intrathoracic injury. Concern for injuries in this area, regardless of physical
exam findings, merits further endoscopic or radiographic evaluation.
C. Chest Radiography
Patients who sustain chest trauma should be evaluated with a screening
anterior-posterior chest x-ray. Portable chest radiographs can be quickly
obtained in a supine immobilized patient. Films should be interpreted
methodically to ensure life-threatening injuries are efficiently identified. The
airway is examined for midline position and for any aspirated foreign bodies.
Lungs fields are then evaluated for pneumothoraces, pleural effusions or
intrathoracic radiopacities for hemothoraces, and lung parenchymal
consolidation for pulmonary contusions. The mediastinum is assessed for
pneumomediastinum and abnormal widening. Air in the mediastinal region
suggests esophageal or tracheobronchial injury, while a widened mediastinum
is suspicious for aortic injury. Skeletal structures are then examined for fracture
and dislocation, and soft tissues are assessed for subcutaneous emphysema.
Supportive lines and tubes should be evaluated for location and positioning.
D. Ultrasonography
Ultrasonography of the chest may be indicated in hemodynamically
stable patients when chest x-ray findings are inconclusive for pleural injury or
pleural effusions. Resuscitation should not be delayed in a hemodynamically