10 Routine CT- Chest in Primary Evaluation of the Major Blunt Trauma Patients; Pros and Cons Abdel-Mohsen M. Hamad Department of Cardiothoracic Surgery, Tanta University,Tanta, Egypt 1. Introduction Trauma is a major worldwide public health problem and it is one of the leading causes of death in both industrialized and developing countries. Injuries of the thorax are a major cause of morbidity and mortality in blunt trauma patients. Approximately 20% of trauma- related deaths are attributable to chest injuries (LoCicero and Mattox, 1989). In trauma patients, a clear history is rarely available as most patients are confused, unconscious or even anesthetized and the clinical findings have been shown to be equivocal or misleading in 20–50% of victims of blunt polytrauma (Poletti et al., 2002). Consequently, radiology plays a major role in evaluation of the trauma patient. The Advanced Trauma Life Support (ATLS 2004) course recommended performing the plain film radiography of the chest, abdomen, and cervical spine in all the blunt trauma patients. Nowadays, Chest computed tomography (CCT) is being used with increasing frequency in the evaluation of blunt chest trauma. CCT frequently detects injuries not seen on routine initial chest x-ray (CxR) (occult findings). However, in the vast majority of patients the impact of these findings on patient management is debatable (Blostein et al., 1997, Hamad and regal, 2010). CT is used primarily to assess for traumatic aortic injuries but also has been shown to be useful in the evaluation of skeletal, pulmonary, airway, and diaphragmatic injuries. 2. Chest wall injuries Rib fractures are the most common finding after blunt chest trauma with an incidence reported up to 40%. Chest radiography is routinely used to assist in the diagnosis of rib fractures, even though it has limited sensitivity. it is even more insensitive in showing costochondral fractures. CT is the most sensitive technique for imaging rib fractures, since it can help to determine the site and number of fractures and, more importantly, provide information regarding any associated injuries (Primak and Collins, 2002). Sternal fractures are found in 8–10% of blunt chest traumas and it is a marker of a high- energy trauma. The most common site of the sternal fractures is approximately 2 cm down from the manubrio-sternal joint. Sternal fracture usually cannot be diagnosed on frontal chest radiographs, whereas the lateral projections can detect it with high sensitivity. Spiral