Sonographic diagnosis in blunt thoracic trauma

Chest sonography after blunt thoracic trauma allows the immediate institution of emergency treatment before X-ray examination. Especially in cases of hemothorax or/and hemopericardium, ultrasound is more specific and sensitive than conventional X-ray. A definite diagnosis of pneumothorax is possible when the typical sonographic findings are present: there is a strong line of reflexes along the chest wall, with complete extinction. Unilateral intensification of air-stipulated repeating echoes may be a sign of mantle pneumothorax. Ruptures of the diaphragm are usually recognizable on radiographic examination only when there is massive intrathoracic splanchnectopia. They are better recognized by ultrasound examination, so that iatrogenic complications caused by thoracocentesis can be avoided. Continued ultrasound check-ups are necessary to reveal any secondary appearance of pleural fluid and to monitor the effect of pleural drains. Ultrasound is also useful for guidance when pleural aspirations are performed. In 64 patients sonography showed hemothorax in 39 cases (radiographic: 13 certain, 9 uncertain), hemopericardium in 1 case, and rupture of the diaphragm in 1 case (radiography: no pathologic findings in either of the last 2). In 2 cases rupture of the diaphragm seemed possible on ultrasound but was excluded by later (ultrasound) controls, and in 2 cases with ultrasound findings suggestive of pneumothorax subsequent X-ray examination confirmed the diagnosis of mantle pneumothorax. At follow-up, 29 pathologic findings according to radiographic examination were recognized on ultrasonography as liquid or organized pleural effusions or pulmonary infiltrates. False-negative or false-positive findings (apart from two supposed diaphragmatic injuries) were not recorded with ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)