CT Scan of Chest

CT Scan of Chest
CT scans of the chest are

very common examinations.
performed for shortness of breath, chest pain,
coughing up blood, and for the evaluation of
possible cancer, biopsi.
These exams usually require intravenous
contrast but no oral contrast.
( Studies are performed with the feet entering the
donut or gantry first,) and scan time is
approximately 35 seconds
CT Scan of Chest
CT scan of chest ordered without contrast

CT scan done
Small child - 4mm thick, 4mm spiral sections
Large child- 8mm thick, 8mm spiral sections
CT scan done starting at thoracic inlet through bony
thorax, arms over head with normal breathing.
CT scan starts with AI

and lateral scout and
film run to include:
Soft tissue windows
Bone windows
Lung windows
When dictated, impression should include but not

limited to:
Type of Pectus Excavatum
Mild
Moderate
Severe
Hailer index and from what image
measurement was taken.
Hailer index is the transverse (coronal)
measurement divided by the Al (sagittal)
measurement at its deepest point.
Measurements ~3~2 arc considered severe.
Length of the deformity

Symmetty
Rotation/nonrotation of sternum
Cardiac impressions should Include but not limited to the
presence of the following:
Compression
Displacement
Distortion of shape
Puhnonary impressions should include but not limited to:
Compression
Presence of Atelectasis
Distortion of shape
Skeletal (rib or vertebral) anomalies
Other organ involvement or skeletal defects that the pectus
deformity may have an effect on must also be noted.
Emergency CT Examinations of the Chest
Two reasons for ordering an emergent chest CT that are clearly

appropriate are:
A patient is becoming septic and pus is suspected within the
thorax.
A patient is suspected of having a dissection of the aorta.
Two reasons for ordering an emergent chest CT that are currently
still under investigation are:
A patient is suspected of having a pulmonary embolism.
A patient is suspected of having a transection of the aorta.
Pulmonary Abscess
Stanford Type "A"or a Type "B".
If an aortic dissection is clinically suspected use the STAT chest

x-ray to exclude other causes that might mimic the signs and
symptoms of a dissection.
Chest Trauma
Pneumothorax 69% (44/64) Cardiac Contusion 9% 6/64)

Lung Contusion 67% (43/64) Scapula Fracture 8% (5/64)
Rib Fractures 66% (42/64) Sternal Fracture 5% (3/64)
Hemothorax 28% (18/64) Diaphragm Injury 5% (3/64)
Flail Chest 14% ( 9/64) Vascular Injury 2% (1/64)
T-Spine Fracture 13% ( 8/64) Bronchus Fracture 2% /64)
Clavicle Fracture 13% ( 8/64)
The role of CT
controversial.
The advantages of CT
1) A negative CT scan excludes a significant number of patients who
might otherwise undergo an unnecessary and invasive procedure
(mortality and morbidity risks for aortography are estimated at 1.7%(1);
2) In the course of evaluating the patient for possible aortic dissection
with CT, many other unsuspected findings not identified by plain
films are discovered including: pneumothorax, pneumomediastinum,
pneumopericardium, thoracic spine fractures, sternal and manubrial
fractures and other skeletal and lung trauma;
3) Using CT as a screening tool rather than the plain film to determine
who needs aortography has potential health care cost savings. cost
The disadvantages of using CT to screen patients for aortic injury

1) Delay in obtaining the definitive aortogram or delays in taking the
patient to surgery while pursuing the CT may adversely affect
prognosis in patients with aortic tears. (With the increased speed of
Helical CT and the widespread use of abdominal CT to survey a
majority of blunt trauma victims, this disadvantage is debatable)
2) Mediastinal hemorrhage is fairly common after blunt chest trauma.
Most of these patients will not have an aortic injury, but a few will.
These patients then undergo two contrast studies, a CT and an
aortogram, both of which are likely to be negative.
3) Few, if any surgeons, will operate based on the CT findings of
aortic injury without angiographic confirmation.
4) The utility of detecting branch vessel injury with CT is not known.
Injuries to the great vessels occur in 1-2% of patients
CT findings of aortic injury
mediastinal hemorrhage; aortic contour

deformity; intimal flap; thrombus protruding
into the aortic lumen; pseudoaneurym;
abrupt change in caliber of the descending
aorta compared with the ascending aorta
(pseudocoarctation); and rarely contrast
extravasation.
Helical scanning mode with
protocol
8 sec spiral time; single-breath hold acquisition through the arch;

5 mm slice collimation reconstructed every 3 mm;
Pitch of 1.5-2; and 150 cc of intravenous contrast administered via injector at 3cc/sec. (a
50 cc saline chaser is used to wash out the remaining intravenous contrast in the I.V.
line.)
Scanning begins at the level of the diaphragm and progresses cephalad to above the
arch.
Smart prep to monitor contrast enhancement and the Spiral CT scan is begun when
contrast reaches the right ventricle.
After the aorta and chest are scanned, we immediately proceed to scan the abdomen
and pelvis from the diaphragm down, having pre-programmed this second helical
acquisition.
Both axial images of the aorta and parasagittal LAO reformatted images through the
aortic arch are evaluated for contour deformities and the presence of mediastinal
hemorrhage.
Thin section CT is mandatory since most tears occur in the region of the ligamentum
arteriosum. This area must be carefully scrutinized for hemorrhage or contour deformity
on axial and parasagittal reformatted images.
Generate 3D images of the aorta which may be helpful to both angiographers (when
trying to confirm aortic injuries with aortography) and to surgeons in planning operative
repair.
Fortunately, both 2D and 3D images, which take additional time to generate, are not
critical for detecting acute injuries.

CT Scan of Chest

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CT Scan of Chest

CT scans of the chest are

CT scan of chest ordered without contrast

CT scan starts with AI

When dictated, impression should include but not

Length of the deformity

Emergency CT Examinations of the Chest

Two reasons for ordering an emergent chest CT that are clearly

Stanford Type "A"or a Type "B".

If an aortic dissection is clinically suspected use the STAT chest

Pneumothorax 69% (44/64) Cardiac Contusion 9% 6/64)

The disadvantages of using CT to screen patients for aortic injury

CT findings of aortic injury

mediastinal hemorrhage; aortic contour

Helical scanning mode with

8 sec spiral time; single-breath hold acquisition through the arch;

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