Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation.

BACKGROUND: The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. METHODS: This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. RESULTS: Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. CONCLUSIONS: Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.

Latex-injected, non-decapitated, saturated salt method-embalmed cadaver technique development and application as a head and neck surgery training model.

Published cerebrovascular injection techniques have mostly used decapitated, fresh cadavers or heads embalmed with 10% formaldehyde. There have been no reports using vascular-injected cadavers for head and neck surgical training models or using vascular injections in saturated salt method-embalmed cadavers. Thus, we performed vascular labeling of five saturated salt method-embalmed cadavers without decapitation. Latex mixed with red ink was injected into the common carotid artery via a 3D-printed vascular adapter. The injection force was provided by a peristaltic pump. Thyroidectomy, submandibular gland excision, neck dissection, parotidectomy, and mandibulotomy were performed on both sides of each cadaver (n = 10). The consistency of the cadavers was softer than fresh ones. Subcutaneous tissues were well preserved, and muscles were moist and elastic. Five physicians graded the resemblance of the heads and necks of the latex-injected, saturated salt method-embalmed, non-decapitated of five cadavers compared to living humans using a Likert scale from 0 (no resemblance) to 5 (maximum resemblance). Fifty-two percent of the head and neck region resemblance scale ratings were four or five. Although the cadavers were practical for head and neck surgical simulations, the brain parenchyma was only partially preserved and unsuitable for use. The most distal arterial branches reached by the injected latex were measured. The external caliber of the smallest vessels reached were lacrimal arteries (mean caliber ± SD, 0.04 ± 0.04 mm; 95% CI [0, 0.09]). There were no significant differences in the mean caliber of the smallest vessels reached between the left- and right-sided arterial branches (all p < 0.05).