Pneumomediastinum in blunt trauma: If aerodigestive injury is not seen on CT, invasive workup is not indicated

Authors

Nicholas G. Matthees, Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: nicholas.mathees@dignityhealth.org.Follow
James A. Mankin, Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: sammankin@gmail.com.
Amy M. Trahan, Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: amy.trahan@dignityhealth.org.
Sharjeel Israr, Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Sharjeel.israr@dignityhealth.org.
Michael D. Jones, Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: michael.jones@dignityhealth.org.
Jonathan L. Dameworth, Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: jonathan.dameworth@dignityhealth.org.
Scott R. Petersen, Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: sprmdpc@aol.com.
Jordan A. Weinberg, Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: jordan.weinberg@dignityhealth.org.

Document Type

Article

Abstract

BACKGROUND: Pneumomediastinum following blunt trauma is often observed on CT imaging, and concern for associated aerodigestive injury often prompts endoscopy and/or fluoroscopy. In recent years, adoption of multi-detector CT technology has resulted in high resolution images that may clearly identify aerodigestive injuries. The purpose of this study was to evaluate the utility of multi-detector CT in the identification of blunt aerodigestive injuries. METHODS: Over five years, patients with pneumomediastinum following blunt trauma were identified from the registry of a level 1 trauma center. All CT imaging of trauma patients during this time period was accomplished with 64-slice scanners. RESULTS: 127 patients with blunt traumatic pneumomediastinum were identified. Five airway injuries were identified, and all injuries were evident on CT imaging. No patient was found to have airway injury by endoscopy that was not evident on CT. No patient had an esophageal injury. CONCLUSION: Multi-detector CT imaging identifies aerodigestive injuries associated with pneumomediastinum following blunt trauma. The absence of a recognizable aerodigestive injury by CT effectively rules out the presence of such injury.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Digestive System (diagnostic imaging, injuries); Female; Follow-Up Studies; Humans; Male; Mediastinal Emphysema (diagnosis, etiology); Middle Aged; Multidetector Computed Tomography; Registries; Respiratory System (diagnostic imaging, injuries); Retrospective Studies; Risk Factors; Sensitivity and Specificity; Wounds, Nonpenetrating (complications, diagnostic imaging); Young Adult

Publication Date

6-1-2019

Publication Title

American journal of surgery

E-ISSN

1879-1883

Volume

217

Issue

6

First Page

1047

Last Page

1050

PubMed ID

30446160

Digital Object Identifier (DOI)

10.1016/j.amjsurg.2018.11.002

Recommended Citation

Matthees, Nicholas G.; Mankin, James A.; Trahan, Amy M.; Israr, Sharjeel; Jones, Michael D.; Dameworth, Jonathan L.; Petersen, Scott R.; and Weinberg, Jordan A., "Pneumomediastinum in blunt trauma: If aerodigestive injury is not seen on CT, invasive workup is not indicated" (2019). Neuroradiology. 2.
https://scholar.barrowneuro.org/neuroradiology/2