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Description : Check out this medical presentation on Radiology and Imaging, which is titled "Imaging the chest in trauma", to know about imaging the chest in trauma.

Tags : Radiology, Imaging, chest, trauma

Published on : Jul 28, 2021 | Views : 3551 | Downloads : 24

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Slide 1-

Imaging the chest in trauma
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Chest trauma Blunt Penetrating
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Trauma Chest Radiograph Usually AP, often supine, frequently in poor inspiration.
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CT Chest
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Fractures and Dislocations Spine Ribs Clavicles Sternum Shoulders
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Spine Injuries Loss of alignment, fractures and paraspinal hematoma.
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Rib Fractures Indicator of underlying pleura, lung, liver, spleen, kidney injuries.
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Flail Chest Multiple rib fractures, especially if individual ribs fractured more than once, may cause paradoxical motion. Associated pulmonary contusion.
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Clavicle Injuries
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Sterno-clavicle joint dislocation
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Sterno-clavicle dislocation: CT
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Shoulder Injuries dislocations and scapula fractures
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CT Needed if Scapula Fracture Seen
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Sternum Fractures
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AIR where it shouldn’t be Pneumothorax Pneumomediastinum Subcutaneous emphysema Systemic venous air embolism Pneumopericardium Pneumoperitoneum/retroperitoneum
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pnx
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PNEUMOTHORAX: CT Much more sensitive Even a small traumatic pneumothorax is important, especially if patient mechanically ventilated or going to OR: A simple pneumothorax can be converted into a life- threatening tension pneumothorax.
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PNEUMOTHORAX: CT
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Pneumothorax: Simple Erect AP/PA view best Visceral pleural line No vessels or markings Variable degree of lung collapse No shift
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PNEUMOTHORAX: Simple
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PNEUMOTHORAX: Tension Erect AP/PA view best Shift of mediastinum/heart/trachea away from PTX side Depressed hemidiaphragm Degree of lung collapse is variable
Slide 22-

PNEUMOTHORAX: Tension
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PNEUMOTHORAX: Supine Supine AP view has limited sensitivity: 50% Deep sulcus sign Too sharp heart border/hemidiaphragm sign Increased lucency over lower chest Cant see vessels
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PNEUMOTHORAX: Open A large hole in the chest caused by a large low velocity missile. Air enters the hole rather than the trachea causing hypoxia.
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PNEUMOMEDIASTIUM Usually from ruptured alveoli. Can also be from trachea, bronchi, esophagus, bowel and neck injuries.
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Signs Linear paratracheal lucencies Air along heart border “V” sign at aortic- diaphragm junction Continuous diaphragm sign
Slide 29-

Continuous diaphragm sign
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V sign of naclerio
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PNEUMOMEDIASTINUM: CT
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Trachea/bronchi injuries Tears occur within 2cm of carina Persistant pneumothorax Large pneumomediastin um “Fallen lung”
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Subcutaneous Emphysema Causes: Same as pneumomediastin um
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Pneumopericardium
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Pneumoperitoneum Pneumoperitoneum and sometimes pneumo- retroperitoneum are seen on upright chest film, but occasionally are visible on supine chest radiograph.
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HEMOTHORAX Venous or arterial bleeding Can miss hundreds of cc’s on supine film
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HEMOTHORAX
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Slide 39-

CT: HEMOTHORAX
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PULMONARY CONTUSION and LACERATION Contusion: Blood in intact lung parenchyma Laceration: Blood in torn lung parenchyma Can’t tell difference on chest film. Contusions peak in 2-3 days, begin to resolve in a week; lacerations take much longer to resolve and may leave scars
Slide 41-

Pulmonary Contusion and Laceration
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Marked contusions
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Contusions
Slide 44-

CT: Pulmonary Contusion
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DIAPHRAGM Injuries 5% of major blunt trauma, also thoraco- abdominal penetrating trauma Left clinically injured more than right 60/40 Sensitivity of Chest film 40%. CT better, but still misses some Hard signs: NGT through g.e. junction then up into chest, and hollow viscus above diaphragm Soft signs: Indistinct diaphragm, effusion, atelectasis
Slide 46-

Position of NG Tube
Slide 47-

Gut in Chest
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Vascular Injury Signs of mediastinal haematoma: widened mediastinum indistinct or abnormal aortic contour deviation of trachea or NGT to the right depression of left main bronchus widened paraspinal stripe
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CT Indirect signs of aortic injury: mediastinal haematoma periaortic fat stranding CTA : sensitivity 100%; specificity 100%. Signs of mediastinal haematoma: abnormal soft tissue density around mediastinal structures Location – periaortic haematoma than isolated mediastinal haematoma remote from the aorta. Signs of aortic injury: intraluminal filling defect (intimal flap or clot) abnormal aortic contour (mural haematoma) Pseudoaneurysm & extravasation of contrast
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