SUMMARY AND CONCLUSION
Multi-detector computed tomography (MDCT) has sparked its use as a principal screening study for polytrauma patients and is increasingly commonly obtained in nontraumatic emergency department (ED) patients.
The chest radiograph continues to be performed as a screening study in the polytrauma setting and for patients presenting to the ED with complaints related to the thorax. However, CT provides a significant improvement in sensitivity for detection of both traumatic and nontraumatic acute thoracic pathologies, which has fostered its common use in these settings.
As regard the Life support devices-CT can accurately localize their sites, detect their malpositions and other possible complications resulting from their introduction e.g, surgical emphysema, pneumothorax and chest wall hematoma.
Pulmonary parenchymal lesions-CT can differentiate between different lesions .It precisely detect the consolidation and its possible etiology (e,g infection ,aspiration ,lung injury ,hemorrhage, infarction and finally BAC ) based on the clinical context. It also detects the type of atelectasis and its etiology, it also show signs of CHF and decompensation. CT scan can detect type of emphysema, possible complications and different subtypes of ILDS.
As regard the pleural lesions-contrast enhanced CT is very important and definitely aids in diagnosis of underlying pleural malignancy either primary e.g mesothelioma or metastatic from intra thoracic or extra-thoracic malignancy. It accurately detect hemothorax (high attenuating) and its different possible etiology. CT also very clearly detects all signs of pneumothorax which is life threatening condition.
As regard the blunt/penetrating trauma-CT is essential to directly assess the thoracic vessels, pericardial fluid and to potentially demonstrate airway and esophageal injuries. CT is far more sensitive than radiography for detection of pneumothorax, pleural fluid, and lung parenchymal injury. CT can document sites of active thoracic bleeding or vascular injury to direct surgical or angiographic intervention. In most polytrauma patients multiple CT studies are usually indicated and inclusion of the chest as part of a general survey (total body CT) is being increasingly used in trauma centers. Even when the admission chest radiograph shows no definitive injury, CT can confirm the impression of normality with a higher level of accuracy or detect subtle but important pathology not revealed on the chest film.
The use of CT for patients presenting with chest pain to the ED is increasing, because this approach can diagnose or exclude a wide variety of acute thoracic pathology. In these patients, MDCT has the potential to assess the aorta, pulmonary arteries, and coronary arteries simultaneously, the so called ‘‘triple rule-out.’’ It now appears that 40- or 64-slice units will be required for consistently performing high quality studies for this application.
MDCT has become the definitive test to rapidly assess for pulmonary embolization and different aortic lesions e.g. aortic dissection being accurate, rapidly obtained, and cost-effective.
Finally the widely available, easily operated, single breath hold, multiplanar reformatting images as well as cost effectiveness make CT is the gold standard for chest imaging.
Conclusion:
CT is considered the gold standard for chest imaging in ICU patients, it can detect different lesions precisely and their possible etiologies ,It also aids in diagnosis of many pathologies ,detect different complications which allows change in further management of many patients .it is widely available ,single breath hold which facilitate the follow up of the patients.
Actually CT showed great success in management of ICU patients and it is considered the modality of choice.
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