients with severe polytrauma and to assess the effects of these injuries on the hospital course and resultant outcome. This study was planed as follow: This study was conducted on 100 patients presented to the emergency department of Emergency Hospital Mansoura University with severe polytrauma. All patients are subjected to: 1- Careful history taking and physical examination. 2- Electrocardiogram and Echo cardiography. 3- Chest & upper abdominal C.T. 4- Laboratory investigations: arterial blood, complete blood picture and markers of cardiac injury (L.D.H., CK and CK-MB). 5- Glasgow coma score, injury severity score and thoracic trauma severity score. Results revealed: 1. Trauma usually affects all the populations specially the most active groups and all ages. 2. Trauma alters almost all the vital signs and affects all the body regions. 3. Many traumatic lesions can be missed by the routine investigations usually done to the traumatic patients specially the thoracic trauma. 4. Minimal heamothorax and pneumothorax can be effectively determined by thoracic CT scanning which is more sensitive and specific than conventional X-ray used for diagnosis of the thoracic injuries. 5. Cardiac contusion can be detected by a number of tests including ECG, cardiac enzymes and electrocardiography. No single test can solely detect cardiac contusion. 6. Pulmonary contusion can be detected by many investigations as arterial blood gases, plain X-ray chest and chest CT. No single test is reliable to detect this contusion but the most reliable is the chest CT. 7. The extent of thoracic injuries (predicted by the thoracic trauma score), the associated other injuries (predicted by the injury severity score) and the associated head trauma (predicted by the Glasgow coma scale) are good predictors for the outcome in blunt trauma patients. 8. ECG, cardiac enzymes and chest CT must be done for every patient with severe polytrauma and suspected chest trauma. 9. Echocardiography must be done to selected patients with suspected myocardial contusion from abnormal ECG and cardiac enzymes. 10. A 20% of the cases showed missed thoracic injuries which can not be detected by the conventional methods of investigations done for trauma patients, but a combination of clinical signs, laboratory tests, conventional investigations should be synergized by CT chest and ECHO cardiography to decrease that incidence of missed injuries. This study has recommended that: 1. ECG, cardiac enzymes and chest CT must be done for every patient with severe polytrauma and suspected chest trauma. 2. Echocardiography must be done to selected patients with suspected myocardial contusion from abnormal ECG and cardiac enzymes. 3. More efforts must be done to reach a simple diagnostic test to detect the missed thoracic injuries among severe polytrauma patients. 4. Thoracic injuries must be treated vigorously as it affects outcome and mortality of the blunt trauma patients.