Computed Tomography in Thoracoabdominal Trauma

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Abstract
CT [computed tomography] scanning in thoracic and abdominal trauma was studied. The accuracy and usefulness of CT with regard to type of trauma, location of injury, timing of scanning, timing of operative intervention, confirmatory findings and ultimate patient outcome were analyzed. Between 1978 and 1983, 2069 CT scans were performed for trauma in our institution, of which 122 were abdominal and 10 thoracic, in 98 patients. Patients (31) had operation or autopsy confirmation of the findings; for 11 patients subsequent CT was available. Abdominal scanning was positive in 48 patients. The organs most commonly injured were spleen (17 patients), pancreas (9), kidney (11), and liver (8). 2 pancreatic scans were initially interpreted as negative, but in retrospect definite abnormalities were present. Thoracoabdominal CT scanning documents injury to the liver, spleen, kidney, and retroperitoneum with a high degree of accuracy. CT is most useful in stable trauma patients without obvious indications for laparotomy but with abnormal findings requiring explanation. CT scanning is useful in evaluating patients for delayed complications following trauma. Attention to details of technique and clinical correlation are essential to avoid misinterpretation of thoracoabdominal CT scans, especially of the pancreas. Use of CT scans may assist in the safe, nonoperative management of selected patients with injury limited to solid organs.