What is the role of radiography in the workup of smoke inhalation injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Obtain chest radiographs in patients with a history of significant exposure or pulmonary symptoms. The chest film is likely to be normal—initial studies have only 8% sensitivity for smoke inhalation—but it provides a baseline for subsequent comparison in cases of significant injury. Radiographic evidence of pulmonary injury typically does not appear until 24-36 hours after the inhalation.

When present, abnormal findings may include atelectasis, pulmonary edema, and acute respiratory distress syndrome (ARDS). Hyperinflation may suggest injury of the smaller airways and air trapping.

Individuals with fume fever often are sent home after 4 hours of observation and with a clear chest radiograph, only to return after the initial recovery and latent phase with more severe dyspnea and florid noncardiogenic pulmonary edema. The chest film in a patient with significant zinc oxide exposure may not show any abnormality until 4-6 hours post exposure. Radiographic abnormalities in these patients may improve slowly with supportive care or advance to a long-standing diffuse interstitial fibrosis.

In phase III of oxides of nitrogen exposure, a noncardiogenic pulmonary edema pattern may be seen on the chest radiograph. The chest radiograph may also show a pattern similar to military tuberculosis, which corresponds to a pathologic finding of classic bronchiolitis fibrosa obliterans. Fibrotic changes either may clear spontaneously or proceed to severe respiratory failure.

Cervical spine radiography is indicated to investigate neck injury in all unconscious patients and in those with a potential mechanism of injury (eg, a patient who jumped from a window to escape fire or fell down stairs).


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