Skip to main content
SpringerLink
Log in

Thoraxtrauma

Teil I: Bedeutung – Symptome – Diagnostik

Chest injury

Part I: Significance – symptoms – diagnostic procedures

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Thoraxverletzungen können isoliert und in Kombination mit anderen Verletzungen auftreten. Da sich im Thoraxraum für die Vitalfunktionen entscheidende Organe befinden können, lebensbedrohliche Komplikationen entstehen. Hierzu zählen u. a. die Atemwegsobstruktion, der Spannungspneumothorax, ein weit offener Pneumothorax, ein instabiler Thorax, die Perikardtamponade und ein massiver Hämatothorax. Die Sterblichkeit von hospitalisierten Patienten mit Thoraxtrauma beträgt bis zu 10%. Neben der klinischen Untersuchung und der Kenntnis über mögliche Läsionen (hoher Verdachtsmoment) gehören die Standardröntgenaufnahme, die Sonographie und die thorakale Computertomographie zu den entscheidenden technischen Untersuchungen. In diesem ersten Teil zur Problematik des Thoraxtraumas werden neben der Anatomie, der Pathophysiologie und den Symptomen v. a. die Indikationen zu den genannten und weiterführenden Untersuchungen dargestellt.

Abstract

Chest injuries can be sustained in isolation or in association with multiple injuries. Life-threatening complications may ensue because organs that are vital to survival of the organism are situated within the thoracic cavity. These complications include airway obstruction, tension pneumothorax, wide open pneumothorax, flail chest, cardiac tamponade and massive hemothorax. The mortality of patients hospitalized with chest injury can be as high as 10%. Clinical examination and awareness of the possibility of other injuries (high level of suspicion) are essential, and standard chest X-ray, ultrasound and thoracic computed tomography may also be needed for the diagnosis. The first part of this serial paper on the management of chest injuries focuses on anatomical aspects, pathophysiology and symptoms, but mainly on the indications for the standard diagnostic procedures and further high-tech examinations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D (2000) Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG Polytrauma of DGU. Unfallchirurg 103: 355–363

    Article  PubMed  Google Scholar 

  2. Chen S, Chang K, Hsu C (1998) Accuracy of auscultation in the detection of haemopneumothorax. Eur J Surg 164: 643–645

    Article  PubMed  Google Scholar 

  3. Chen S, Markmann J, Kauder D, Schwab C (1997) Hemopneumothorax missed by auscultation in penetrating chest injury. J Trauma 42: 86–89

    PubMed  Google Scholar 

  4. Committee on Trauma (2004) Advanced trauma life support (ATLS). American College of Surgeons, Chicago

  5. Demetriades D, Gomez H, Velmahos GC et al. (1998) Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients. Arch Surg 133: 1084–1088

    Article  PubMed  Google Scholar 

  6. Exadaktylos AK, Sclabas G, Schmid SW et al. (2001) Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with „normal“ chest radiograph? J Trauma 51: 1173–1176

    PubMed  Google Scholar 

  7. Gittelman MA, Gonzalez-del-Rey J, Brody AS, DiGiulio GA (2003) Clinical predictors for the selective use of chest radiographs in pediatric blunt trauma evaluations. J Trauma 55: 670–676

    PubMed  Google Scholar 

  8. Hirshberg A, Thomson S, Huizinga W (1988) Reliability of physical examination in penetrating chest injuries. Injury 19: 407–409

    Article  PubMed  Google Scholar 

  9. Holmes JF, Sokolove PE, Brant WE, Kuppermann N (2002) A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med 39: 492–499

    Article  PubMed  Google Scholar 

  10. Karaaslan T, Meuli R, Androux R et al. (1995) Traumatic chest lesions in patients with severe head trauma: a comparative study with computed tomography and conventional chest roentgenograms. J Trauma 39: 1081–1086

    PubMed  Google Scholar 

  11. Knudtson JL, Dort JM, Helmer SD, Smith RS (2004) Surgeon-performed ultrasound for pneumothorax in the trauma suite. J Trauma 56: 527–530

    PubMed  Google Scholar 

  12. Kulshrestha P, Munshi I, Wait R (2004) Profile of chest trauma in a level I trauma center. J Trauma 57: 576–581

    PubMed  Google Scholar 

  13. Lichtenstein DA, Lascols N, Meziere G, Gepner A (2004) Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 30: 276–281

    Article  PubMed  Google Scholar 

  14. Ma OJ, Mateer JR (1997) Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med 29: 312–315; discussion 315–316

    Article  PubMed  Google Scholar 

  15. Rodriguez RM, Hendey GW, Marek G et al. (2006) A pilot study to derive clinical variables for selective chest radiography in blunt trauma patients. Ann Emerg Med 47: 415–418

    Article  PubMed  Google Scholar 

  16. Rozycki GS, Feliciano DV, Ochsner MG et al. (1999) The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 46: 543–551; discussion 551–542

    PubMed  Google Scholar 

  17. Sisley AC, Rozycki GS, Ballard RB et al. (1998) Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma 44: 291–296; discussion 296–297

    PubMed  Google Scholar 

  18. Sturm JA, Lackner CK, Bouillon B et al. (2002) Advanced Trauma Life Support (ATLS). Unfallchirurg 105: 1027–1032

    Article  PubMed  Google Scholar 

  19. Trupka A, Waydhas C, Hallfeldt KKJ et al. (1997) The value of thoracic computed tomography in the first assessment of severely injured patients with blut chest trauma. J Trauma 43: 405–411

    PubMed  Google Scholar 

  20. Walz M, Muhr G (1990) Sonographic diagnosis in blunt thoracic trauma. Unfallchirurg 93: 359–363

    PubMed  Google Scholar 

  21. Waydhas C, Sauerland S (2003) Thoraxtrauma und Thoraxdrainage: Diagnostik und Therapie – Ein systematisches Review. Notfall Rettungsmed 6: 627–639

    Article  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    C. Waydhas & D. Nast-Kolb

Authors
  1. C. Waydhas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Nast-Kolb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Waydhas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waydhas, C., Nast-Kolb, D. Thoraxtrauma. Unfallchirurg 109, 777–785 (2006). https://doi.org/10.1007/s00113-006-1149-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-006-1149-7

Schlüsselwörter

Keywords

Search

Navigation