Ann Thorac Surg 2008;85:344. doi:10.1016/j.athoracsur.2007.02.018
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Three-Dimensional Imaging of Traumatic Multiple Fractures of the Thorax by Multislice Computed Tomography
Toshihiro Osaki, MDa,*,
Tetsuro Baba, MDa,
Hiroshi Matsuura, MDb
a Department of Chest Surgery, Saiseikai Fukuoka General Hospital, Chuo-ku, Fukuoka, Japan
b Department of Surgery, Saiseikai Fukuoka General Hospital, Chuo-ku, Fukuoka, Japan
* Address correspondence to Dr Osaki, Department of Chest Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan (Email: tyymm-osaki{at}hig.bbig.jp).
The chest of a 50-year-old man was accidentally injured at work by a falling 6-m iron pole. He complained of debilitating chest pain and dyspnea. There was a paradoxical chest wall motion with an excavation in the distal portion of the sternum, resulting in ineffective ventilation. A chest roentgenogram and computed tomographic scan showed bilateral lung collapse and pleural effusion with multiple rib fractures. He was diagnosed with bilateral traumatic hemopneumothorax with multiple fractures of the thorax. Chest tubes were inserted into the bilateral thorax and a massive amount of bloody effusion was drained with air leakage. However, we had difficulty evaluating fracture details (particularly the extent of the sternum injury) from these conventional roentgenograms.
Three-dimensional computed tomographic imaging was obtained using a 16-row multislice computed tomographic scanner (Aquilion 16 [Toshiba, Tokyo, Japan]) from the neck to the pelvis. An anterior view on three-dimensional computed tomography (Fig 1A) clearly shows the fracture line of the distal corpus of the sternum (arrow) and bilateral multiple rib fractures (asterisks). A left lateral view (Fig 1B) more clearly shows the fracture lines and dislocations of the third to sixth rib (asterisks). A posterior view (Fig 1C) clearly shows the fracture line of the left scapula (arrow) and three rib fractures that were not detected on other views (asterisks). The three-dimensional computed tomographic images revealed a total of 11 fractures in just a short time. To improve the instability of the chest wall with multiple rib fractures and a sternal fracture, surgical repair of the sternum was undertaken. Through a midline incision, the flail sternum was fixed using an absorbable rib-connecting pin and two stainless steel wires placed parallel and fashioned to fit the contour of the sternum. The postoperative course was uneventful, and the patient was discharged 11 days postoperatively. Three-dimensional computed tomographic imaging was shown to be a useful modality enabling accurate evaluation leading to adequate management. In this case, three-dimensional computed tomography facilitated the planning of surgical repair for traumatic multiple fractures of the thorax.
