Author’s Affiliations:
Department of Acute Care Surgery, Chiba Emergency Medical Center3-32-1
Isobe Mihama-ku, Chiba-shi, ChibaKen 261-0012, JapanPhone number:
+81-43-279-2211Email: motosuka99@yahoo.co.jp
Corresponding Author : Masaya Ushio
Informed consent was obtained from the patient to publish this report in
accordance with the journal’s patient consent policy.
Key Words: 4D-CT, flail chest, locking plates
Abstract
A 51-year-old man underwent surgery after being diagnosed with a flail
chest by 4D-CT. 4D-CT adds a time axis to 3D-CT; hence, it can be
performed in patients with a flail segment to aid in pre-operative
evaluation of the most effective fixation site.
Key clinical message
4D-CT visualizes the movement of the thorax during inspiration and
expiration and aids in flail chest diagnosis and enables preoperative
evaluation of the most effective fixation site.
Flail chest is diagnosed by visual examination; however, the diagnosis
can be challenging in post-intubation cases.1 A
51-year-old man underwent surgery following a motor vehicular accident,
after being diagnosed with a flail chest by four-dimensional computed
tomography (4D-CT). CT revealed fractures of the right second- eighth
ribs (second- fifth segment fracture) with right lung contusion (Figure
A). His respiratory condition worsened after arrival, and we intubated
and treated him with continuous positive pressure ventilation. 4D-CT
taken on day 3 showed paradoxical movement, and he was diagnosed with
flail chest (Figure B, inspiration; Figure C, expiration). We performed
fixation of the third, fourth, fifth, and seventh ribs with a locking
plate on the fifth day (Figure D). The patient was discharged after 17
days. 4D-CT is gaining popularity as a diagnostic tool alongside
angiography. It uses the scan speed of a 320-detector row CT and adds
time-axis to the conventional three-dimensional image, enabling
evaluation of hemodynamics and function.2 It aids in
flail chest diagnosis and enables preoperative evaluation of the most
effective fixation site.