Imaging the chest in traumaImaging the chest in trauma
Chest traumaChest trauma
Blunt
Penetrating
Trauma Chest RadiographTrauma Chest Radiograph
Usually AP,
often supine,
frequently in
poor
inspiration.
CT ChestCT Chest
Fractures and DislocationsFractures and Dislocations
Spine
Ribs
Clavicles
Sternum
Shoulders
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
paradoxi...
Clavicle InjuriesClavicle Injuries
Sterno-clavicle joint dislocationSterno-clavicle joint dislocation
Sterno-clavicle dislocation: CTSterno-clavicle dislocation: CT
Shoulder InjuriesShoulder Injuries
dislocations and
scapula fractures
CT Needed if Scapula Fracture SeenCT Needed if Scapula Fracture Seen
Sternum FracturesSternum Fractures
AIR where it shouldnAIR where it shouldn’’t bet be
Pneumothorax
Pneumomediastinum
Subcutaneous emphysema
Systemic veno...
pnxpnx
PNEUMOTHORAX: CTPNEUMOTHORAX: CT
Much more sensitive
Even a small traumatic pneumothorax is
important, especially if pat...
PNEUMOTHORAX: CTPNEUMOTHORAX: CT
Pneumothorax: SimplePneumothorax: Simple
Erect AP/PA view best
Visceral pleural line
No vessels or markings
Variable d...
PNEUMOTHORAX: SimplePNEUMOTHORAX: Simple
PNEUMOTHORAX: TensionPNEUMOTHORAX: Tension
Erect AP/PA view best
Shift of mediastinum/heart/trachea away
from PTX side
...
PNEUMOTHORAX: TensionPNEUMOTHORAX: Tension
PNEUMOTHORAX: SupinePNEUMOTHORAX: Supine
Supine AP view has limited sensitivity: 50%
Deep sulcus sign
Too sharp heart b...
PNEUMOTHORAX: OpenPNEUMOTHORAX: Open
A large hole in the
chest caused by a
large low velocity
missile.
Air enters the ho...
PNEUMOMEDIASTIUMPNEUMOMEDIASTIUM
Usually from ruptured alveoli.
Can also be from trachea, bronchi,
esophagus, bowel and ...
SignsSigns
Linear paratracheal
lucencies
Air along heart
border
“V” sign at aortic-
diaphragm junction
Continuous
diap...
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
pneumom...
Subcutaneous EmphysemaSubcutaneous Emphysema
Causes: Same as
pneumomediastin
um
PneumopericardiumPneumopericardium
PneumoperitoneumPneumoperitoneum
Pneumoperitoneum
and sometimes
pneumo-
retroperitoneum are
seen on upright chest
film, b...
HEMOTHORAXHEMOTHORAX
Venous or arterial bleeding
Can miss hundreds of cc’s on supine film
HEMOTHORAXHEMOTHORAX
CT: HEMOTHORAXCT: HEMOTHORAX
PULMONARY CONTUSION andPULMONARY CONTUSION and
LACERATIONLACERATION
Contusion: Blood in intact lung
parenchyma
Laceratio...
Pulmonary Contusion andPulmonary Contusion and
LacerationLaceration
Marked contusionsMarked contusions
ContusionsContusions
CT: Pulmonary ContusionCT: Pulmonary Contusion
DIAPHRAGM InjuriesDIAPHRAGM Injuries
5% of major blunt
trauma, also thoraco-
abdominal
penetrating trauma
Left clinicall...
Position of NG TubePosition of NG Tube
Gut in ChestGut in Chest
Vascular InjuryVascular Injury
Signs of mediastinal haematoma:
widened mediastinum
indistinct or abnormal aortic contour...
CTCT
Indirect signs of aortic injury:
mediastinal haematoma
periaortic fat stranding
CTA : sensitivity 100%; specificity...
Imaging chest trauma
Imaging chest trauma
Imaging chest trauma
Imaging chest trauma
Imaging chest trauma
Imaging chest trauma
Imaging chest trauma
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Imaging chest trauma

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Imaging chest trauma

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Imaging chest trauma

  1. 1. Imaging the chest in traumaImaging the chest in trauma
  2. 2. Chest traumaChest trauma Blunt Penetrating
  3. 3. Trauma Chest RadiographTrauma Chest Radiograph Usually AP, often supine, frequently in poor inspiration.
  4. 4. CT ChestCT Chest
  5. 5. Fractures and DislocationsFractures and Dislocations Spine Ribs Clavicles Sternum Shoulders
  6. 6. Spine InjuriesSpine Injuries Loss of alignment, fractures and paraspinal hematoma.
  7. 7. Rib FracturesRib Fractures Indicator of underlying pleura, lung, liver, spleen, kidney injuries.
  8. 8. Flail ChestFlail Chest Multiple rib fractures, especially if individual ribs fractured more than once, may cause paradoxical motion. Associated pulmonary contusion.
  9. 9. Clavicle InjuriesClavicle Injuries
  10. 10. Sterno-clavicle joint dislocationSterno-clavicle joint dislocation
  11. 11. Sterno-clavicle dislocation: CTSterno-clavicle dislocation: CT
  12. 12. Shoulder InjuriesShoulder Injuries dislocations and scapula fractures
  13. 13. CT Needed if Scapula Fracture SeenCT Needed if Scapula Fracture Seen
  14. 14. Sternum FracturesSternum Fractures
  15. 15. AIR where it shouldnAIR where it shouldn’’t bet be Pneumothorax Pneumomediastinum Subcutaneous emphysema Systemic venous air embolism Pneumopericardium Pneumoperitoneum/retroperitoneum
  16. 16. pnxpnx
  17. 17. PNEUMOTHORAX: CTPNEUMOTHORAX: 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.
  18. 18. PNEUMOTHORAX: CTPNEUMOTHORAX: CT
  19. 19. Pneumothorax: SimplePneumothorax: Simple Erect AP/PA view best Visceral pleural line No vessels or markings Variable degree of lung collapse No shift
  20. 20. PNEUMOTHORAX: SimplePNEUMOTHORAX: Simple
  21. 21. PNEUMOTHORAX: TensionPNEUMOTHORAX: Tension Erect AP/PA view best Shift of mediastinum/heart/trachea away from PTX side Depressed hemidiaphragm Degree of lung collapse is variable
  22. 22. PNEUMOTHORAX: TensionPNEUMOTHORAX: Tension
  23. 23. PNEUMOTHORAX: SupinePNEUMOTHORAX: 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
  24. 24. 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.
  25. 25. PNEUMOMEDIASTIUMPNEUMOMEDIASTIUM Usually from ruptured alveoli. Can also be from trachea, bronchi, esophagus, bowel and neck injuries.
  26. 26. SignsSigns Linear paratracheal lucencies Air along heart border “V” sign at aortic- diaphragm junction Continuous diaphragm sign
  27. 27. Continuous diaphragm signContinuous diaphragm sign
  28. 28. V sign of naclerioV sign of naclerio
  29. 29. PNEUMOMEDIASTINUM: CTPNEUMOMEDIASTINUM: CT
  30. 30. Trachea/bronchi injuriesTrachea/bronchi injuries Tears occur within 2cm of carina Persistant pneumothorax Large pneumomediastin um “Fallen lung”
  31. 31. Subcutaneous EmphysemaSubcutaneous Emphysema Causes: Same as pneumomediastin um
  32. 32. PneumopericardiumPneumopericardium
  33. 33. PneumoperitoneumPneumoperitoneum Pneumoperitoneum and sometimes pneumo- retroperitoneum are seen on upright chest film, but occasionally are visible on supine chest radiograph.
  34. 34. HEMOTHORAXHEMOTHORAX Venous or arterial bleeding Can miss hundreds of cc’s on supine film
  35. 35. HEMOTHORAXHEMOTHORAX
  36. 36. CT: HEMOTHORAXCT: HEMOTHORAX
  37. 37. PULMONARY CONTUSION andPULMONARY CONTUSION and LACERATIONLACERATION 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
  38. 38. Pulmonary Contusion andPulmonary Contusion and LacerationLaceration
  39. 39. Marked contusionsMarked contusions
  40. 40. ContusionsContusions
  41. 41. CT: Pulmonary ContusionCT: Pulmonary Contusion
  42. 42. DIAPHRAGM InjuriesDIAPHRAGM 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
  43. 43. Position of NG TubePosition of NG Tube
  44. 44. Gut in ChestGut in Chest
  45. 45. Vascular InjuryVascular 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
  46. 46. CTCT 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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