Qu'apporte l'échographie chez les traumatisés graves du thorax ?

Standardized ultrasonography examination is included in the management of thoracic trauma patients. During the initial phase, two ultrasound examinations should be associated with the focus abdominal sonography for trauma (FAST): (1) an echocardiographic examination to rule out a pericardial hemorrhage; (2) an anterior and posterior pleural ultrasound examination to diagnose a pneumothorax and a hemothorax, respectively. These rapid and easy to perform examinations participate into the diagnosing of the cause of a respiratory or hemodynamic instability including the determination of the origin of a hemorrhagic shock. They also allow ruling out underestimated obstructive causes that often worsen the patient's physical exam. Transoesophageal echocardiography is recommended in case of: suspicion of aortic dissection; unexplained hemodynamic instability or major hypoxemia. In thoracic trauma patients, the echocardiography is also the reference exam for the diagnosis of cardiac and aortic traumatic injuries. Echocardiography is also an integral part of hemodynamic monitoring in this setting.