The role of computed tomography in gunshot lesions of the chest. The authors' personal experience

PURPOSE: CT is a valuable tool in assessing thoracic gunshot wounds. CT is also the method of choice in emergency, because it permits rapid depiction of bullet damage to the chest and to other body districts. This in turn permits correct assessment of the main thoracic injuries, plus adequate and prompt planning of surgical treatment or support intensive care. We report on the role of CT in diagnosing the complex pleuropulmonary, cardiovascular and thoracic wall injuries caused by gunshot wounds, with their specific and acute signs which differ greatly from those of other types of chest trauma. MATERIAL AND METHODS: In the last 4 years, we observed 76 cases of gunshot injury, twenty-six of them involved the chest. The patients, 25 men and 1 woman (mean age: 32 years, range: 17-48), were all submitted to emergency CT with i.v. contrast agent injection and the CT-angiography technique. The reanimator was always present to monitor the patients' vital functions and shock state. CT of the chest was integrated with CT of the abdomen and pelvis in 4 cases and with CT of the skull in 3 cases, to detect associated bullet wounds if any. RESULTS: The most frequent CT finding was lung parenchyma tear and bruise (25 cases), followed by hemothorax (18 cases) and subcutaneous chest wall emphysema (9 cases). Pneumothorax was seen in 5 cases, associated with hemothorax in 6; rib injuries were found in 7 cases; pneumomediastinum was found in 4 cases and areas of pulmonary atelectasis in 3; the diaphragm was ruptured in 4 cases. CT showed spinal involvement in 11 patients, with injury of D3 and D5 in 4 and 3 cases, respectively; signs of interrupted spinal marrow were found in 7 cases. Damage from gunshot wounds was detected in the liver, spleen, skull and limbs in 3, 2, 3 and 10 cases, respectively. DISCUSSION AND CONCLUSIONS: Chest radiography shows major gunshot wound damage to the chest and lungs, except for heart injuries and minimal pneumothorax. When abdominal and skull injuries are associated, CT should be the method of choice because it permits prompt and panoramic assessment of the severity of pulmonary and extrathoracic damage. This results in prompt and targeted treatment, avoiding unnecessary delays which may damage the patient further.     

Liver trauma due to penetrating lesions: miscellanea, personal case series, clinical and CT findings

PURPOSE: Penetrating liver wounds are related to many causes and rank second after blunt abdominal and liver trauma. We will report the clinical and radiological findings of our personal series of patients with penetrating trauma, especially by firearms and stab and cut wounds. We will also try to define the diagnostic workup of these traumas, which is especially based on CT signs of liver damage and associated changes and which is of basic importance for following treatment, both surgical or conservative. MATERIAL AND METHODS: In the last seven years we retrospectively reviewed 31 cases of penetrating liver trauma. The patients were 19 men and 12 women, ranging in age 18 to 73 (mean 42), with penetrating liver injuries from firearms (16 patients) and stab (9 cases) wounds; 6 patients had injuries from different causes. Abdominal CT was carried out in emergency with the CT Angiography (CTA) technique in all patients. In the patients with suspected chest and abdomen involvement CT was performed from the mid-chest for accurate assessment of diaphragm and lung bases and to exclude associated pleuropulmonary damage. RESULTS: Penetrating liver wounds were caused by firearms in 70% of cases, by stabbing in 12% and, in the extant 18%, by other causes such as home accidents, road and work traumas, and liver biopsy. In our series, the liver was most frequently involved, especially by firearms wounds; in our 16 cases the most frequent injuries were hemorrhagic tears. We found bullets in the liver in 6 cases. In one case of home accident the patient wounded himself while slicing bread with a long knife, which cut into the anterior abdominal wall and tore the anterior liver capsule, as seen at CTA. DISCUSSION AND CONCLUSIONS: Penetrating wounds to liver and abdomen are less frequent than those to the chest. In the past decade the use of CT has changed the diagnostic and therapeutic approach to such injuries completely, decreasing the resort to explorative laparotomy and hepatorrhaphy. Indeed, CT provides a clear picture of the extent and severity of damage, which permits to choose a conservative treatment in case of intraparenchymal hematomas and lacerocontusive foci without hemoperitoneum, which can be followed-up with physical and CT examinations. Moreover, Helical CT could provide the early diagnosis of active bleeding in the peritoneum and of focal bleeding in the liver, thus permitting prompt hepatorrhaphy or targeted hepatectomy. A diaphragm injury suspected at CT should always prompt the surgeon to intervention, especially when hemothorax, lung base pneumothorax, large liver hematoma or tear of the liver dome are associated. Finally, subdiaphragmatic free gas indicates gut perforation associated with liver damage, in which case surgery is necessary too.     

Spontaneous pneumothorax and pneumomediastinum in IPF

Patients with idiopathic pulmonary fibrosis (IPF) are at risk for a variety of acute pulmonary complications, including pneumothorax and pneumomediastinum. Our aim was to describe the radiographic and CT findings and to determine the frequency of complicating spontaneous pneumothorax and pneumomediastinum in patients with IPF. A retrospective study was performed including 78 consecutive patients who underwent CT scanning of the chest and who had confirmed IPF. The chest radiographs and CT scans were reviewed by two chest radiologists and classified as showing features of extra-alveolar air collections. The CT scans showed extra-alveolar air in 9 (11.2 %) of 78 patients (six females and three males; age range 26–90 years, mean age 65 years). Pneumothorax was demonstrated in 5 patients and mediastinal air collections in 4 patients. All patients had dyspnea for 1–48 months (mean 14 months). Of the five cases with pneumothorax, four developed acute onset of dyspnea and pleuritic chest pain, whereas 1 patient had a relatively stable functional status. Of the 4 patients with pneumomediastinum, three presented with nonpleuritic chest pain and acute dyspnea. Chest radiographs showed extra-alveolar air in 6 patients. Three cases were predicted to be negative by chest radiographs. Follow-up CT showed that air collections had resolved completely in 5 patients. Two patients died of respiratory failure within 4 months after CT. Extra-alveolar air should be recognized as a relatively common IPF-related complication. Chest CT is a useful imaging method in determining air collections in patients with IPF that become acutely breathless and their chest radiograph fails to reveal the presence of extra-alveolar air. Received: 9 October 1998; Revised: 26 January 1999; Accepted: 6 April 1999     

Evaluation of the role of chest computed tomography in the management of trauma patients

The role of chest computed tomography (CT) in the management of trauma patients is evolving. The present study reviews the chest radiographic and chest CT findings in a group of trauma patients to determine the clinical impact of findings noted exclusively on chest CT.Fifty-five trauma patients examined with chest radiography and chest CT and whose clinical charts were available for review were retrospectively identified. There were 46 men and 9 women, with a mean age of 39 years. The presence (and size) of pneumothorax, hemothorax, pulmonary contusion, and fractures was tabulated for the chest radiographs and CT scans. The presence of mediastinal widening on chest radiographs and all mediastinal findings on CT were noted. The results of aortography, when applicable, were correlated. The clinical charts were reviewed to assess the impact of CT findings on patient management.Pneumothorax (P<0.05), hemothorax (P<0.05), pulmonary contusions, and fractures were noted more frequently on chest CT than on chest radiography. However, clinical management was affected in only three (5%) of these patients. Chest CT findings related to the mediastinum affected patient management in 13 (24%) patients. CT obviated the need for aortography in 7 of 10 patients with mediastinal widening on chest radiographs. Six other patients had aortography, four for mediastinal hematoma with a normal-appearing aorta on contrast medium-enhanced CT, and two for mediastinal hematoma and aortic injury on CT.Despite detection of significantly more pneumothoraces and hemothoraces on chest CT, clinical management was affected in only a small minority (5%) of cases. CT did prove useful in evaluating the mediastinum, obviating the need for aortography in 7 of 10 patients with a widened mediastinum on chest radiography and accurately diagnosing the presence and site of aortic injury in the two patients with that diagnosis.     

X线平片和CT扫描对胸部创伤的诊断价值

目的：探讨X线平片和CT对胸部创伤的临床诊断价值。方法：总结分析386例严重胸部创伤患者的影像检查,以临床诊断和影像复查为金标准,对X线平片与CT对胸部创伤的诊断价值进行对比分析。结果：386例中,胸壁骨折328例,气胸82例,血胸98例,血气胸136例,肺挫伤265例,肺撕裂伤150例,肺不张75例,支气管损伤11例,胸主动脉损伤8例,纵隔血肿9例,心包心脏损伤12例,膈肌损伤17例,创伤后呼吸窘迫综合症（ARDS）52例。X线平片分别漏诊22,22,20,22,133,72,36,4,6,9,11,17,28例,CT除17例肋骨骨折外均准确诊断。结论：X线和CT联合检查能够明确胸部创伤病变的部位、性质、程度,为临床提供可靠诊断,可监测病情演变,评价治疗效果。     

胸部穿透伤救治中常见失误及预防

目的 探讨和指出胸部穿透伤救治中的失误、难点,危险因素,并发症及防范措施。方法 回顾总结的胸部穿透伤３１８例,重点分析诊治错误和并发症。结果 胸腔伤的物理和Ｘ线漏误诊率为１１．１％（３５／３１６）,但致使误治率仅为４．１％（１３／３１６）,２４例心脏大血管损伤初期漏误诊５例。２８例膈肌损伤早期漏诊９例。２６７例次有腔闭式引流操作失误１１例次（４．１％）。发生需剖胸处理的并发症１７例。全组治愈３０８     

Classification of parenchymal injuries of the lung

Pulmonary contusion, implying interstitial and alveolar injury without significant laceration, has been accepted as the primary lung injury in nonpenetrating chest trauma. Computed tomographic (CT) findings were compared with those of chest radiography in 85 consecutive patients with chest trauma in which there was a pulmonary radiodensity consistent with pulmonary contusion or patients with a history of severe chest trauma with normal parenchyma despite rib fractures, hemothorax, pneumothorax, or widened mediastinum. CT was found to be more sensitive than radiography in that 151 abnormalities (excluding rib fractures) were demonstrated on radiographs versus 423 abnormalities on CT scans, and 99 lacerations were seen on CT scans versus five on radiographs. Pulmonary lacerations were classified into four types on the basis of CT findings and mechanism of injury: compression rupture, compression shear, rib penetration, and adhesion tears. In these cases, pulmonary laceration was shown to be an integral component of the mechanism of injury in pulmonary contusion, pulmonary hematoma, pulmonary cyst or pneumatocele, or cavitation in pulmonary contusion.     

Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT--initial experience

PURPOSE: To prospectively compare the accuracy of ultrasonography (US) with that of supine chest radiography in the detection of traumatic pneumothoraces, with computed tomography (CT) as the reference standard. MATERIALS AND METHODS: Thoracic US, supine chest radiography, and CT were performed to assess for pneumothorax in 27 patients who sustained blunt thoracic trauma. US and radiographic findings were compared with CT findings, the reference standard, for pneumothorax detection. For the purpose of this study, the sonographers were blinded to the radiographic and CT findings. RESULTS: Eleven of 27 patients had pneumothorax at CT. All 11 of these pneumothoraces were detected at US, and four were seen at supine chest radiography. In the one false-positive US case, the patient was shown to have substantial bullous emphysema at CT. Sensitivity and negative predictive value of US were 100% (11 of 11 and 15 of 15 patients, respectively), specificity was 94% (15 of 16 patients), and positive predictive value was 92% (11 of 12 patients). Chest radiography had 36% (four of 11 patients) sensitivity, 100% (16 of 16 patients) specificity, a 100% (four of four patients) positive predictive value, and a 70% (16 of 23 patients) negative predictive value. CONCLUSION: In this study, US was more sensitive than supine chest radiography and as sensitive as CT in the detection of traumatic pneumothoraces.     

Diagnostic Imaging in pediatric thoracic trauma

Thoracic trauma accounts for approximately 14% of blunt force traumatic deaths, second only to head injuries. Chest trauma can be blunt (90% of cases) or penetrating. In young patients, between 60 and 80% of chest injuries result from blunt trauma, with over half as a consequence of impact with motor vehicles, whereas in adolescents and adults, penetrating trauma has a statistically more prominent role. Pulmonary contusions and rib fractures are the most frequent injuries occurring. Chest X-ray is the first imaging modality of choice to identify patients presenting with life-threatening conditions (i.e., tension pneumothorax, huge hemothorax, and mediastinal hematoma) and those who require a CT examination. Multi-Slice Computed Tomography is the gold standard to evaluate chest injuries. In fact, the high spatial resolution, along with multiplanar reformation and three-dimensional (3D) reconstructions, makes MDCT the ideal imaging method to recognize several chest injuries such as rib fractures, pneumothorax, hemothorax, lung contusions and lacerations, diaphragmatic rupture, and aortic injuries. Nevertheless, when imaging a young patient, one should always keep into account the ALARA concept, to balance an appropriate and low-dose technique with imaging quality and to reduce the amount of ionizing radiation exposure. According to this concept, in the recent years, the current trends in pediatric imaging support the rising use of alternative imaging modalities, such as US and MRI, to decrease radiation exposure and to answer specific clinical questions and during the observation period also. As an example, ultrasound is the first technique of choice for the diagnosis and treatment of pleural and pericardial effusion; its emerging indications include the evaluation of pneumothoraces, costocondral and rib fractures, and even pulmonary contusions.     

Penetrating cardiac injury and the significance of chest computed tomography findings

In rare circumstances, hemodynamically stable patients can harbor serious penetrating cardiac injuries. We hypothesized that chest computed tomography (CCT) is potentially useful in evaluation. The records of all patients admitted to our center with wounds to the precordium or who sustained a hemothorax or pneumothorax after penetrating torso injuries over a 48-month period were reviewed. Those having an admission CCT were studied. The potential diagnostic value of hemopericardium (HPC) and pneumopericardium (PPC) on CCT was examined. Most of the 333 patients were male [293 (88.0 %)] with a roughly equal distribution of gunshot [189 (56.8 %)] and stab [144 (43.2 %)] wounds. Mean age was 28.7?±?12.6 years. Thirteen (3.9 %) patients had cardiac injuries that were operatively managed. Eleven (3.3 %) CCT studies demonstrated HPC and/or PPC. Ten of these patients had an injury with one false positive. Retained hemothorax and proximity findings on the three false negative CCT studies led to video-assisted thoracoscopic surgery or subxiphoid exploration with diagnosis of the injury. HPC and/or PPC on CCT had a sensitivity of 76.9 %, specificity of 99.7 %, positive predictive value of 90.9 %, and negative predictive value (NPV) of 99.1 % for cardiac injuries. However, including all findings that changed management, CCT had a sensitivity and NPV of 100 %. CCT is a potentially useful modality for the evaluation of cardiac injuries in high-risk stable patients. The presence of HPC and/or PPC on CCT after penetrating thoracic trauma is highly indicative of a significant cardiac injury.     

Radiological findings in Boerhaave's syndrome

The aim was to define the diagnostic value of chest radiography, esophagography, and computed tomography (CT) in patients with Boerhaave's syndrome. CT findings in 14 patients (11 male, 3 female; mean age: 60 years; median age: 66 years; age range: 36–78 years) with spontaneous esophageal perforation were retrospectively reviewed and compared to those of esophagography (n=11) and chest radiography (n=14). In six patients unenhanced CT scans were available; in ten patients (2/10 patients had an unenhanced CT before) a contrast-enhanced CT was performed as an emergency investigation. In 5/14 patients additional oral contrast medium was given. Chest radiography revealed pleural effusions in 9/14 and infiltrates in 9/14 patients. Pneumothorax and pneumopericardium were observed in two patients each. Pneumomediastinum was seen in three patients. Two chest radiographs were normal. Esophagography performed in 11 patients demonstrated contrast medium extravasation at a supradiaphragmatic level in seven patients, indicating esophageal perforation with esophagopleural fistula, and a submucosal contrast medium collection in four cases. Unenhanced CT scans revealed four intramural hematomas with typical localization. Unenhanced and contrast-enhanced CT demonstrated periesophageal air collections indicating esophageal perforation in all patients. Pleural effusions were seen in 11/14 and infiltrates in 8/14 patients. Contrast medium extravasation was observed in 5/14 patients, whereas a thickening of the esophageal wall was depicted in 11/14 patients. Periaortic air tracks (n=7), pneumothorax (n=3), pneumomediastinum (n=6), and mediastinal fluid collections (n=7) were depicted in CT. By demonstrating periesophageal air tracks suggestive of esophageal perforation, CT reveals the decisive criteria for diagnosing Boerhaave's syndrome and should therefore be performed in the diagnostic work-up of patients in whom this syndrome is part of the differential diagnosis. Electronic Publication     

尘肺的CT检查与X线胸片比较研究

目的对比分析胸部CT及X线胸片对尘肺的诊断价值。方法回顾性分析52例尘肺的胸部CT及X线胸片资料,男47例,女5例,平均年龄59岁。结果52例中有28例胸部CT表现有两肺弥漫性小阴影(直径<10mm的阴影),胸部X线发现19例有小阴影。大阴影(直径>10mm的阴影)CT显示13例,X线胸片显示9例。合并症CT显示20例,其中肺炎5例,肺结核3例,肺癌2例,气胸6例,肺气肿4例。X线胸片显示10例,其中肺炎1例,肺结核1例,气胸6例,肺气肿2例。结论在单纯的尘肺诊断中,CT并不优于X线胸片,但对大阴影、胸膜改变及合并症的检出率明显高于X线胸片,并可弥补X线胸片的不足。     

Bildgebung des stumpfen Thoraxtraumas

Clinical/methodological issue

Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment.

Standard radiological methods

Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma.

Methodological innovations

Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients.

Practical recommendations

In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients.     

周围型肺错构瘤的影像表现

目的 探讨周围型肺错构瘤的影像表现，以提高诊断正确率。方法 回顾性分析经手术病理证实的22例周围型肺错构瘤的影像表现。胸片检查12例，CT扫描16例（其中6例同时有胸片）。结果 所有病例均为单发，右肺13例，左肺9例。全部错构瘤病灶均为边缘清楚、无毛刺或卫星病灶的肺内肿块，浅分叶5例，平片显示钙化3例，CT扫描脂肪成分和钙化的显示分别为8例和6例（其中2例呈典型的爆米花样钙化）。7例行CT增强扫描均无明显强化。结论 爆米花样钙化及脂肪密度是周围型肺错构瘤的特征性影像表现，薄层CT扫描尤其是HRCT检查能提高肺错构瘤的诊断准确率，增强CT扫描对错构瘤的鉴别诊断有一定的价值。     

新生儿气胸并纵隔积气的X线诊断

目的 分析新生儿气胸并纵隔积气的X线表现及特点,提高其诊断水平.方法 47例患者均摄有仰卧前后位胸腹联合片,20例同时摄有仰卧水平侧位片,1例行胸部CT检查,45例有一次或多次随访.结果 47例新生儿气胸中,胸腔前缘积气20例,肋膈角区积气1 5例,纵隔旁积气12例,同时伴有纵隔内积气11例.新生儿多采用仰卧位及卧水平侧位摄片,其气胸和纵隔积气的X线表现与年长儿、成人立位摄片时表现不同,气体多聚集在胸腔前部、肋膈角区及前纵隔旁,X线多表现为一侧胸腔密度降低,中内带明显,同时可见压缩肺边缘,肋膈角异常锐利变深,纵隔心影旁或膈顶部异常清晰锐利;纵隔积气表现胸腺上抬,远离心底部,称为“胸腺帆征”,胸腺边缘清晰,见“八”字征.结论 根据新生儿气胸的X线表现特点,X线可明确新生儿气胸、纵隔积气的诊断.     

Chest radiography after minor chest trauma

The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6 (30%) of the 20 patients with hemo/pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.     

Gunshot wounds of the abdomen studied by computed tomography. The authors' personal experience in 30 cases

INTRODUCTION: CT plays an important role in depicting gunshot wounds in parenchymal and hollow organs in the abdomen. Relative to other techniques and to emergency laparotomy, CT permits good assessment of abdominal content, major injuries and changes in other districts, such as chest, pelvis and skull. We investigated the yield and role of CT in diagnosing abdominal gunshot wounds, with their rich and varied radiological signs and associated injuries. MATERIAL AND METHODS: We retrospectively reviewed the findings of 30 patients with abdominal gunshot wounds examined in 4 years at Loreto-Mare Hospital, Naples. All patients were men, age ranging 19-54 years (mean: 35); 6 of them were not from the European Union. Examinations were carried out from diaphragm to pubis with i.v. contrast injection and the CT angiography technique. CT was integrated with chest studies in 6 cases and with skull studies in 5. Subsequent CT follow-ups were necessary in 12 cases submitted to conservative treatment. RESULTS: Liver was the most damaged parenchyma, with hemorrhage and lacerocontusion in 7 cases and mashed in 1 case; spleen was involved in 4 cases; hemoperitoneum was found in 18 cases. Diaphragm was involved in 5 cases and pancreas in 2; gallbladder, stomach and duodenum were involved in 1 case each and jejunum-ileum and colon in 3 and 6 cases, respectively. CT showed renal injury in 3 cases and bladder injury in 2. Eight patients had vertebral gunshot damage. Pneumothorax, hemothorax and lacerocontusion were found in 7 cases; brain was injured in 4 cases and limbs in 16. DISCUSSION AND CONCLUSIONS: Tissue damage extent depends on the speed and kinetic energy the bullet carries into the abdomen. Abdominal radiography shows the bullet and its site, pneumoperitoneum from gastrointestinal perforation, crash bone injuries, vertebral trauma and subcutaneous emphysema. Instead, CT depicts early parenchymal damage and vascular injury and thus becomes a complete and necessary tool for imaging gunshot wounds. CT provides early diagnostic information which help plan emergency treatment and thus decrease mortality. As for angiography and US, we suggest they be used subsequently because in emergency they may delay the diagnosis. Moreover, vessel rupture and active intraabdominal bleeding are easily detected with spiral CT, which appears the best tool for prompt assessment of the injuries associated with gunshot wounds in other districts such as, the skull. To conclude, CT permits adequate planning of emergency surgery and helps select the cases for follow-up, intensive care and conservative treatment.     

Postmortem ventilation in cases of penetrating gunshot and stab wounds to the chest

We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT).The study included 6 subjects (1 female, 5 male; age 32–67 years) with a penetrating gunshot or stab wound to the chest and consecutive pneumo- and/or haemothorax. The pneumo- and haemothorax were evacuated by a suction pump, and postmortem ventilation was applied using a home care ventilator. PMCT images with and without postmortem ventilation were compared, as well as the autopsy results.In three cases haemo- and pneumothorax was clearly reduced. Postmortem ventilation led to distinct re-expansion of the lungs in two cases, and to re-expansion of single lung lobes in two cases with shotgun injuries. No visible effect was seen in the remaining two cases, because of extensive destruction of lung tissue and blood aspiration. In two cases the injuries sustained in the individual lung lobes were successfully located during postmortem ventilation. The bullet channel was apparent in one case; in another case, injury of the pericardium became visible by generating pneumopericardium.The present method is capable of improving evaluation of the postmortem lung in the presence of single stab or gunshot wounds and if there is no severe destruction of the respiratory system and aspiration. Forensic autopsy should still be considered as the gold standard, although in some cases the present method might be helpful, especially where no autopsy is required.     

新生儿气胸的X线诊断

目的 分析新生儿气胸的X线表现特点，以提高其诊断能力。资料与方法 39例新生儿气胸均摄有仰卧前后位胸片，30例同时摄有仰卧水平侧位片，19例有1次或多次随访X线片，3例作胸部螺旋CT扫描。结果 39例新生儿气胸表现为内侧气胸16例，前部气胸22例，外侧气胸1例，其中伴有纵隔积气9例。结论 由于新生儿多采用卧位摄片，因此其气胸与年长儿、成人的X线表现不同，气体多聚集在胸腔前部和内侧，并常伴有纵隔积气。CT能提供更多的病变信息。     

百草枯中毒的胸部X线表现初步探讨(附12例报告)

目的：探究百草枯中毒的Ｘ线胸片征象。方法：对１２例百草枯中毒病人进行Ｘ线胸片检查,后分析胸片征象。结果：１２例病例均出现肺纹增多,肺实变影,早期肺纤维化,部分病例出现小囊征,在百草枯中毒剂量超过２５ｍｌ的病例中可出现气胸、胸腔积液纵隔气肿及皮下气肿征象。结论：胸部平片检查对于百草枯中毒的诊断治疗结果、预后的判断及随访有十分重要的意义,肺损害的严重程度可能与中毒剂量相关。