Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. CTA can also be performed with or without ECG gating. The ECG gating is usually prospective and allows for better assessment of cardiac injuries as well as concomitant aortic injuries in patients with blunt chest trauma and concomitant cardiac injuries. The role of focused assessment with sonography for trauma (FAST) (or extended-FAST or chest abdominal-FAST in evaluating chest injury) is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT [14,15]. Ultrasound (US) may be able to diagnose certain thoracic and abdominal injuries, but it is an insufficient test to fully exclude injuries to these areas because it has a relatively lower specificity compared with CT [16]. Hemodynamic instability and findings such as abnormal ECG and increased level of high-sensitivity troponin in hemodynamically stable patients should raise the suspicion of cardiac injuries, and these patients should undergo rapid cardiac assessment by echocardiography [7,10]. An initial FAST examination can detect pericardial effusion and wall motion abnormality. Hall et al [11] analyzed the cardiac component of the FAST examination in hypotensive (systolic blood pressure <90 mm Hg) and normotensive trauma patients.
Blunt Chest Trauma Suspected Cardiac Injury. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. CTA can also be performed with or without ECG gating. The ECG gating is usually prospective and allows for better assessment of cardiac injuries as well as concomitant aortic injuries in patients with blunt chest trauma and concomitant cardiac injuries. The role of focused assessment with sonography for trauma (FAST) (or extended-FAST or chest abdominal-FAST in evaluating chest injury) is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT [14,15]. Ultrasound (US) may be able to diagnose certain thoracic and abdominal injuries, but it is an insufficient test to fully exclude injuries to these areas because it has a relatively lower specificity compared with CT [16]. Hemodynamic instability and findings such as abnormal ECG and increased level of high-sensitivity troponin in hemodynamically stable patients should raise the suspicion of cardiac injuries, and these patients should undergo rapid cardiac assessment by echocardiography [7,10]. An initial FAST examination can detect pericardial effusion and wall motion abnormality. Hall et al [11] analyzed the cardiac component of the FAST examination in hypotensive (systolic blood pressure <90 mm Hg) and normotensive trauma patients.