Sjirk Jan Westra MD, Presenter: Nothing to Disclose

1. Present algorithms for an evidence-based imaging workup of pediatric chest trauma, and discuss when CT is indicated. 2. Describe the technical parameters of CT, including dose-reduction strategies. 3. Describe the CT findings of trauma involving the chest wall, pleura, lungs, tracheobroncial tree, cardiomediastinal structures and diaphragm.

Traumatic injury to the chest in children can range from minor to life threatening. Chest radiography remains the most important imaging modality, supplemented by ultrasound or CT in selected circumstances. The challenge in pediatric trauma imaging is to implement a problem-oriented approach at imaging, that addresses the specific mechanism of injury and clinical presentation, and that is sufficiently comprehensive to base treatment decisions on, using the least amount of radiation dose, time and expense. This requires radiologists to remain actively involved in trauma care, engage our clinical colleagues in an open dialogue at all times, and participate in the performance of outcomes studies. The specific indications for chest CT in blunt trauma should be guided by the findings of the initial clinical exam and chest radiograph. A spinal fracture or fractures of the upper ribs, shoulder girdle and sternum will often necessitate a contrast-enhanced CT to look for vascular injury. The indication for placement of chest tubes is most often clinical, or is visible on chest radiographs, but if there is persistent hemorrhagic output from these tubes or progressive pneumomediastinum, a CT is indicated to look for bronchial and/or vascular injury. Although traumatic aortic injury in children remains rare despite the increased incidence of motor vehicle accidents, a high index of suspicion should be maintained for this condition. In the presence of an abnormal mediastinum on plain radiographs a CTA study to evaluate for TAI should be performed expeditiously in the hemodynamically stable child, or if possible an aortogram, when there are signs of hemodynamic instability.

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Westra, S, Imaging Evaluation of Pediatric Chest Trauma.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5000649.html