CTA Chest CT of the chest is warranted in the arterial phase primarily when there is a concern for aortic or other major vessel injury [20]. A delayed scan may be obtained, depending on the findings on the arterial phase CT. US Chest There is no relevant literature to support the use of non-US FAST of the chest in patients who are hemodynamically stable with suspected chest trauma. Its use in detection of pleural fluid and pneumothorax is increasing, but it has not gained acceptance for comprehensive evaluation of blunt chest trauma because of its lack of sensitivity for pulmonary, aortic, cardiac, and musculoskeletal injury [49]. US FAST Scan Chest Abdomen Pelvis The role of FAST is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT. Although US may be able to diagnose certain thoracic and abdominal injuries, its relatively lower specificity compared with CT does not make it a sufficient test to exclude injuries to these areas [5]. Its use in detection of pleural fluid and pneumothorax is increasing, but it has not gained acceptance for a comprehensive evaluation of blunt chest trauma because of its lack of sensitivity for pulmonary, aortic, cardiac, and musculoskeletal injury. Radiography Trauma Series Trauma series radiographs typically consist of portable radiographs of the chest and pelvis. In a patient with suspicion of chest trauma, a rapid assessment with chest radiographs plays a key role in initial workup. A portable AP chest radiograph helps screen for immediate life-threatening findings, such as tension pneumothorax and Major Blunt Trauma A portable radiograph of the pelvis can evaluate for unstable pelvic injuries and hip dislocation [4]. Compared with CT, pelvic radiographs also have lower sensitivity for detecting injury. In a study of 509 consecutive trauma patients, the sensitivity of the AP pelvic radiographs was 77% using CT as the reference standard [53].
Major Blunt Trauma. CTA Chest CT of the chest is warranted in the arterial phase primarily when there is a concern for aortic or other major vessel injury [20]. A delayed scan may be obtained, depending on the findings on the arterial phase CT. US Chest There is no relevant literature to support the use of non-US FAST of the chest in patients who are hemodynamically stable with suspected chest trauma. Its use in detection of pleural fluid and pneumothorax is increasing, but it has not gained acceptance for comprehensive evaluation of blunt chest trauma because of its lack of sensitivity for pulmonary, aortic, cardiac, and musculoskeletal injury [49]. US FAST Scan Chest Abdomen Pelvis The role of FAST is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT. Although US may be able to diagnose certain thoracic and abdominal injuries, its relatively lower specificity compared with CT does not make it a sufficient test to exclude injuries to these areas [5]. Its use in detection of pleural fluid and pneumothorax is increasing, but it has not gained acceptance for a comprehensive evaluation of blunt chest trauma because of its lack of sensitivity for pulmonary, aortic, cardiac, and musculoskeletal injury. Radiography Trauma Series Trauma series radiographs typically consist of portable radiographs of the chest and pelvis. In a patient with suspicion of chest trauma, a rapid assessment with chest radiographs plays a key role in initial workup. A portable AP chest radiograph helps screen for immediate life-threatening findings, such as tension pneumothorax and Major Blunt Trauma A portable radiograph of the pelvis can evaluate for unstable pelvic injuries and hip dislocation [4]. Compared with CT, pelvic radiographs also have lower sensitivity for detecting injury. In a study of 509 consecutive trauma patients, the sensitivity of the AP pelvic radiographs was 77% using CT as the reference standard [53].