Routine Radiology of theTrauma Patient

Chantal VCA 440

Introduction

What to look for in the thorax

Pulmonary contusionsHemothorax

PneumomediastinumPneumothorax

Traumatic diaphragmatic hernia

Pulmonary Contusions

•How it happens:

• Hemorrhage into the lung parenchyma

• Tearing and crushing injury

•Radiographic Signs:

• Patchy, focal or generalized

• Alveolar pattern

• May not be visible right away

•What’s next?

• Be conservative with fluids

• Respiratory support

• +/- Coagulation tests

Pulmonary Contusions

Hemothorax

Hemothorax

•How it happens:

• Trauma to arteries /veins

• Damage to heart, lungs, thymus, or diaphragm

• Ruptured herniated abdominal viscera

•Radiographic signs:

• Pleural effusion

• Diffuse or ventral

• Scalloping/fissures

•What’s next?

• Thoracocentesis

• +/- Surgical exploration

• Oxygen, transfusion, fluids

Pneumomediastinum

•How it happens:

• Ruptured alveoli, trachea, or esophagus

• Tracheal avulsion

•Radiographic signs:

• Distinction of structures normally not seen

• Tracheal wall outlined

• SQ emphysema

•What’s next?

• Repair rents

• Monitor for progression

Pneumomediastinum

Pneumothorax

Pneumothorax

•How it happens:

• Chest wall rent

• Lung rupture

• Extension of pneumomediastinum

•Radiographic signs:

• Retracted lungs

• +/- collapse

• Raised heart

• +/-Small heart

• +/-flat caudal diaphragm

• +/-mediastinal shift

•What’s next?

• Thoracocentesis

Pneumothorax

Traumatic Diaphragmatic Hernia

•How it happens:

• Rapid increase in intra-abdominal pressure

• Rent in the muscular portion

•Radiographic signs:

• +/-Pleural effusion• +/-Gas filled loops, liver

stomach,spleen• +/-Loss of diaphragmatic

outline• +/-Asymmetric on VD/DV• +/-Missing viscera from

abdomen

•What’s next?

• Contrast study to definitively diagnose

The UpperGI

What to look for in the abdomen

Hemoperitoneum

Renal avulsion

Uroperitoneum

Traumatic hernias

Hemoperitoneum

•How it happens:

• Ruptured spleen

• Ruptured liver

• Disrupted vasculature

• Avulsed bladder

•Radiographic signs:

• Peritoneal effusion

• Focal or diffuse

• Decreased serosal detail

•What’s next?

• U/S

• Abdominocentesis

Hemoperitoneum

Renal Avulsion

•Radiographic signs:

• Focal decreased serosal detail

• Missing kidney

• Mass in caudal abdomen

•What’s next?

• U/S

Renal Avulsion

Renal Avulsion

Right Kidney Left (avulsed) Kidney

Uroperitoneum

•How it happens:

• Ruptured bladder

• Avulsed/torn ureter

• Urethral tear

•Radiographic signs:

• Diffuse decreased serosal detail

• Focal detail loss in the RPS

•What’s next?

• Abdominocentesis

• IVP (EU)

• Cystogram

• Urethrogram

Ruptured Bladder

The urethrocystogram

Avulsed or Ruptured Ureter

The Excretory Urogram:

Ruptured Urethra

The Urethrogram

Traumatic Hernia

•How it happens:

• Rapid increase in intra-abdominal pressure

• Rent in the body wall, inguinal canal, or perineal wall

•Radiographic signs:

• Extra-abdominal mass

• Disruption of the body wall

• +/-Containing gas-filled loops of intestines

• +/-Missing abdominal viscera

•What’s next?

• U/S mass

• Surgical repair

Traumatic Hernia

In summary

•Breath

•Stabilize

•Don’t get dazzled by an impressive fracture

•Get ALL the info