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It’s Not Just About the Bones: Detection of Lung and Other Significant Pathology During Routine Cervical Spine CT Trauma Evaluation 2006

General Spine

Philippe M Chu, MD, Non ASSR Member
Louis Tsai, MD, Non ASSR Member
Steven Lev, MD, Non ASSR Member

Scientific Poster

Purpose

We intend to demonstrate that thorough examination of both lung and soft tissue windows during routine CT evaluation of cervical spine trauma must not be neglected. We have detected a wide range of pathologies both incidental and associated to the trauma.

Methods & Materials

We have been prospectively reviewing the cervical spine CT examinations performed at our Level One Trauma Center during the past year. All studies were performed with a Siemens 16 slice MDCT, and reformatted 2D images were routinely obtained. We noted all neck and upper mediastinal pathologies, optimally detected utilizing lung and soft tissue windows. Where indicated, we also kept note of appropriate CT and clinical follow-up.

Results

Lung pathologies related to the traumatic event included both apical and mediastinal pneumothoraces and hemopneumothoraces as well as parenchymal contusions. Incidental findings were diverse, such as emphysematous changes, apical scarring and calcified pleural plaques indicative of tuberculosis, and ground glass appearances suggestive of sarcoidosis. Additional dedicated studies and often emergent treatment were required for the detection of spiculated lesions, Pancoast tumors, and cavitary masses. A perusal of the airway is also important. Observation of a dilated upper esophagus, for example, led to a thoracic CT demonstrating esophageal carcinoma. An assortment of entities, such as neck carcinomas, may be fortuitously detected upon soft tissue inspection. Thyroid masses are commonly seen, and laryngeal pathologies, such as laryngocele, may be occasionally noted.

Conclusion

We emphasize the value of meticulous evaluation of both the lung and soft tissue windows of cervical spine trauma CT. It is imperative that the emergency radiologist should not be blindsided by the obvious bony injury, and ignore other potentially equally important findings.