Differential diagnosis of pediatric blunt chest trauma

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