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Imaging chest trauma
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Imaging the chest in Imaging the chest in traumatrauma
Chest traumaChest traumaBlunt
Penetrating
Trauma Chest RadiographTrauma Chest Radiograph
Usually AP, often supine, frequently in poor inspiration.
CT ChestCT Chest
Fractures and DislocationsFractures and DislocationsSpineRibsClaviclesSternumShoulders
Spine InjuriesSpine Injuries
Loss of alignment, fractures and paraspinal hematoma.
Rib FracturesRib Fractures
Indicator of underlying pleura, lung, liver, spleen, kidney injuries.
Flail ChestFlail Chest
Multiple rib fractures, especially if individual ribs fractured more than once, may cause paradoxical motion.
Associated pulmonary contusion.
Clavicle InjuriesClavicle Injuries
Sterno-clavicle joint Sterno-clavicle joint dislocationdislocation
Sterno-clavicle dislocation: Sterno-clavicle dislocation: CTCT
Shoulder InjuriesShoulder Injuries
dislocations and scapula fractures
CT Needed if Scapula Fracture CT Needed if Scapula Fracture SeenSeen
Sternum FracturesSternum Fractures
AIR where it shouldnAIR where it shouldn’’t bet bePneumothoraxPneumomediastinumSubcutaneous emphysemaSystemic venous air embolismPneumopericardiumPneumoperitoneum/
retroperitoneum
pnxpnx
PNEUMOTHORAX: CTPNEUMOTHORAX: CTMuch 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.
PNEUMOTHORAX: CTPNEUMOTHORAX: CT
Pneumothorax: SimplePneumothorax: SimpleErect AP/PA view bestVisceral pleural lineNo vessels or markingsVariable degree of lung collapseNo shift
PNEUMOTHORAX: SimplePNEUMOTHORAX: Simple
PNEUMOTHORAX: TensionPNEUMOTHORAX: TensionErect AP/PA view bestShift of
mediastinum/heart/trachea away from PTX side
Depressed hemidiaphragmDegree of lung collapse is
variable
PNEUMOTHORAX: TensionPNEUMOTHORAX: Tension
PNEUMOTHORAX: SupinePNEUMOTHORAX: SupineSupine AP view has limited sensitivity:
50%Deep sulcus signToo sharp heart
border/hemidiaphragm signIncreased lucency over lower chest
Cant see vessels
PNEUMOTHORAX: OpenPNEUMOTHORAX: Open
A large hole in the chest caused by a large low velocity missile.
Air enters the hole rather than the trachea causing hypoxia.
PNEUMOMEDIASTIUMPNEUMOMEDIASTIUMUsually from ruptured alveoli.Can also be from trachea,
bronchi, esophagus, bowel and neck injuries.
SignsSigns
Linear paratracheal lucencies
Air along heart border
“V ” sign at aortic-diaphragm junction
Continuous diaphragm sign
Continuous diaphragm signContinuous diaphragm sign
V sign of naclerioV sign of naclerio
PNEUMOMEDIASTINUM: CTPNEUMOMEDIASTINUM: CT
Trachea/bronchi injuriesTrachea/bronchi injuries
Tears occur within 2cm of carina
Persistant pneumothorax
Large pneumomediastinum
“Fallen lung”
Subcutaneous EmphysemaSubcutaneous Emphysema
Causes: Same as pneumomediastinum
PneumopericardiumPneumopericardium
PneumoperitoneumPneumoperitoneum
Pneumoperitoneum and sometimes pneumo-
retroperitoneum are seen on upright chest film, but occasionally are visible on supine chest radiograph.
HEMOTHORAXHEMOTHORAXVenous or arterial bleedingCan miss hundreds of cc’s on
supine film
HEMOTHORAXHEMOTHORAX
CT: HEMOTHORAXCT: HEMOTHORAX
PULMONARY CONTUSION PULMONARY CONTUSION and LACERATIONand LACERATIONContusion: Blood in intact lung
parenchymaLaceration: Blood in torn lung
parenchymaCan’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
Pulmonary Contusion and Pulmonary Contusion and LacerationLaceration
Marked contusionsMarked contusions
ContusionsContusions
CT: Pulmonary ContusionCT: Pulmonary Contusion
DIAPHRAGM InjuriesDIAPHRAGM Injuries5% 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
Position of NG TubePosition of NG Tube
Gut in ChestGut in Chest
Vascular InjuryVascular Injury
Signs of mediastinal haematoma:widened mediastinumindistinct or abnormal aortic contourdeviation of trachea or NGT to the rightdepression of left main bronchuswidened paraspinal stripe
CTCTIndirect signs of aortic injury:mediastinal haematomaperiaortic fat stranding
CTA : sensitivity 100%; specificity 100%.Signs of mediastinal haematoma:abnormal soft tissue density around mediastinal structuresLocation – 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