Thorax computed tomography findings in patients victims of chest trauma

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ORIGINAL ARTICLE

**!"#$%&' (#)+,-.' ,#)#/$%"0' 12.32/4' 32' *%5-2,4' 63(5)4' #7'**

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Francisco Jose Rodrigues de Moura Filho

1

_{. Marilza Oliveira}

2

_.

1 Médico, graduado em Medicina na Universidade Federal do Ceará (UFC), com Especialidade Médica em Radiologia e Diagnóstico por Imagem, Instituto Doutor Jose Frota (IJF), Fortaleza, Ceará, Brasil. 2 Médica, graduada em Medicina na Universidade Federal do Ceará (UFC), com Especialidade Médica em Radiologia e Diagnóstico por Imagem, Instituto Doutor Jose Frota (IJF), Fortaleza, Ceará, Brasil.

ABSTRACT

Objective:!"#!$%&'()*%!+,#(-.!'#/01+%$!+#/#2(-0,3!45$)52&!)5!0-+)%5+&!-&&)&+%$!)5!+,%!%/%(2%5'3!15)+!#6!75&+)+1+%!8(!9#&%!:(#+-!

(IJF). Materials and Methods:!8%&'()0+);%!&+1$3!-5-<3=)52!>?@!'#5&%'1+);%!'#5+(-&+A%5,-5'%$!+,#(-.!'#/01+%$!+#/#2(-0,3!#6! 0-+)%5+&!;)'+)/&!#6!+,#(-')'!+(-1/-!-$/)++%$!+#!+,%!%/%(2%5'3!15)+!#6!79:B!*%+C%%5!D#;%/*%(!>&+B!E@>F!-5$!9-51-(3!G>&+B!E@>HI!

Results: J*5#(/-<!45$)52&!C%(%!#*&%(;%$!)5!K>BE!L!#6!+,%!0-+)%5+&I!J/#52!+,%/B!+,%!6#<<#C)52!45$)52&!C%(%!/#&+!6(%M1%5+<3!

#*&%(;%$N! 6(-'+1(%&! OFPLQB! ,%/#+,#(-.! OFGLQB! -+%<%'+-&)&! OGRLQB! 05%1/#+,#(-.! OE?LQ! -5$! <152! '#5+1&)#5&! O>RLQ! S10+1(%! #6! +,%! %&#0,-21&! C-&! &%%5! )5! +,(%%! 0-+)%5+&I! Conclusion:!T%! (%'#25)=%! +,-+! +,%! 45$)52&! %5'#15+%(%$! )5! #1(! &+1$3! -(%! #6! &)/)<-(! 0(%;-<%5'%!+#!+,%!#5%&!(%0#(+%$!)5!+,%!<)+%(-+1(%!-5$!+,-+!U"!&'-5!)&!%&&%5')-<!+#!M1)'V<3!$)-25#&%!+,%&%!45$)52&I

Keywords: Multidetector computed tomography. Thoracic injuries. Diagnostic imaging.

RESUMO

Objetivo:! 8%&'(%;%(! #&! -',-$#&! +#/#2(W4'#&! $%! 0-')%5+%&! &1*/%+)$#&! X! +#/#2(-4-! '#/01+-$#()=-$-! $%! +Y(-.! -+%5$)$#&! 5#!

pronto-socorro do Instituto Dr Jose Frota (IJF). Materiais e Métodos:!Z&+1$#!$%&'()+);#!0%<-!-5W<)&%!&%M1%5')-<!$%!>?@!+#/#2(-4-&! $%!+Y(-.!$%!0-')%5+%&!;[+)/-&!$%!+(-1/-!+#(W')'#!-$/)+)$#&!5#!0(#5+#A&#'#((#!$#!79:!%5+(%!>!$%!5#;%/*(#!$%!E@>F!-!G>!$%!\-5%)(#! $%!E@>HB!&1*/%+)$#&!-!+#/#2(-4-!'#/01+-$#()=-$-!'#/!-!-$/)5)&+(-]^#!$%!'#5+(-&+%!%5$#;%5#&#I!Resultados: Observou-se a 0(%&%5]-!$%!-<+%(-]_%&!%/!K>BEL!$#&!%.-/%&I!8%&+-&B!-&!/-)&!6(%M1%5+%&!6#(-/N!6(-+1(-&!OFPLQB!,%/#+Y(-.!OFGLQB!-+%<%'+-&)-! OGRLQB! 05%1/#+Y(-.! OE?LQ! %! '#5+1&^#! 01</#5-(! O>RLQI! S10+1(-! $%! %&`6-2#! 6#)! %5'#5+(-$-! %/! +(a&! 0-')%5+%&I! Conclusão: S%'#5,%'%/#&!M1%!#&!-',-$#&!%5'#5+(-$#&!%/!5#&&#!%&+1$#!&^#!$%!&)/)<-(!0(%;-<a5')-!-!$%!#1+(#&!(%<-+#&!$%&'()+#&!5-!<)+%(-+1(-! %!M1%!-!+#/#2(-4-!'#/01+-$#()=-$-!b!%&&%5')-<!0-(-!0(#5+-/%5+%!$)-25#&+)'-(!%&&%&!-',-$#&I

Palavras-chave:!"#/#2(-4-!'#/01+-$#()=-$-!/1<+)$%+%'+#(%&I!"(-1/-+)&/#&!+#(W')'#&I!8)-25Y&+)'#!0#(!)/-2%/I

Corresponding Author: Francisco Jose Rodrigues de Moura Filho, Rua Barão do Rio Branco 1816, Centro, Fortaleza, Ceará. CEP: 60025-061.

E-mail: [email protected]

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INTRODUCTION

Thoracic injuries and its related complications are the third /#&+! '#//#5! +30%! #6! )5\1()%&! 6#15$! )5! +(-1/-! 0-+)%5+&B! increasing thus mortality and morbidity in trauma setting, -5$! /-3! %;#<;%! +#! <%+,-<)+3! )5! 10! +#! EHL! #6! '-&%&I1,2_Motor

;%,)'<%!'#<<)&)#5&!-(%!+,%!/-\#(!&#1('%!#6!*<15+!',%&+!+(-1/-! (%0(%&%5+)52! -00(#.)/-+%<3! +C#! +,)($&! #6! +,%! '-&%&B! 5%.+! +#! 6-<<&!-5$!*<#C&!6(#/!*<15+!#*\%'+&IG_{Penetrating chest injuries}

-(%! -<&#! (%<%;-5+! -5$! /-3! *%! '-+%2#()=%$! -&! *%)52! #6! <#CB! /%$)1/!#(!,)2,!;%<#')+3I!c#CA;%<#')+3!)5\1()%&B!&1',!-&!V5)6%! C#15$&B! -(%! +,#&%! +,-+! '-1&%! <%&)#5! #5<3! )5! +,%! &+(1'+1(%&! 0%5%+(-+%$B! C,%(%-&! /%$)1/A;%<#')+3! #5%&! <%-$! +#! 2(%-+%(! 0()/-(3!+)&&1%!$%&+(1'+)#5B!&1',!-&!*1<<%+!C#15$&!6(#/!/#&+! +30%&! #6! ,-5$215&B! C,)',! )&! <%&&! %.+%5&);%! $-/-2%! +,-5! +,%! C#15$&!'-1&%$!*3!,)2,A;%<#')+3!6#('%&!#()2)5-+%$!6(#/!()d%&! -5$!6(#/!/)<)+-(3!C%-0#5&IF

7/-2)52!&+1$)%&!0<-3!-5!%&&%5+)-<!(#<%!#6!+,#(-')'!+(-1/-!'-(%! *%)52!-5!)/0#(+-5+!+##<!)5!/-5-2%/%5+!#6!+,%&%!',%&+!+(-1/-! patients.H_{Chest radiography has limitations regarding in}

$%+%'+)52! &#/%! 45$)52&! -5$! 15$%(%&+)/-+%&! +,%! &%;%()+3! -5$! %.+%5+! #6! ',%&+! +(-1/-! )5! &#/%! '-&%&B! +,1&! +,%! /1<+)$%+%'+#(! computed tomography (MDCT) has been increasingly used 6#(! +(-1/-B! *%'-1&%! )+&! &0%%$! -5$! *%++%(! -*)<)+3! #6! $)-25#&%! -!;-()%+3!#6!)5\1()%&!-5$!)+!/-3!%;%5!$%/#5&+(-+%!&)25)4'-5+! 45$)52&!)5!0-+)%5+&!C)+,!5#(/-<!)5)+)-<!(-$)#2(-0,&I6_!J$%M1-+%!

+%',5)M1%! )&! (%M1)(%$! )5'<1$)52! +,%! 1&%! #6! )5+(-;%5#1&! iodinated contrast media.

75!+,)&!-(+)'<%B!C%!$%&'()*%!+,%!',-(-'+%()&+)'!e8U"!45$)52&! #6! +(-1/-+)'! ',%&+! )5\1()%&! 6#15$! )5! 0-+)%5+&! -$/)++%$! +#! +,%! %/%(2%5'3!15)+!#6!75&+)+1+%!8(!9#&%!:(#+-B!+,%!/-)5!%/%(2%5'3! -5$!+(-1/-!,#&0)+-<!#6!U%-(W!&+-+%B!C)+,!(-$)#<#2)&+&!-;-)<-*<%! EF!,#1(&!0%(!$-3I!75\1()%&!(%0#(+%$!-(%!+,#&%!#6!+,%!0<%1(-<!&0-'%! (hemothorax, pneumothorax), lungs (pulmonary contusion), %&#0,-21&! O(10+1(%! #6! %&#0,-21&QB! ,%-(+! O,%/#0%()'-($)1/QB! -#(+-! O-#(+)'! $)&&%'+)#5QB! $)-0,(-2/! -5$! ',%&+! C-<<! O()*! 6(-'+1(%B! &'-01<%! 6(-'+1(%B! &1*'1+-5%#1&! %/0,3&%/-QI! 7+! &,#1<$! *%! ,)2,<)2,+%$! +,-+! /1<+)0<%! #6! +,%&%! )5\1()%&! /-3! coexist in a single patient.

f%'-1&%!#6!+,%!&,#(+-2%!#6!<#'-<!&')%5+)4'!&+1$)%&!#5!+,%!+,#(-.! +(-1/-!e8U"!45$)52&!-5$!'#5&)$%()52!+,%!(%<%;-5'%!#6!+,)&! )&&1%B!+,%!0(%&%5+!&+1$3!C-&!-)/%$!-+!$%&'()*)52!+,%&%!45$)52&! )5!',%&+!e8U"!-6+%(!+(-1/-I

MATERIALS AND METHODS

J! $%&'()0+);%! &+1$3! C-&! 15$%(+-V%5! C)+,! &%M1%5+)-<! -5-<3&)&! #6! >?@! +,#(-.! e8U"! #6! 0-+)%5+&! -$/)++%$! +#! +,%! %/%(2%5'3! 15)+! #6! 75&+)+1+%! 8(! 9#&%! :(#+-! $1()52! +,(%%! /#5+,&B! 6(#/! D#;%/*%(!>&+B!E@>F!15+)<!9-51-(3!G>&+B!E@>HI ",%!+,#(-.!e8U"!+,-+!C%(%!&%<%'+%$!)5!+,)&!&+1$3!C%(%!+,#&%! 6(#/!0-+)%5+&!-$/)++%$!+#!+,%!79:g&!%/%(2%5'3!15)+!$1()52!+,%! /%5+)#5%$!0%()#$!C)+,!',%&+!+(-1/-!,)&+#(3B!(%2-($<%&&!#6!*%)52! -!*<15+!#(!0%5%+(-+)52!',%&+!+(-1/-B!-5$!+,-+!C%(%!&1*/)++%$! +#!+,#(-.!'#5+(-&+A%5,-5'%$!e8U"I!7/-2%&!#*+-)5%$!6(#/!U"! &'-55)52!#6!+,%&%!0-+)%5+&!C%(%!-5-<3=%$!*3!+C#!(-$)#<#2)&+&!-+! C#(V&+-+)#5B!*%6#(%!-5$!-6+%(!+,%!-$/)5)&+(-+)#5!#6!)5+(-;%5#1&! contrast media. ",%!&'-5&!C%(%!0%(6#(/%$!C)+,!+,%!0-+)%5+&!)5!$#(&-<!$%'1*)+1&B! in a 16-slice MDCT scanner Siemens Somatom Emotion, C)+,! -! 0(#+#'#<! +,-+! )5'<1$%$! )5+(-;%5#1&! -$/)5)&+(-+)#5! #6! >BH! /chV2! #6! )#$)5-+%$! '#5+(-&+! /%$)1/! -+! -! d#C! ! (-+%! #6! F!/ch&B!'#<<)/-+)#5!#6!>IEH!//B!+1*%!;#<+-2%!#6!>G@!Vi0!-5$!-! variable tube current time product (mAs).

T%!'#5&)$%(%$!+C#!+30%&!#6!45$)52&N!+,#&%!$)(%'+%$!(%<-+%$!+#! ',%&+! +(-1/-! -5$! #+,%(! 45$)52&! %5'#15+%(%$! 5#+! 5%'%&&-()<3! caused by the trauma.

RESULTS

75! +,%! &-/0<%! #6! +,)&! &+1$3B! >F?! e8U"! OK>IELQ! 0(%&%5+%$! -<+%(-+)#5&!-5$!#5<3!>F!OPIPLQ!,-$!(%&1<+&!C)+,)5!+,%!5#(/-<)+3! &+-5$-($&I!",%!-;%(-2%!-2%!#6!+,%!0-+)%5+&!C-&!GK!3%-(&B!-5$! >E?!C%(%!/-<%!ORPIPLQ!-5$!GF!6%/-<%!OE>IELQI

j6! +,%! >F?! e8U"! #6! 0-+)%5+&! C)+,! -*5#(/-<! 45$)52&! #5<3! G>! OE>IELQ! ,-$! -! &)52<%! -*5#(/-<)+3B! ,-;)52! +,%! #+,%(&! >>H! ORPIPLQ!*%+C%%5!E!-5$!K!-*5#(/-<!45$)52&I!

",%! /#&+! '#//#5! 45$)52! %5'#15+%(%$! C-&! 6(-'+1(%! &%%5! )5! -</#&+!H@!L!#6!+,%!0-+)%5+&!O"-*<%!>QB!*%)52!+,%!/#&+!'#//#5! <#'-+)#5!#6!6(-'+1(%!)5!+,%!()*&!Ok(-0,)'!>QI! l%5%+(-+)52!+(-1/-!#''1((%$!)5!EG!0-+)%5+&!O>FLQB!$1%!+#!*1<<%+! C#15$&!(%0#(+%$!-&!/%+-<!$%5&)+)%&!<#'-+%$!%)+,%(!)5!',%&+!C-<<! or lung parenchyma. j+,%(!e8U"!45$)52&!%5'#15+%(%$!+,-+!/-3!*%!%)+,%(!(%<-+%$!+#! '#/0<)'-+)#5&!#6!#+,%(!+,#(-')'!+(-1/-!)5\1()%&!#(!0(%%.)&+)52! '#/#(*)$)+)%&!-(%!&,#C5!)5!"-*<%!EI

DISCUSSION

75! #1(! &+1$3! +,%! /-\#()+3! #6! +,#(-.! e8U"! OmK@LQ! 6(#/! 0-+)%5+&! ;)'+)/! #6! ',%&+! +(-1/-! ,-$! -*5#(/-<! 45$)52&! #5! MDCT scan.

S)*! 6(-'+1(%! )&! +,%! /#&+! '#//#5! &V%<%+-<! )5\1(3! )5! *<15+! chest trauma.R_{! T%! %5'#15+%(%$! +,)&! 45$)52! )5! FE! 0-+)%5+&!}

OE?!LQ!C,)',!'#((%&0#5$&!+#!HF!L!#6!-<<!6(-'+1(%&!#*&%(;%$I! J<+,#12,! 6(-'+1(%&! #6! +,%! &'-01<-! -(%! 15'#//#5B! #''1(()52! )5! -*#1+! F! L! #6! 0-+)%5+&! C)+,! /1<+)0<%! )5\1()%&P_{! +,)&! C-&! +,%!}

&%'#5$!/#&+!'#//#5!+30%!#6!6(-'+1(%B!*%)52!#*&%(;%$!)5!>?! 0-+)%5+&! O>@LQI! n)25)4'-5+! 6#('%! )&! 5%'%&&-(3! +#! 6(-'+1(%! +,%! &'-01<-!C,)',!'#//#5<3!)&!&%%5!)5!/#+#(!;%,)'<%!'#<<)&)#5&! -5$!)5!6-<<&!6(#/!2(%-+!,%)2,+&B!*%)52!+,%!4(&+!#5%!/%5+)#5%$! the leading cause in our patientsR_{I! j+,%(&! 6(-'+1(%&! 6#15$!}

C%(%!;%(+%*(-<!6(-'+1(%&!#6!+,%!+,#(-')'!&0)5%B!&+%(5-<!6(-'+1(%B! '<-;)'<%! 6(-'+1(%! -5$! ,1/%(1&! 6(-'+1(%! &%%5! )5! KB! ?B! F! -5$! >! patient(s) , respectively.

o%/#+,#(-.B!+,%!&%'#5$!/#&+!'#//#5!45$)52!#*&%(;%$!)5!?K! 0-+)%5+&!OFGLQB!)&!+,%!0(%&%5'%!#6!*<##$!)5!+,%!0<%1(-<!&0-'%B!

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C,)',! /-3! #()2)5-+%! 6(#/! )5\1()%&! )5;#<;)52! +,%! <152B! ',%&+! C-<<B!,%-(+B!2(%-+!;%&&%<&!#(!-*$#/)5-<!)5\1()%&I!e%-&1(%/%5+! #6! 0<%1(-<! d1)$! -++%51-+)#5! C-&! +-V%5! )5! -<<! %.-/&! #6! +,%! 0-+)%5+&!C)+,!0<%1(-<!%661&)#5!*%)52!'#5&)$%(%$!,%/#+,#(-.!)5! +,#&%!C)+,!;-<1%&!*%+C%%5!GHAR@!opI J+%<%'+-&)&B!-!'#5$)+)#5!)5!C,)',!#5%!#(!/#(%!-(%-&!#6!+,%!<152&! '#<<-0&%! #(! $#5g+! )5d-+%! 0(#0%(<3B! C-&! 6#15$! )5! ?@! 0-+)%5+&! OGRLQI!",)&! 45$)52! C-&! 0(%;-<%5+! )5! +,#&%! 0-+)%5+&! C)+,! ()*! 6(-'+1(%! 0#&&)*<3! $1%! +#! +,%! <)/)+%$! (%&0)(-+#(3! /#;%/%5+! +,-+! /-3! <%-$! +#! -5! )5'(%-&%$! 0(%;-<%5'%! #6! -+%<%'+-&)&! -5$! &1*&%M1%5+! 05%1/#5)-IK_{! U#5&#<)$-+)#5! C-&! 6#15$! )5! EP!}

0-+)%5+&! O>RLQI! :1(+,%(/#(%B! *<##$! )5! +,%! 0<%1(-<! &0-'%! (hemothorax) can compress the underlying lung and cause atelectasis also. n L Fracture RP FPBP Hemothorax ?K FGB> Atelectasis 60 GRBH Pneumothorax FE 26,2 Lung Contusion EP >RBH Subcutaneous emphysema ER >?BP

Metal density in thorax EG >FBG

e%$)-&+)5-<!&,)6+ >P 11,2 Hidropneumothorax >G PB> Hemopericardium P H Pneumomediastinum P H 75\1(3!#6!$)-0,(-2/ F EBF Condroesternal dislocation G 0,6 S10+1(%!#6!%&#0,-21& G 0,6 Aortic dissecation G 0,6

Table 1. Findings related to chest trauma

n L Consolidation EP >RBH Bullous emphysema >G PB> l<%1(-<!%661&)#5 12 RBH Lung nodule 11 ?BK k(#15$!2<-&&!#0-')+3 K HB? l1</#5-(3!4*(#&)&! 6 GBR Pulmonary cysts H GB> Bronchiectasis H GB> l<%1(-<!+,)'V%5)52 F EBF

Pleural empyema F EBF

75+%(<#*1<-(!&%0+-<!+,)'V%5)52 2 1,2

Lung abscess 2 1,2

Tree-in-bud opacity 1 0,6

Pulmonary metastatic implants 1 0,6

J''%5+1-+)#5!#6!+,%!01</#5-(3!;-&'1<-(!/-(V)52& 1 0,6 Mediastinal lymphadenomegaly 1 0,6 "-*<%!EI!j+,%(!45$)52&!#*&%(;%$ k(-0,)'!>I!8)&+()*1+)#5!#6!6(-'+1(%& 5q!51/*%(!#6!0-+)%5+&!#6!+,%!&-/0<%!C)+,!+,%!45$)52I Lq!0%('%5+-2%!#6!+,%!45$)52!C)+,)5!+,%!&-/0<%!-5-<3&%$I 5q!51/*%(!#6!0-+)%5+&!#6!+,%!&-/0<%!C)+,!+,%!45$)52I Lq!0%('%5+-2%!#6!+,%!45$)52!C)+,)5!+,%!&-/0<%!-5-<3&%$I

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l5%1/#+,#(-.! )&! -5! -*5#(/-<! '#<<%'+)#5! #6! -)(! #(! 2-&! )5! +,%! 0<%1(-<! &0-'%! +,-+! '-1&%&! -5! 15'#10<)52! #6! +,%! <152! 6(#/! +,%! ',%&+! C-<<B! )&! -! ;%(3! '#//#5! +(-1/-+)'! '#5$)+)#5! +,-+! )&! &%%5! )5! >HLrF@L! #6! -<<! *<15+! ',%&+! +(-1/-! 0-+)%5+&I10,11,12

75! #1(! &+1$3! 05%1/#+,#(-.! C-&! 6#15$! )5! FE! 0-+)%5+&! OE?LQ! O:)21(%!>QB!+,1&!)5!-''#($-5'%!C)+,!+,%!<)+%(-+1(%I!e%$)-&+)5-<! &,)6+! C-&! #*&%(;%$! )5! >P! 0-+)%5+&! O>>LQI! !J<+,#12,! +%5&)#5! pneumothorax is a clinical diagnose it may be suggested -+! )/-2)52! C,%5! &#/%! &)25&! -(%! 0(%&%5+! )5! -$$)+)#5! +#! +,%! 05%1/#+,#(-.B! &1',! -&! /%$)-&+)5-<! &,)6+! +#! +,%! '#5+(-<-+%(-<! side. T%!6#15$!01</#5-(3!'#5+1&)#5!)5!EP!0-+)%5+&!O>RLQ!O:)21(%! EQI!7+!)&!+,%!/#&+!'#//#5!<152!)5\1(3!6(#/!*<15+!',%&+!+(-1/-B! C)+,!-!0(%;-<%5'%!#6!>RLrR@L!I>GB>F_{!7+!)&!-!6#'-<!0-(%5',3/-<!} )5\1(3! #6! +,%! -<;%#<-(! %0)+,%<)1/B! C)+,! )5+%(&+)+)-<! %$%/-! -5$! -<;%#<-(! ,%/#((,-2%B! *1+! C)+,#1+! &)25)4'-5+! -<;%#<-(! disruption.>HB>?_{! l-+)%5+&! C,#! ,-;%! 01</#5-(3! '#5+1&)#5! -(%!}

-+! )5'(%-&%$! ()&V! 6#(! $%;%<#0)52! 05%1/#5)-! -5$! (%&0)(-+#(3! distress syndrome.

S10+1(%!#6!+,%!%&#0,-21&!C-&!6#15$!)5!G!0-+)%5+&!OELQ!O:)21(%! &! G!JB! f! -5$! UQI!J<+,#12,! *<15+! +(-1/-! +#! +,%! %&#0,-21&! )&!

:)21(%! >I! l5%1/#+,#(-.! O-((#CQ! )&! )<<1&+(-+%$! )5! +,)&! '#5+(-&+A %5,-5'%$! -.)-<! U"! )/-2%! #6! -! RA3%-(A#<$! ',)<$! ;)'+)/! #6! *<15+! +(-1/-I!J5! %.+%5&);%! -(%-! #6! <152! '#5+1&)#5! )5! +,%! ()2,+! <152! O>QB! &1*'1+-5%#1&!%/0,3&%/-!OEQ!-5$!05%1/#/%$)-&+)51/!OGQ!-(%!-<&#! &,#C5I

:)21(%! EI! f)<-+%(-<! -(%-&! #6! <152! '#5+1&)#5! O-((#C&QB! 0(%&%5+)52! -&! 0-+',3!#0-')+)%&!C)+,!+,)5!&1*0<%1(-<!&0-()52B!/#(%!%.+%5&);%!)5!+,%! <%6+! <152B! -(%! &,#C5! )5! +,)&! '#5+(-&+A%5,-5'%$! -.)-<! U"! )/-2%! #6! -! >RA3%-(A#<$!-$#<%&'%5+!;)'+)/!#6!*<15+!+(-1/-I

rare due to its position in the mediastinum,1_{in our study}

+,)&!)5\1(3!C-&!6#15$!)5!0-+)%5+&!C,#!C%(%!;)'+)/&!#6!!*<15+! trauma and not penetrating trauma. Pneumomediastinum, a e8U"! 45$)52! +,-+! /-3! &122%&+! +,%! $)-25#&)&! #6! +(-1/-+)'! %&#0,-2%-<! 0%(6#(-+)#5B! C-&! %5'#15+%(%$! )5! +,%&%! 0-+)%5+&I! ",%!&-/%!0(%;-<%5'%!OELQ!C-&!6#15$!6#(!-#(+)'!$)&&%'-+)#5I! J#(+)'!$)&&%'+)#5B!C,)',!)&!(%<-+);%<3!15'#//#5B!)&!-!&%()#1&! '#5$)+)#5! )5! C,)',! +,%! )55%(! <-3%(! #6! +,%! -#(+-! +%-(&I! f<##$! &1(2%&!+,(#12,!+,%!+%-(B!'-1&)52!+,%!)55%(!-5$!/)$$<%!<-3%(&!#6! the aorta to separate (dissect).

f<15+! )5\1()%&! +#! +,%! $)-0,(-2/! -(%! 15'#//#5B! C)+,! -! 0(%;-<%5'%! #6! @I>?LrHL! )5! *<15+! +(-1/-! 0-+)%5+&>RB>P!_and

they develop by a sudden increase in intraabdominal or )5+(-+,#(-')'!0(%&&1(%!-2-)5&+!-!4.%$!$)-0,(-2/I!75!#1(!&+1$3! C%!,-$!+,)&!45$)52!)5!F!0-+)%5+&!OEBFLQI

:)21(%! G! OJQI! Z.+%5&);%! 05%1/#/%$)-&+)51/! O-((#C&Q! )&! &,#C5! )5! +,)&! '#(#5-<! 5#5A'#5+(-&+! U"! )/-2%! #6! -! RFA3%-(A#<$! C#/-5! C)+,! (10+1(%!#6!+,%!%&#0,-21&!;)'+)/!#6!*<15+!+(-1/-I

:)21(%! G! OfQI! Z.+%5&);%! 05%1/#/%$)-&+)51/! O-((#C&Q! )&! &,#C5! )5! +,)&! &-2)+-<! 5#5A'#5+(-&+! U"! )/-2%! #6! -! RFA3%-(A#<$! C#/-5! C)+,! (10+1(%!#6!+,%!%&#0,-21&!;)'+)/!#6!*<15+!+(-1/-I

(5)

Como citar:

e#1(-!:9!:)<,#B!j<);%)(-!eI!",#(-.!'#/01+%$!+#/#2(-0,3!45$)52&!)5!0-+)%5+&!;)'+)/&!#6!',%&+!+(-1/-I!S%;!e%$!p:UI!E@>H!\1<A$%=sHHOEQNEPAGEI

REFERENCES

>I! l-<-&! 9B! e-+#&! JlB! e-&'-(%5,-&! iB! o%(b$)-! iB! S-/-<,#! eI! e1<+)$%+%'+#(! '#/01+%(! +#/#2(-0,3N! %;-<1-+)#5! #6! *<15+! ',%&+! +(-1/-!)5!-$1<+&I!S-$)#<!S%&!l(-'+I!E@>FsE@>FN>A>EI

EI! U<-(V! 8ZB! :-5+1&! S9I! D-+)#5-<! +(-1/-! $-+-! *-5VN! -551-<! (%0#(+! E@@R! t75+%(5%+uI! ! ",%! J/%()'-5! U#<<%2%! #6! n1(2%#5&! U#//)++%%! #5!"(-1/-!c%-$%(&,)0I!!i%(&^#!RI@I!U,)'-2#N!J/%()'-5!U#<<%2%!#6! n1(2%#5&s!E@@R!t-'%&&#!E@>H!/-(!@EuI!?F0I!8)&0#5[;%<!%/N!,++0&Nhh CCCI6-'&I#(2hvh/%$)-h6)<%&hM1-<)+3LE@0(#2(-/&h+(-1/-h5+$*h 5+$*-551-<(%0#(+E@@RI-&,.

GI! e)(V-! oB! :%($-! 9B! f-.-! 9I! e1<+)$%+%'+#(! '#/01+%$! +#/#2(-0,3! #6!',%&+!+(-1/-N!)5$)'-+)#5&B!+%',5)M1%!-5$!)5+%(0(%+-+)#5I!!75&)2,+&! 7/-2)52I!E@>EsGOHQNFGGAFKI

FI! n,-,-5)! SB! k-<<-! 98B! "-<-;%(-! :B! n',C-(+=! 8nB! e)<<)V%5! 9UI! l%5%+(-+)52! ',%&+! +(-1/-! t75+%(5%+uI! D%C! w#(VN! e%$&'-0%s! E@@R! t-'%&&#! E@>H! /-(! @EuI! 8)&0#5[;%<! %/N! ,++0Nhh%/%$)')5%I/%$&'-0%I '#/h-(+)'<%hFEH?KPA#;%(;)%Cx-@>@E

HI! n'-2<)#5%! eB! l)5+#!JB! l%$(#&-! 7B! n0-(-5#!JB! S#/-5#! cI! e1<+)A $%+%'+#(! (#C! '#/01+%$! +#/#2(-0,3! -5$! *<15+! ',%&+! +(-1/-I! ! Z1(! 9! S-$)#<I!E@@Ps?HOGQNGRRAPPI ?I!Z.-$-V+3<#&!JyB!n'<-*-&!kB!n',/)$!nTB!n',-<<%(!fB!z)//%(/-55! oI!8#!C%!(%-<<3!5%%$!(#1+)5%!'#/01+%$!+#/#2(-0,)'!&'-55)52!)5!+,%! 0()/-(3!%;-<1-+)#5!#6!*<15+!',%&+!+(-1/-!)5!0-+)%5+&!C)+,!{5#(/-<|! ',%&+!(-$)#2(-0,}!9!"(-1/-I!E@@>sH>O?QN>>RGA?I RI!y-%C<-)!SB!J;%(3!ccB!J&(-5)!JiB!D#;%<<)5%!SJI!e1<+)$%+%'+#(!U"! #6!*<15+!+,#(-')'!+(-1/-I!S-$)#2(-0,)'&I!E@@PsEPO?QN>HHHAR@I PI!T%%5)52!fB!T-<+#5!UB!U#<%!lJB!J<-5%=)!yB!o-5&#5!flB!f,-5$-()! eI! c#C%(! /#(+-<)+3! )5! 0-+)%5+&! C)+,! &'-01<-(! 6(-'+1(%&I! 9! "(-1/-I! E@@HsHKO?QN>FRRAP>I

KI! f-(5%-! wB! y-&,+-5! oB! nV#(5)'V! wB! T%(*)5! DI! 7&#<-+%$! ()*! 6(-'+1(%&! )5! %<$%(<3! 0-+)%5+&N! /#(+-<)+3! -5$! /#(*)$)+3I! U-5! 9! n1(2I! E@@EsFHO>QNFGA?I

>@I! e##(%! ZZB! :%<)')-5#! 8iB! e-++#.! ycB! %$)+#(%&I! "(-1/-I! RI! %$I! D%CAw#(VN! e'k(-CAo)<<! Z$1'-+)#5s! E@>GI! U-0[+1<#! EHB! c152B! +(-',%-B!-5$!%&#0,-21&s!0I!F?PAPFI

>>I!e-3*%((3!9UI!7/-2)52!)5!+,#(-')'!+(-1/-N!+,%!+(-1/-!&1(2%#5g&! 0%(&0%'+);%I!9!",#(-'!7/-2)52I!E@@@s>HOEQNR?AP?I

>EI! e)<<%(! cJI! U,%&+! C-<<B! <152B! -5$! 0<%1(-<! &0-'%! +(-1/-I! S-$)#<! U<)5!D#(+,!J/I!E@@?sFFOEQNE>GAEFI

>GI! T-25%(! SfB! U(-C6#($! Tj! 9(B! n',)/06! llI! U<-&&)4'-+)#5! #6! 0-(%5',3/-<!)5\1()%&!#6!+,%!<152I!S-$)#<#23I!>KPPs>?RO>QNRRAPEI >FI!U#,5!neI!l1</#5-(3!'#5+1&)#5N!(%;)%C!#6!+,%!'<)5)'-<!%5+)+3I!9! "(-1/-I!>KKRsFEOHQNKRGAKI

>HI! e1<<)5).! J9B! :#<%3! T8I! e1<+)$%+%'+#(! '#/01+%$! +#/#2(-0,3! and blunt thoracoabdominal trauma. J Comput Assist Tomogr. E@@FsEP!!n10<!>N!nE@ARI!

>?I!j)V#5#/#1!JB!l(-&&#0#1<#&!lI!U"!)/-2)52!#6!*<15+!',%&+!+(-1/-I! 75&)2,+&!7/-2)52I!E@>>sEOGQNEP>AKHI!!

>RI!n<)V%(!UTI!7/-2)52!#6!$)-0,(-2/-+)'!)5\1()%&I!S-$)#<!U<)5!D#(+,! J/I!!E@@?sFFN>KKAE>>I

>PI! e)(;)&! nZB! n,-5/12-5-2+,-5! yI! 7/-2)52! ,%/)$)-0,(-2/-+)'! )5\1(3I!Z1(!S-$)#<I!E@@Rs>RO?QN>F>>AE>I

:)21(%! G! OUQI! Z.+%5&);%! 05%1/#/%$)-&+)51/! O-((#C&Q! )&! &,#C5! )5! +,)&! -.)-<! 5#5A'#5+(-&+! U"! )/-2%! #6! -! RFA3%-(A#<$! C#/-5! C)+,! (10+1(%!#6!+,%!%&#0,-21&!;)'+)/!#6!*<15+!+(-1/-I

J&! 0(%;)#1&<3! /%5+)#5%$B! "-*<%! E! <)&+%$! #+,%(! 45$)52&! %5'#15+%(%$B! &#/%! #6! +,%/! &1',! -&! 01</#5-(3! /%+-&+-+)'! )/0<-5+&!-5$!<152!5#$1<%&!C%(%!0(%%.)&+)52!45$)52&!5#+!(%<-+%$! +#!',%&+!+(-1/-I!j+,%(&!&1',!-&!05%1/#5)-h'#5&#<)$-+)#5!/-3! %)+,%(!*%!0(%%.)&+)52!45$)52&!#(!+#!,-;%!*%%5!$%;%<#0%$!-&!-! '#5&%M1%5'%!#6!+,%!#+,%(&!)5\1()%&!'-1&%$!*3!+,%!+(-1/-I

CONCLUSION

In the present study, the most common contrast-enhanced ',%&+! e8U"! 45$)52&! )5! %/%(2%5'3! +(-1/-! &%++)52&! %5'#15+%(%$! C%(%! &)/)<-(! +#! +,#&%! #*&%(;%$! )5! #+,%(! &+1$)%&! previous reported. Multidetector computed tomography scan 0<-3&!-5!)/0#(+-5+!(#<%!)5!+(-1/-!&%++)52!#5'%!)+!'-5!M1)'V<3! and accurately diagnose these thoracic injuries described in our study.