Spiral CT Evaluation Of Closed Pulmonary Trauma

Objective: To analyze the CT characteristics of closed pulmonary trauma, and to explore its formation mechanisms.Material and Methods: The serial chest CT films and clinical data of 110 patients with closed pulmonary trauma covering a period from Oct. 2002 to Oct. 2006 were retrospectively studied.Results:â‘ traumatic pulmonary consolidation (110 cases): All of them were divided into two groups (localized-type and widespread-type) by its extent. 32 cases of the localized-type traumatic pulmonary consolidations lie in subpleural pulmonary parenchyma while 9 cases lies in pulmonary parenchyma besides some structures, such as: interlobar fissure, mediastinum and thoracic vertebra. The widespread-type traumatic pulmonary consolidation can be depicted by back-in-chief, multifocal, unilateral pulmonary consolidation and diffuse. Compared traumatic pulmonary consolidation and the rib fracture, we found: subpleural localized-type traumatic pulmonary consolidation always complicated with rib fracture; unilateral pulmonary consolidation and ribs fracture can be seen simultaneous; non-subpleural localized-type and diffuse widespread-type traumatic pulmonary consolidation did not correlate to rib fracture.â‘¡Among the 110 patients, 53 post-traumatic pulmonary pseudocysts (PPPs) from 33 patients were found, 32 ones localized subplueral pulmonary parenchyma while others lie in pulmonary parenchyma besides some structures, such as: interlobar fissure, pulmonary ligament, mediastinum and thoracic vertebra. Most of PPPs have an oval shape and regular margin, while 22.6ï¼…PPPs have an irregular shape. The size of PPPs with irregular shape were larger than one with oval shape significantly (P=0.000). Follow-up examinations demonstrate: PPPs could be converted to pulmonary hematoma and resolute after 11-82 days; the surrounding consolidation would resolute in 15 days post injury; large pneumothorax and/or hemothorax could be found in some cases in 3-5 days from the accident, and then the PPP would diminish in size or disappear.â‘¢traumatic pneumothorax (60 cases): Moderate-size pneumothorax in 19 cases, unilateral pulmonary consolidation always consisted with homonymy moderate-size pneumothorax. Among the 41 case of small pneumothorax (less than 1 cm thick and not extending past the mid-coronal line), 22ï¼…localized in anterior costophrenic angle and 5 cases located in the paraspinal regions.Conclusions:â‘ Chest CT has an important role in demonstrating dimensional and topographic characteristics of closed pulmonary trauma.â‘¡It's not true that traumatic pulmonary consolidation correlate to rib fracture because their formation mechanism is not the same.â‘¢Posttraumatic pulmonary pseudocyst (PPP) is formed in a way that a tear force applied to the pulmonary parenchyma leading to the formation of a closed space in which coming of air or/and bleeding of vessels. Non-filled or liquid-filled pseudocyst and hematoma belong to PPP. The size of the lesion has an effect to its shape and evolution. Diagnosis of PPP is achieved on the basis of the clinical scenario of chest trauma and on the presence of typical radiological features. Uncomplicated PPP have favorable outcome without specific treatment.