Available at http://radiographics.rsna.org/content/full/31/4/E101.full
RadioGraphics 2011; 31:1161-1162
Steven J. Co, MD , Charlotte J. Yong-Hing, MD , Sandro Galea-Soler, MD Balazs Ruzsics, MD, PhD , U. Joseph Schoepf, MD ,Amr Aljan, MD Paul Farand, Msc, MD , Savvas Nicolaou, MD
Cardiac injury due to blunt or penetrating chest trauma is common and is associated with significant morbidity and mortality. Understanding the mechanisms, types, and complications of cardiac injuries and the roles of various imaging modalities in characterizing them is important for appropriate diagnosis and treatment. These injuries have not been well documented at imaging, but there are now fast and accurate methods for evaluating the heart and associated mediastinal structures. The authors review the broad spectrum of injuries that can result from blunt or penetrating trauma to the chest, as well as the imaging modalities commonly used in the acute trauma setting for evaluation of the heart and mediastinal structures. The spectrum of injuries may include any of the associated anatomic structures with varying degrees of involvement. Traumatic pericardial effusions, pericardial lacerations with or without cardiac luxation, myocardial transmural or papillary muscle rupture, valvular dysfunction, and coronary artery injuries may all be encountered, albeit with different frequencies. Penetrating wounds to the mediastinum can concomitantly injure the heart, great vessels, trachea, esophagus, and the bony cage of the thorax and therefore necessitate coordinated input from medical and surgical subspecialties. The authors include a pictorial review of both common and rarely documented cardiac injuries, including myocardial contusion, myocardial rupture, pericardial injuries, coronary artery injuries, and traumatic valvular dysfunction.
Selection of the most appropriate modality for evaluation and recognition of the imaging findings of cardiac injuries in the acute trauma setting is important to expedite treatment and improve survival. While many imaging modalities are now available, multidetector computed tomography (CT) is the most important modality for initial evaluation of patients with blunt or penetrating chest trauma. The entire thorax can be quickly and accurately imaged, and life-threatening injuries can be efficiently diagnosed and treated. CT has high sensitivity for identification