Nathan M. Mollberg, DO, Stephen R. Wise, MD, Alberto L

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Chest Computed Tomography for Penetrating Thoracic Trauma After Normal Screening Chest Roentgenogram Nathan M. Mollberg, DO, Stephen R. Wise, MD, Alberto L. De Hoyos, MD, Fang-Ju Lin, MS, Gary Merlotti, MD, Malek G. Massad, MD The Annals of Thoracic Surgery Volume 93, Issue 6, Pages 1830-1835 (June 2012) DOI: 10.1016/j.athoracsur.2012.02.095 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Depiction of wound classifications for penetrating thoracic trauma: (Left Panel) T1, periclavicular without entry into the mediastinum; T2, mediastinal (mediastinal violation demonstrated by metallic fragments overlying the mediastinum, central hematoma, visceral injury, or thoracic spinal injury); T3, parasternal (any bullet hole located between the nipples and between the xiphoid process and sternal notch without evidence of mediastinal violation); (Right Panel) T4, thoracoabdominal (trajectory that traversed the diaphragm as defined by a positive diagnostic peritoneal lavage or confirmed by operative exploration); T5, peripheral. The Annals of Thoracic Surgery 2012 93, 1830-1835DOI: (10.1016/j.athoracsur.2012.02.095) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Utilization of chest computed tomography (CCT) over time as a percentage of patients per year who presented with penetrating thoracic trauma who were evaluated with CCT overall (blue bars) and after a normal screening chest roentgenogram (CXR [black bars]), as well as that percentage of patients who were found to have an occult finding on CCT (green bars) after a normal screening CXR. The Annals of Thoracic Surgery 2012 93, 1830-1835DOI: (10.1016/j.athoracsur.2012.02.095) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Outcomes for patients presenting with penetrating thoracic trauma and normal screening chest roentgenogram (CXR) and physical examination. (CCT = chest computed tomography; exam = examination; FAST = focused assessment with sonography for trauma; NPV = negative predictive value; PPV = positive predictive value.) The Annals of Thoracic Surgery 2012 93, 1830-1835DOI: (10.1016/j.athoracsur.2012.02.095) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions