Influence of medical speciality and experience on interpretation of helicoidal thoracic computed tomography in blunt chest trauma.

OBJECTIVE: To compare the quality of interpretation of chest helicoidal computed tomography (HCT) by physicians with different levels of experience and medical specialty. DESIGN: Prospective observational study. SETTING: Trauma critical care unit at a French university hospital (US equivalent: level 1). PATIENTS: HCT of 50 consecutive patients with blunt chest trauma were assessed by four groups of physicians [residents in anaesthesiology (n=5), residents in radiology (n=5), senior anaesthesiologists (n=5), and senior radiologists (n=5)]. Interpretation from each physician was compared with a grid obtained from an expert interpretation by a senior radiologist and a senior anaesthesiologist. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: No group of observers performed better than another in their interpretation of lung and parietal injuries on HCT. In contrast, senior radiologists were better than anaesthesiologists for the diagnosis of pneumomediastin. However, residents in radiology performed better than other physicians in detecting the presence of gastric and tracheal tubes. CONCLUSIONS: Compared with anaesthesiologists, senior radiologists seem more expert in the diagnosis of HCT mediastinal injuries whereas residents in radiology were better at detecting resuscitation materials in thoracic trauma patients. This article reinforces the usefulness of the interpretation of the HCT by a senior radiologist in the case of blunt chest trauma. This also reinforces the usefulness of an aspect team of radiologists and anaesthesiologists in the case of trauma. The logical usefulness of a systematic interpretation of the images should be borne in mind.

[Acute acalculous cholecystitis following hepatic artery embolism in multiple trauma]. / Cholécystite aiguë alithiasique après embolisation de l'artère hépatique dans un contexte de polytraumatisme.

We have reported a case of acute acalculous cholecystitis occurring after hepatic artery embolization in a woman sustaining multiple traumatic injuries. Although many classical factors such as shock, sepsis, transfusion or narcotic administration may be involved in the genesis of gall-bladder necrosis, we have discussed the possible involvement of hepatic artery embolization in the ischaemic process. Indeed, this mechanism has already been reported in non traumatic patient following hepatic tumor chemoembolization.

[Heart injury following closed thoracic injury]. / Plaie du coeur après un traumatisme fermé du thorax.

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open fracture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.