The authors concluded that performing echocardiography in hypotensive blunt trauma patients is effective in evaluating myocardial rupture with limited evaluation of the right ventricle, valvular injuries such as valvular or perivalvular regurgitation, hemopericardium, tamponade, pneumopericardium, and myocardial infarction. The authors have also stressed that a cardiac FAST examination may not be an effective use of resources for normotensive blunt trauma patients. In general, hemodynamically stable patients should be either monitored or evaluated by cardiac imaging if the abnormal ECG findings persist or cardiac troponin levels are rising [7]. Patients with normal ECG and cardiac troponin levels are usually considered low probability for cardiac blunt trauma and therefore can be safely discharged [7,18,19]. CT chest has been accepted as an imaging modality of choice in patients with blunt chest trauma [20-23]. The superior spatial resolution combined with the ability of contrast enhancement to display the anatomic structures and 3-D reconstructions allows for accurate assessment of cardiovascular anatomy and the associated detection of pathology. Ideally, CT chest in patients with suspected cardiac injuries as part of the blunt trauma evaluation should be performed with intravenous (IV) contrast. However, in some instances, CT chest could be performed either without or with and without IV contrast, as described in the CT chest sections below. CT Chest Without IV Contrast In patients with suspected cardiac injury, CT chest studies without IV contrast can easily identify hemothorax or hemopericardium from pleural and pericardial effusion by measuring the attenuation within the pleural or pericardial space. CT chest without IV contrast can also accurately detect sternal fractures by evaluating the sagittal and 3-D reconstructions.
Blunt Chest Trauma Suspected Cardiac Injury. The authors concluded that performing echocardiography in hypotensive blunt trauma patients is effective in evaluating myocardial rupture with limited evaluation of the right ventricle, valvular injuries such as valvular or perivalvular regurgitation, hemopericardium, tamponade, pneumopericardium, and myocardial infarction. The authors have also stressed that a cardiac FAST examination may not be an effective use of resources for normotensive blunt trauma patients. In general, hemodynamically stable patients should be either monitored or evaluated by cardiac imaging if the abnormal ECG findings persist or cardiac troponin levels are rising [7]. Patients with normal ECG and cardiac troponin levels are usually considered low probability for cardiac blunt trauma and therefore can be safely discharged [7,18,19]. CT chest has been accepted as an imaging modality of choice in patients with blunt chest trauma [20-23]. The superior spatial resolution combined with the ability of contrast enhancement to display the anatomic structures and 3-D reconstructions allows for accurate assessment of cardiovascular anatomy and the associated detection of pathology. Ideally, CT chest in patients with suspected cardiac injuries as part of the blunt trauma evaluation should be performed with intravenous (IV) contrast. However, in some instances, CT chest could be performed either without or with and without IV contrast, as described in the CT chest sections below. CT Chest Without IV Contrast In patients with suspected cardiac injury, CT chest studies without IV contrast can easily identify hemothorax or hemopericardium from pleural and pericardial effusion by measuring the attenuation within the pleural or pericardial space. CT chest without IV contrast can also accurately detect sternal fractures by evaluating the sagittal and 3-D reconstructions.