Yusuf YÜRÜMEZ, Yüksel TERZİ, Bumin DEĞİRMENCİ, Okan SOLAK, Hıdır ESME, Yavuz YÜCEL

Bilgisayarlı tomografi ile saptanabilen toraks yaralanmalarının tedavi ve morbiditeye etkisi

Amaç: Toraks yaralanmalarının saptanmasında toraks bilgisayarlı tomografisi (BT), yüksek duyarlılığa sahiptir ve konvansiyonel akciğer grafisine (AG) üstündür. Bu çalışmada sadece toraks BT'de toraks patolojisi saptanan olguların klinik seyir ve tedavileri değerlendirildi ve patolojileri AG�de saptanan hastalarla karşılaştırıldı.Çalışma planı: Çalışmaya künt toraks travması nedeniyle toraks BT çekilen 56 olgu (44 erkek, 12 kadın; ort. yaş 41.8; dağılım 18-72) alındı. Yaş, cinsiyet, travma nedeni, radyolojik inceleme, yaralanma ağırlık skoru, hastane ve yoğun bakım kalış süresi ve tedavi yaklaşımı açısından değerlendirildi.Bulgular: Bilgisayarlı tomografi ile 46 olguda toraks patolojisi saptandı. Bunların 27'sinde aynı patoloji AG'de de vardı (AG - BT grubu), 19'unda ise AG normaldi (BT grubu). Akciğer grafisi ve BT'nin normal oldu ğu 10 olgu vardı (kontrol grubu). Ortalama yaralanma ağırlık skoru, hastane ve yoğun bakım kalış süresi AG - BT grubu ile karşılaştırıldığında BT ve kontrol grubunda anlamlı olarak daha düşüktü. Fakat BT grubu ile kontrol grubu arasında anlamlı bir fark yoktu. Tüp torakostomi uygulanan olguların oranı BT ve kontrol grubu ile karşılaştırıldığında AG - BT grubunda anlamlı olarak daha yüksekti.Sonuç: Akciğer grafisi toraks yaralanmalarının tanısında toraks BT'den daha az hassas olmasına karşın klinik olarak önemli patolojileri gösterebilir. Sadece BT ile saptanabilen patolojiler hasta morbiditesini artırmamaktadır.

Effects of thoracic injuries that can only be detected by computed tomography on treatment and morbidity

Objectives: Thorax computed tomography (CT) is highly sensitive for the detection of thoracic injuries and is considered to be superior to conventional thorax radiography (X-ray). In this retrospective study, the clinical course and treatment of patients with CT-only diagnosed thoracic injuries were evaluated and compared with patients with X-ray-proven thorax injuries.Methods: 56 patients (44 males, 12 females; mean age 41.8 years; range 18 to 72 years) underwent thorax CT for blunt thoracic trauma were included in this study. Records were reviewed for age, sex, mechanism of injury, radiological modalities, Injury Severity Score, length of hospital stay and intensive care unit stay, and treatment methods.Results: A computed tomography diagnosis of thoracic injury was made in 46 patients. Of these, 27 also had a thoracic injury on X-ray (X-ray - CT group) and 19 had a normal X-ray (CT group). Ten patients had a normal CT (Control group). Mean Injury Severity Score, length of hospital and intensive care unit stay were significantly lower in the CT group and Control group compared with the X-ray - CT group. No statistically significant difference was detected between the CT group and the Control group. The percentages of patients requiring tube thoracostomy were significantly higher in the X-ray - CT group compared with CT and Control groups.Conclusions: Although X-ray is less sensitive than thorax CT in diagnosing thoracic injuries, clinically it can reveal significant pathologies. The finding of thoracic injuries by CT alone does not increase patient morbidity.

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