- Sternoclavicular joint dislocation
- Rib fracture
- Pneumothorax
- Pneumomediastinum
- Pulmonary contusion
- Pulmonary laceration / pneumatocele
- Tracheobronchial injury
- Esophageal perforation
- Pericardial effusion
- Thoracic aortic injury
- Diaphragmatic rupture
Approach to the differential diagnosis of blunt chest trauma:
- CXR always underestimates amount of injury present (rib fracture, pneumothorax, pneumomediastinum, pulmonary contusion, pneumatocele)
- Clinically significant pneumothorax can be hard to see on supine CXR so have high index of suspicion for it
- Look for great vessel and cardiac injuries
- Mediastinal widening (mediastinal / chest ratio > 0.25) on CXR is sensitive for mediastinal bleeding and should be investigated with CT to rule out thoracic aortic injury
- Pericardial effusion should be suspected if the cardiac silhouette appears enlarged on CXR
- Tracheobronchial injury should be suspected in patients with pneumomediastinum / pneumothorax who do not improve with a chest tube
- Diaphragmatic rupture is a diagnosis usually made long after the traumatic event
Pediatric Imaging 