Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation
Issued Date
2022-12-01
Resource Type
ISSN
23791381
eISSN
2379139X
Scopus ID
2-s2.0-85142348140
Pubmed ID
36412690
Journal Title
Tomography
Volume
8
Issue
6
Start Page
2772
End Page
2783
Rights Holder(s)
SCOPUS
Bibliographic Citation
Tomography Vol.8 No.6 (2022) , 2772-2783
Suggested Citation
Kaewlai R., Chatpuwaphat J., Butnian K., Thusneyapan K., Panrong N., Lertpipopmetha W., Wongpongsalee T. Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation. Tomography Vol.8 No.6 (2022) , 2772-2783. 2783. doi:10.3390/tomography8060231 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85225
Title
Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation
Author's Affiliation
Other Contributor(s)
Abstract
Background: The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. Methods: This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. Results: Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. Conclusions: Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.