Diagnostic radiology: trauma Flashcards

1
Q

What can be affected in chest trauma?

A
  • Mediastinum (aorta, heart)
  • Lung
  • Diaphragm
  • Chest wall and ribs
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2
Q

What can be affected in abd trauma?

A
  • Visceral organs:
  • Liver
  • Spleen
  • Pancreas
  • Kidneys
  • Vessels – aorta, IVC
  • Bowel
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3
Q

What can be affected in pelvic trauma?

A
  • Bony pelvis
  • Vascular structures
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4
Q

What is the standard trauma series plain films?

A

Cervical spine: to clear cervical spine
CXR: chest trauma
Pelvis: pelvic trauma

LS spine, limbs, face X ray according to clinical scenario
AXR: limited value (low sensitivity for pneumoperitoneum/ haematoma unless gross)

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5
Q

What areas does FAST Scan assess?

A
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6
Q

If FAST scan positive, what imaging done next?

A

CT for better delineation of injury

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7
Q

What imaging for abdomen in trauma?

A

CT (IV contrast is needed inless contnraindicated)
High sensitivity to detet visceral injury, abnormal fluid/gas

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8
Q
A
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9
Q
A
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10
Q
A
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11
Q
A
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12
Q
A

Pneumothorax

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13
Q
A

Pneumothorax on supine CXR
Deep sulcus sign

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14
Q

What treatment is necessary and why?

A

Tension pneumothorax
Mass effect: trachea deviated contralaterally
Lung collapse
Positive pressure compressing on venous return compromising cardiac output

Requires needle decompression at 2nd ICS MCL or 5th ICS anterior axillary line

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15
Q
A

Lung contusion

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16
Q
A

Rupture of airway/lung parenchyma or repeated vomiting causing tear of esophagus can give rise to pneumomediastinum

surgical emphysema (bubbly sensation at supraclavicular region)

17
Q
A

Gas in prevertebral space
Supraclavicular and axillary region accumulation of gas

Pneumomediastinum and surgical emphysema

18
Q
A
19
Q

Associated injury with lower ribs and 1st/2nd ribs

A

Lower ribs: splenic, hepatic, diaphragmatic
1st, 2nd ribs: mediastinal injury, thoracic aorta

20
Q
A

-Widened mediastinum-Abnormal aortic contour-Airspace shadowing-Thickened right and left para tracheal stripe-Deviation of trachea

Dx: acute traumatic aortic injury (ATAI)

21
Q

Where does ATAI occur?

A
22
Q

What are the CXR appearances of mediastinal haematoma?

A

Patient most likely lying down in haemothorax (supine = will observe contusion and haziness)

23
Q

What imaging may be indicated in ATAI?

A

-Contrast enhanced CT with CT angiography
Transoesophagealechocardiography (TEE)
-Arteriography

24
Q

ATAI

A

-Mediastinal haematoma-Displaced oesophagus-Bilateral haemothoraces-Contrast outside aorta

25
Q

What imaging best for ATAI (acute traumatic aortic injury)?

A

CT: fast with high sensitivity
If CT equivocal, then TEE/arteriography indicated. Risks with arteriography are related to catheter technique and intra-arterial contrast reactions

26
Q

-A 35-year old night club bouncer with increasingly SOB for 2 weeks -Involved in a fight with some sailors a month previously -Was kicked several times in the abdomen

A

-Opacity in the left lower zone-Left hemidiaphragm not seen-Hyperlucent area within opacity-Rest of lungs clear

27
Q
A

Herniation of stomach through the perforated diaphragmatic wall
Loss of gastric bubble in CXR

28
Q
A

Water soluble contrast follow through
Defect/perforation in diaphragm
Bowel loops herniate into hemithorax

29
Q

A 16 year old girl was knocked down by a tram while rushing to school. On admission, her abdomen was tender with some rebound localisedto the left upper quadrant. Her vital signs were quite stable although her HB was only 10gm/dl.

What imaging to consider?

A

FAST scan: perisplenic fluid

30
Q

A 16 year old girl was knocked down by a tram while rushing to school. On admission, her abdomen was tender with some rebound localisedto the left upper quadrant. Her vital signs were quite stable although her HB was only 10gm/dl.
What is done after fast scan

A

Post contrast the normal organs are enhanced hence making the blood appear more hypodense

Splenic haematoma

31
Q

In abd trauma, what do you look for in pre contrast and post contrast scan?

A

Blood in precontrast scan, blood = hyperdense fluid (Bright)
Post contrast scan: laceration/contusion of organs

32
Q
A

Liver laceration

33
Q
A

Pancreatic laceration

Look out for duodenal injury, fracture of spine (T12,L1)

34
Q
A

Perinephric haematoma
Laceration of kidney with contrast extravasation

35
Q
A
36
Q

What is the causes of pneumoperitoneum?

A
  • From ruptured viscus (small bowel, stomach) penetrating wound, diagnostic peritoneal lavage or recent surgery
  • CT excellent for detecting small pockets of free gas particularly in a traumatized patient
  • Gas trapped within the mesentery suggests bowel perforation
37
Q

What is a cause of pneumoretroperitoneum in surgery?

A

ERCP (puncture duodenum)

  • Rupture of hollow viscus in retroperitoneum
  • Second to forth part of duodenum - Ascending/descending colon
38
Q

Use of CT in pelvic fractures?

A

Visualize vascular injury
Associated visceral injury: bladder, bowel

39
Q

What is important to assess in the rupture of bladder

A

Extraperitoneal (conservative treatment)/intraperitoneal bladder rupture (requires repair of urinary bladder)