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Chest pains: Pediatric chest trauma
Case presentation
A 17-year-old male presents to the Emergency Department after being shot in the back. He reports chest pain and dyspnea. His vital signs are a heart rate of 110 beats per minute, a blood pressure of 110/75 mm Hg, and a respiratory rate of 25 breaths per minute. His physical examination is significant for an entry wound in his right axilla without any obvious exit wound. He also complains of right upper quadrant abdominal pain on palpation, although there is no external sign of injury.
Imaging considerations
Imaging modality choice depends on the mechanism of injury and the clinical examination. Children with a reliable, unremarkable physical examination who have sustained isolated minor thoracic trauma generally do not require imaging. While there are no specific thoracic trauma clinical scenarios that mandate chest imaging, children who have sustained major thoracic trauma (such as penetrating injury); have significant associated injuries (such as femur fracture, intracranial hemorrhage); have multisystem trauma, significant hemothorax, or hemothorax that is not resolving or worsening; or have abnormal physical examination findings should undergo imaging. Particular attention should be given to abnormalities in blood pressure, Glasgow Coma Scale score, respiratory rate, focal chest findings, or the presence of femur fractures, as these findings have been shown to correlate with thoracic injury. There are several imaging options available to the clinician.
Plain radiography
Readily available, cost effective, and with minimal ionizing radiation exposure, plain radiography of the chest is the first-line imaging modality in the pediatric patient with thoracic trauma. Clinically significant injuries are readily identified, such as hemothorax and pneumothorax. While anteroposterior (AP) and lateral views are helpful, an AP view is acceptable in a trauma scenario.
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