Diagnostic imaging pathways in the setting of acute chest wall trauma

Recognition of thoracic injuries during trauma assessment must be a priority due to the potential severity of intrathoracic or intrabdominal lesions. While primary care is carried out following the Advanced Trauma Life Support (ATLS) protocols, special attention must be taken to detect life-threatening conditions such as tension pneumothorax, pericardial tamponade or massive hemothorax, guided by clinical suspicion, assessment of the trauma mechanism and noninvasive imaging techniques available in situ or in the emergency department. Chest X-ray and bedside ultrasound (focused assessment in sonography for trauma, FAST) are the initial tests for unstable patients, higher clinical suspicion or high-energy mechanism of accident. After initial resuscitation, during the secondary surgery, chest computed tomography (CT) is the cornerstone test for assessing the presence of intrathoracic lesions secondary to penetrating or high- energy trauma, that can potentially threaten patient’s life. Concise and early detection can be life-saving and determines the final results. In this article we review these techniques and their indications.