SELECTED TOPICS IN CHEST TRAUMA

The medical and social impact of chest trauma is immense (1). Chest injuries directly cause 25% of all trauma-related deaths and contribute markedly to another 25% (2,3). Sadly, many of these injuries affect young, otherwise healthy individuals. Even more sadly, since motor vehicle accidents cause most major chest trauma (4-7), many of these injuries could be prevented by the routine use of seat belts and by strict enforcement of speed limits and drunk driving laws. This article is not an all-inclusive catalog of thoracic injuries. Many excellent books (2,4,8-10) and articles (5-7,11- 15) have already been written that provide a broad, sweeping overview of chest trauma. I have instead decided to review the biomechanical, clinical, and radiologic features of a relatively small number of thoracic injuries chosen either because of their profound effect on patient morbidity and mortality and/or because of the peculiar diagnostic difficulties they present to radiologists and clinicians alike. Strategies for avoiding the diagnostic pitfalls associated with these entities are presented, and the advantages and disadvantages of available imaging studies are discussed.