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About Recent Edits Go ad-free. Edit article. View revision history Report problem with Article. Citation, DOI and article data. Hacking, C. Mediastinal widening differential. Reference article, Radiopaedia. A CXR is capable of accurately allowing diagnosis of a wide range of traumatic injuries in the chest, ranging from bony rib, scapular or clavicular fractures to pulmonary contusions or haemo-pneumothoraces [ 2 ]. Other subtler signs of underlying injuries such as subcutaneous emphysema, mediastinal emphysema and aortic injuries may be detected depending on the quality of the film and the experience of the reading physician.
While the diagnostic yield of rib, lung and pleural injuries has been previously described [ 2 ], the role of chest X ray in identifying patients with mediastinal injuries is less clear. In an era of increasing resource constraints, it would be helpful to know how a widened mediastinum seen on CXR correlates to great vessel injuries so that unnecessary CT thorax scans can be safely avoided.
We aimed to compare the rate of detection of mediastinal injuries using widened mediastinum on CXR and eventual findings on CT thorax by means of a retrospective review of the imaging results and radiologists' reports of all trauma patients captured in our electronic health records system.
A database search was performed on our hospital trauma registry to retrieve all patients with a diagnosis associated with trauma who received a CT thorax, and their unique National Registration Identification Card number was recorded. Their electronic health records were then extracted; the radiologist's report was then compared for both the initial CXR as well as the CT thorax.
Statistical analysis was carried out by Microsoft Excel Ver As this was a retrospective database study, no informed consent was deemed necessary from the included patients.
A total of patients' records were retrieved from our trauma database. Of these, a total of 66 patients were excluded from analysis, 22 patients due to inappropriate diagnosis and 44 patients due to missing radiological data. The demographic data of the remaining patients is shown in Table 1. The majority were males Figure 1: Breakdown of patient cohort by ethnicity. View Figure 1. Table 1: Overall demographics. View Table 1.
Almost all the patients A total of 74 patients Figure 2: Breakdown of location where incident leading to injury occurred. View Figure 2. A total of 52 patients 8. Another 14 patients who had widened mediastinum reported on their CXR had no signs of mediastinal injury on CT thorax, of which 6 of these patients had other non-mediastinal injuries on CT thorax.
There was therefore an overall sensitivity of Out of patients with non-mediastinal injuries on CT thorax, patients The sensitivity of detecting a non-mediastinal injury on CXR was The multiply injured patient poses a significant diagnostic and management dilemma as available history is limited and physical examination may be compromised by distractions such as other injuries or stress from deteriorating patient vital signs. This can result in missed or delayed diagnosis of injuries.
This is widely used in our hospital by both ED physicians and the general surgical trauma team in our hospital; we therefore set out to explore if this leads to missed injuries or unnecessary imaging due to mediastinal widening seen on CXR.
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