Diagnostic radiology: trauma Flashcards
What can be affected in chest trauma?
- Mediastinum (aorta, heart)
- Lung
- Diaphragm
- Chest wall and ribs
What can be affected in abd trauma?
- Visceral organs:
- Liver
- Spleen
- Pancreas
- Kidneys
- Vessels – aorta, IVC
- Bowel
What can be affected in pelvic trauma?
- Bony pelvis
- Vascular structures
What is the standard trauma series plain films?
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)
What areas does FAST Scan assess?
If FAST scan positive, what imaging done next?
CT for better delineation of injury
What imaging for abdomen in trauma?
CT (IV contrast is needed inless contnraindicated)
High sensitivity to detet visceral injury, abnormal fluid/gas
Pneumothorax
Pneumothorax on supine CXR
Deep sulcus sign
What treatment is necessary and why?
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
Lung contusion
Rupture of airway/lung parenchyma or repeated vomiting causing tear of esophagus can give rise to pneumomediastinum
surgical emphysema (bubbly sensation at supraclavicular region)
Gas in prevertebral space
Supraclavicular and axillary region accumulation of gas
Pneumomediastinum and surgical emphysema
Associated injury with lower ribs and 1st/2nd ribs
Lower ribs: splenic, hepatic, diaphragmatic
1st, 2nd ribs: mediastinal injury, thoracic aorta
-Widened mediastinum-Abnormal aortic contour-Airspace shadowing-Thickened right and left para tracheal stripe-Deviation of trachea
Dx: acute traumatic aortic injury (ATAI)
Where does ATAI occur?
What are the CXR appearances of mediastinal haematoma?
Patient most likely lying down in haemothorax (supine = will observe contusion and haziness)
What imaging may be indicated in ATAI?
-Contrast enhanced CT with CT angiography
Transoesophagealechocardiography (TEE)
-Arteriography
ATAI
-Mediastinal haematoma-Displaced oesophagus-Bilateral haemothoraces-Contrast outside aorta
What imaging best for ATAI (acute traumatic aortic injury)?
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
-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
-Opacity in the left lower zone-Left hemidiaphragm not seen-Hyperlucent area within opacity-Rest of lungs clear
Herniation of stomach through the perforated diaphragmatic wall
Loss of gastric bubble in CXR
Water soluble contrast follow through
Defect/perforation in diaphragm
Bowel loops herniate into hemithorax
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?
FAST scan: perisplenic fluid
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
Post contrast the normal organs are enhanced hence making the blood appear more hypodense
Splenic haematoma
In abd trauma, what do you look for in pre contrast and post contrast scan?
Blood in precontrast scan, blood = hyperdense fluid (Bright)
Post contrast scan: laceration/contusion of organs
Liver laceration
Pancreatic laceration
Look out for duodenal injury, fracture of spine (T12,L1)
Perinephric haematoma
Laceration of kidney with contrast extravasation
What is the causes of pneumoperitoneum?
- 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
What is a cause of pneumoretroperitoneum in surgery?
ERCP (puncture duodenum)
- Rupture of hollow viscus in retroperitoneum
- Second to forth part of duodenum - Ascending/descending colon
Use of CT in pelvic fractures?
Visualize vascular injury
Associated visceral injury: bladder, bowel
What is important to assess in the rupture of bladder
Extraperitoneal (conservative treatment)/intraperitoneal bladder rupture (requires repair of urinary bladder)
