Image-Guided Aspiration Chest There is no relevant literature to support the use of image-guided aspiration chest in the initial imaging of recent minor blunt trauma with suspected pleural effusion. MRI Chest Without and With IV Contrast There is no relevant literature to support the use of MRI chest without and with IV contrast in the initial imaging of recent minor blunt trauma with suspected pleural effusion. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest without IV contrast in the initial imaging of recent minor blunt trauma with suspected pleural effusion. Radiography Chest Chest radiography is considered a first-line imaging test for patients with chest trauma and a clinical indication for imaging [46]. In the prospective NEXUS Chest CT trial, blunt trauma patients without an abnormal chest radiograph and 6 clinical criteria could avoid an unnecessary chest CT (sensitivity 99.2%; 95% CI, 95.4%-100%, specificity 20.8%; 95% CI, 19.2%-22.4%) [47]. A meta-analysis of the pooled sensitivity and specificity of chest radiographs for the detection of hemothorax in patients with chest trauma was 54% (95% CI, 33%-75%) and 99% (95% CI, 94%-100%), respectively, when using chest CT as the reference standard [48]. A study of 24 patients using only PA radiographs found a similar sensitivity of 62.5% and specificity of 100% for the detection of pleural effusions in patients with chest trauma [49]. In 2 prospective series of patients with minor blunt thoracic trauma and an initial normal chest radiograph, 7.4% to 11.8% had a pleural effusion on follow-up radiography within 2 weeks, clinically ascribed as a delayed hemothorax [39,40]. A delayed hemothorax on chest radiographs after minor blunt thoracic trauma was significantly more likely in patients with at least 1 fracture between the third and ninth ribs [50]. US Chest The sensitivity and specificity of chest US for only minor blunt trauma has not been reported.
Workup of Pleural Effusion or Pleural Disease. Image-Guided Aspiration Chest There is no relevant literature to support the use of image-guided aspiration chest in the initial imaging of recent minor blunt trauma with suspected pleural effusion. MRI Chest Without and With IV Contrast There is no relevant literature to support the use of MRI chest without and with IV contrast in the initial imaging of recent minor blunt trauma with suspected pleural effusion. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest without IV contrast in the initial imaging of recent minor blunt trauma with suspected pleural effusion. Radiography Chest Chest radiography is considered a first-line imaging test for patients with chest trauma and a clinical indication for imaging [46]. In the prospective NEXUS Chest CT trial, blunt trauma patients without an abnormal chest radiograph and 6 clinical criteria could avoid an unnecessary chest CT (sensitivity 99.2%; 95% CI, 95.4%-100%, specificity 20.8%; 95% CI, 19.2%-22.4%) [47]. A meta-analysis of the pooled sensitivity and specificity of chest radiographs for the detection of hemothorax in patients with chest trauma was 54% (95% CI, 33%-75%) and 99% (95% CI, 94%-100%), respectively, when using chest CT as the reference standard [48]. A study of 24 patients using only PA radiographs found a similar sensitivity of 62.5% and specificity of 100% for the detection of pleural effusions in patients with chest trauma [49]. In 2 prospective series of patients with minor blunt thoracic trauma and an initial normal chest radiograph, 7.4% to 11.8% had a pleural effusion on follow-up radiography within 2 weeks, clinically ascribed as a delayed hemothorax [39,40]. A delayed hemothorax on chest radiographs after minor blunt thoracic trauma was significantly more likely in patients with at least 1 fracture between the third and ninth ribs [50]. US Chest The sensitivity and specificity of chest US for only minor blunt trauma has not been reported.