Imaging of severe thoracic trauma : with special focus on costal cartilage fractures and penetrating chest trauma

Rib fractures are well known in blunt chest trauma patients. However, costal cartilage fractures (CCFX) are not as known among radiologists or clinicians. The incidence of CCFX in blunt chest trauma patients was investigated in a large level I trauma center in Finland. CCFXs contribute to anterior chest wall instability and may remain symptomatic months and years after trauma. The incidence of CCFX among chest trauma patients was 19.9%, and in all trauma patients 7.8%.CCFXs were associated with high trauma energy, and major coinciding injuries (multiple rib fractures, blunt aortic injury, liver laceration). The existing literature is sparse on CCFX and their healing process. Patients with previously diagnosed CCFX were summoned for a clinical and radiological follow-up study. A total of 21 patients voluntarily participated in the study and multimodality imaging (ultra-low-dose-CT, MRI and US) was performed. Most of the fractures had healed, but four patients (19%) reported persistent symptoms. Cross-sectional imaging with CT or MRI, and a combination of clinical and radiological workup aided in overall evaluation of patients. Penetrating trauma is a far less common entity than blunt trauma in the Nordic countries. Penetrating trauma features are crucial to identify for all on-call radiologists. Stab wounds (SW) are more commonly seen than gun shot wounds (GSW), yet the incidence of gun violence has increased during the last decades. Patients with penetrating injuries were identified from trauma registry data in Traumacentrum Karolinska, Stockholm. The spectrum of injuries and imaging findings of penetrating chest trauma were discussed. GSW patients had higher injury severity scores than SW patients, and were more likely to undergo emergency surgery on arrival (OR 5.5 (95% CI 1.22 – 24.81)). Additionally, the value and use of postoperative CT within 48 hours after emergency surgery in penetrating trauma patients was evaluated. Of the 38 patients, 20 (52.6%) had additional findings in postoperative CT. Based on the imaging findings, six patients (15.8%) required further surgical or angiographic treatment for their injuries. Benefits of WBCT (whole body computed tomography) imaging after emergency surgery include detecting unexpected injuries in and outside the surgical field, discovering potential surgical complications and active bleeding.