CASE REPORT Multi-detector computed tomography demonstrates smoke inhalation injury at early stage Virve Koljonen & Kreu Maisniemi & Kaisa Virtanen & Mika Koivikko Received: 19 December 2006 / Accepted: 12 January 2007 / Published online: 7 February 2007 # Am Soc Emergency Radiol 2007 Abstract A multitrauma victim was transported to our trauma centre. Smoke inhalation injury was suspected based on trauma history and clinical examination. The first trauma computer tomography (CT) obtained 2.8 h after the injury revealed subtle ground-glass opacifications with mainly peribronchial distribution and patchy peribronchial consol- idations centrally in the left lung. A repeated scan showed a more distinctive demarcation of the peribronchial opacities, further substantiating the clinically verified smoke inhalation injury. The golden standard for diagnosing smoke inhalation injury still is fibroptic bronchoscopy examination. This paper shows that lesions typical to smoke inhalation injury appear much earlier than previously reported. Whether assessment of smoke inhalation injury severity using CT could clinically benefit patients is controversial and still requires further research. Multi-detector computed tomography is readily available in trauma centres and to simply neglect its potential as a diagnostic tool in some inhalation injury would be unwise. Keywords Smoke inhalation injury . Diagnosis . Computed tomography A 26-year old man was transported by ambulance to the Emergency Department of the Töölö Hospital, Helsinki University Hospital, Helsinki, Finland, on 2004, at 7:51 A.M.. The victim was the seat-belted driver. His car exploded into flames after crashing the rock cutting in the motorway, and he was trapped inside the vehicle. After the patient was rescued from the burning vehicle, he was found to be unconscious with spontaneous breathing. Nostril hair was burned, inside the mouth, sooting was noted. Respiratory sounds were wheezing, breathing increasingly difficult but oxygenation still adequate. Because of unconsciousness and smoke inhalation injury (SII) suspicion, the patient was intubated and mechanical ventilation was started at the injury site. During the intubation, it was observed that the epiglottal area was normal, and sooting was present in the trachea. In the emergency room, primary survey revealed severe ventilatory and gas exchange disturbances with decreased lung compliance. High peak inspiratory pressure, peep and FiO 2 1.0 were needed to maintain oxygenation at acceptable levels. Despite these measures, hypercapnia (pCO2 7.7–8.2) persisted. Large amounts of crystalloids were needed to preserve adequate volume status and tissue perfusion. Clinical examination revealed multiple, superficial lacer- ations in the face, left distal radius fracture, bilateral ankle fractures with right sided Gustillo II fracture. The patient sustained deep, third degree burns in his right hand, in the anteromedial thigh, in both ankles, the %TBSA was 5. Emerg Radiol (2007) 14:113–116 DOI 10.1007/s10140-007-0579-z V. Koljonen (*) Department of Plastic Surgery, Helsinki University Hospital, P.O. Box 266, 00029 HUS Helsinki, Finland e-mail: virve.koljonen@hus.fi K. Maisniemi Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland K. Virtanen Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland M. Koivikko Helsinki Medical Imaging Center, Department of Radiology, Helsinki University Hospital, Helsinki, Finland