A Review of the Role and Utility of Chest Computed Tomography in Penetrating Chest Trauma

Abstract

Penetrating chest trauma is a major cause of morbidity and mortality in the USA, with changes in imaging techniques due to the advent of chest computed tomography. In this paper, we aim to review current literature and discuss indications for chest computed tomography (CCT) in the setting of hemodynamically stable patients with penetrating chest trauma. This review will also discuss the different injury patterns seen in thoracic and transmediastinal injuries and how CCT can aid in the identification of clinically relevant penetrating injuries. Chest computed tomography has proven to be more sensitive compared to traditional plain x-ray and other invasive modalities for many of the injury patterns associated with penetrating chest trauma. Where it fails, however, is in the diagnosis of esophageal injuries, where esophagoscopy and esophagography remain superior to current imaging techniques. More recently, CT esophagography has gained traction in diagnosing esophageal injuries associated with penetrating trauma. Although limited to a small prospective cohort, the use of CT esophagography appears promising and will likely play a larger role in the future. This review focuses on the current imaging trends for thoracic and transmediastinal injury patterns in penetrating chest trauma and discusses the indications and limitations of using chest computed tomography in these selected patients.