Role of Pleural Fluid Attenuation Value on CT as a Diagnostic Tool in Traumatic Hemothorax

Study Overview
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Brief Summary
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To define the potential role of pleural fluid attenuation value determined on computed tomography (CT) for diagnosis of traumatic hemothorax and differentiate it from other pleural effusion.

Detailed Description
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Hemothorax is defined as blood accumulation in the pleural space. It is a consequence of blunt trauma in 90% of cases. Hemothorax due to blunt trauma mechanisms e.g traffic accidents,sport accidents and falls are among the commonest injuries of the chest. It is manifested in 30-50% of chest trauma cases. In such cases, bleeding might be caused by damage to pulmonary parenchyma or intercostal arteries associated with or without rib fractures and other chest wall tissue injuries including parietal pleura or other thoracic structures. Although other pleural effusion types may also manifest such as chylothorax in case of chest trauma, however fluid detected in pleural space is usually considered blood unless proven not to be. Despite the clinical and radiological findings provide important data about the content of pleural cavity, however tube thoracostomy and diagnostic thoracocentesis are still required to relieve pressure and characterize the fluid. Tube thoracostomy is an invasive procedure which can lead to immediate procedural injuries, infections and pain which can contribute to respiratory failure in patients with chest wall injury. Although needle thoracocentesis is less invasive than tube thoracostomy, however it carries small but definitive risks such as pneumothorax, bleeding and chest wall hematoma. Since hemothorax is a potentially life threatening, it must be diagnosed quickly and accurately and all these unnecessary complications should be avoided. Chest computed tomography [CT] has been accepted as the gold standard imaging study for evaluating chest trauma and usually performed in patients with grossly severe chest trauma, as it helps to detect even small hemothorax. CT can also allow for more advanced characterization of pleural fluid and distinguish hemothorax from any other types of effusion by means of scaling Hounsfield units as in literature, any attenuation value for pleural fluid between 35 and 70 HU is considered typically blood, so it can be considered as an important non-invasive diagnostic tool for diagnosis of hemothorax in traumatic patients.

Official Title
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Role of Pleural Fluid Attenuation Value Measurement on Computed Tomography as a Diagnostic Tool for Hemothorax in Traumatic Patients

Conditions
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Hemothorax; Traumatic

Intervention / Treatment
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* Device: CT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients above 18 years old History of blunt chest trauma Having mild to moderate effusion CT chest within 1st 24 hours of trauma Patients underwent tube thoracostomy or thoracocentesis Exclusion Criteria: Patients in need of emergency transfer to surgery. Hemodynamically stable. Patients with penetrating trauma. Patients with no need for tube thoracostomy or thoracocentesis. Patients with minimal effusion. Pregnant females.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: CT|Non-contrast Multidetector Computed Tomography will be done for all patients using 16 or 64 MDCT scanner. Standard scanning parameters of chest CT are used with slice thickness 5 mm, 120kv and automated mAs.The evaluation of pleural effusion attenuation will be done using the average measure of 3 slices with greatest amount of fluid. A region of interest (ROI) is placed for measurement of Hounsfield unit values, where pleural fluid is observed to be most intense and the density values of the pleural fluid and of the aorta are quantitatively measured in the same section with taking care not to involve adjacent ribs, lung parenchyma or areas of pleural thickening.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Role of pleural fluid attenuation value measurement on CT as a diagnostic tool for traumatic hemothorax | Measurements of pleural effusion attenuation value on CT to diagnose traumatic hemothorax and differentiate it from other types of pleural effusion. | from 1 December 2019 to 1 December 2020 |