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Emergency chest radiology: chest wall, pleura, lungs and diaphragm

Department of Radiology, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, UK

• The chest radiograph remains the initial imaging investigation and has an important triage role.
  
• Multidetector CT is increasingly used in trauma and emergency situations – it provides accurate and reliable assessment of a range of possible chest injuries.
  
• Despite the use of CT, many significant chest injuries remain a diagnostic challenge.
  
• Injuries to the thoracic spine and diaphragm are often initially missed.
  

Imaging has a pivotal role in the assessment of the patient brought to the emergency department, whether the admission is due to trauma or a medical condition. The chest radiograph remains an important investigation in the rapid triage of trauma patients and emergency patients, but CT is a more accurate technique for characterization of virtually all thoracic injuries, particularly those of the heart, pericardium, thoracic spine, mediastinum, aorta and lungs. Many trauma patients require imaging of several body areas and current multidetector CT scanners are able to perform a whole body study in a matter of seconds. As well as allowing a detailed cross-sectional study, these modern scanners minimize the time the patient has to spend away from the emergency department.