CT Chest

Aka: CT Chest, Chest CT, Chest Computed Tomography

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II. Indications: Contrast Enhancement

  1. Precautions
    1. Avoid IV contrast in severe contrast allergy and Renal Failure
    2. IV Contrast is NOT needed in the following routine cases
      1. Pneumonia (without abscess or empyema)
      2. Evaluation of Lung Nodules (unless staging or presurgical evaluation)
      3. Evaluation of low mechanism Trauma for number of Rib Fractures
      4. Evaluation of lung fibrosis
  2. Chest Trauma
    1. High-Energy Blunt Trauma
      1. High mechanism Motor Vehicle Accident (e.g. MVA >40 MPH, rollover, passenger ejection)
      2. Fall from height >10-20 feet
    2. .Suspected Vascular Injury
      1. Traumatic Aortic Rupture
      2. Mediastinal Widening or other abnormal thoracic contour on Chest XRay
      3. Grest vessel injury
      4. Large Hemothorax
    3. Penetrating Chest Injury
      1. Trace trajectory of Gunshot Wounds and Stab Wounds
    4. Blunt Cardiac Injury
      1. Myocardial Contusion
      2. Hemopericardium
      3. Pneumopericardium
    5. Diaphragmatic Rupture
    6. Complicated bony injury
      1. Significant Sternal Fractures
      2. Complicated multiple Rib Fractures
  3. Vascular
    1. Pulmonary Embolism (CTPA, venous timing)
    2. Aortic Dissection or Aortic aneurysm (arterial timing)
    3. Superior Vena Cava Syndrome
  4. Oncology Staging (identifies tumors in relation to vessels, mediastinal involvement)
    1. Suspected Lung Cancer
      1. Juxtapose with Lung Cancer Screening CT Chest which does NOT require CT contrast
    2. Lymphoma
    3. Lung metastases
  5. Mediastinal and Pleural Abnormalities
    1. Lung Mass
    2. Abscess and other infections
    3. Mediastinal Lymphadenopathy
  6. Infections and Inflammation
    1. Empyema
    2. Mediastinitis
  7. References
    1. Shyu (2020) J Am Coll Radiol 17(5S):S160-74 +PMID: 32370960 [PubMed]

III. Approach: Emergency CT Review

  1. Aorta
    1. Size (diameter)
    2. Shape and contour
    3. Lumen
  2. Heart
    1. Chamber size
    2. Pericardial Effusion
  3. Pulmonary Vasculature
    1. Pulmonary arteries (e.g. PE)
  4. Pleura
    1. Pneumothorax
    2. Pleural Effusions
  5. Lung Parenchyma
    1. Lung Contusion
    2. Consolidation (e.g. Pneumonia)
    3. Lung Mass
  6. Bones
    1. Rib Fractures
    2. Pathologic lesions (e.g. osteolytic lesions)

IV. References

  1. Tubbs and Janicki (2025) Emergency Chest CT, Mastering Emergency Imaging, CCME, accessed 5/13/2026

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