32 - CT of the Chest

Summary

INDICATIONS

CT of the chest accounts for approximately 6% to 13% of CT scans ordered in the ED (1,2). Trauma is one of the most common indications for thoracic CT. Nevertheless, a standard protocol for the use of chest CT following blunt chest trauma remains to be established (3).

Supine chest radiography is the accepted initial imaging modality in the evaluation of chest trauma (3,4). Chest radiographs are able to diagnose or suggest many traumatic injuries, including pneumothorax, hemothorax, diaphragmatic rupture, flail chest, pulmonary contusion, pneumopericardium, and pneumo- and hemomediastinum (5). The sensitivity of chest radiography to diagnose major thoracic injuries is significantly lower than CT (6–8). It is becoming more common for emergency physicians to include a chest CT with the initial trauma imaging (5). Many studies encourage its use in major chest trauma victims (6–9) because more than 50% of major chest trauma victims with normal chest radiographs have multiple thoracic injuries on CT (9). Chest CT is extremely useful in the assessment of injuries to the aorta, chest wall, lung parenchyma, airway, pleura, and diaphragm (4).

Nontraumatic chest pain is another indication for thoracic CT. Chapter 34 discusses CT angiography in the diagnosis of pulmonary embolism and aortic dissection.