unstable patient for chest US, unless there concern is for cardiac tamponade.
Bedside ultrasound (US) is typically performed as a focused assessment with
sonography for trauma (FAST), which evaluates the abdomen for free fluid and
heart for pericardial effusion. Sonographic examination in the trauma setting
may also be extended to include the thorax. The sensitivity and specificity of
ultrasound for the detection of pneumothoraces are 86%-98% and 97%-100%,
respectively. Hemothoraces can be identified with similar accuracy when a
minimum of 20 mL of pleural fluid is present for a supine patient. To evaluate
for a pneumothorax, a high frequency probe is usually placed on the anterior
chest at the 3rd and 4th intercostal space, mid-clavicular line. Diagnosis is
established with the absence of pleural sliding and comet tail artifacts.
Hemothorax is diagnosed with an anterior or lateral approach by the presence
of an anechoic dependent effusion with inspiratory movement.
D. Computed Tomography
The use of thoracic computed tomography (CT) scans has increased
tremendously in the pediatric trauma setting. This imaging modality is more
sensitive than plain film chest x-ray for injury detection and can provide
immediate high resolution images of the soft tissue, skeletal, and visceral
components of the chest. Furthermore, a CT angiography scan with
intravenous contrast is particularly useful when there is concern for mediastinal