Theoritical

1. Chest Trauma

2. What To Look For
 Rib fractures
 Pulmonary contusions
 Pulmonary lacerations
 Abnormal collections of air
 Abnormal collections of fluid

4. Rib Fractures
 Only important for what they are associated with or produce
 Rib 1 only — facial fractures
 Ribs 1, 2 and 3 — Serious Trauma — ruptured bronchus
 Ribs 4 – 9 — pneumothorax, contusion
 Ribs 10 – 12 — lacerations of liver/spleen

5. Trauma - Rib fracture

7. PA film of right ninth rib fracture. No PTX was present.

8. Trauma
 Fracture of the upper three ribs is associated
with an increased risk of aortic injury
because of the excessive force needed to
fracture these ribs.
 Fracture of the lower three ribs can be
associated with liver or spleen injury.
 Multiple bilateral rib fractures in various
stages of healing are associated with child
abuse in children or alcohol abuse.

10. CT examination clearly shows the rib displacement near the liver on the right.

12. Pulmonary Contusion
 Most common finding in blunt chest injury
 Hemorrhage into lungs
 Appears within 6 hours of injury
 Clears in 48 hours
 Usually at point of impact

13. Trauma

14. Pulmonary Laceration
Traumatic Lung Cyst, Hematoma
 Usually not apparent at first because of surrounding contusion
 Laceration of the lung parenchyma
 Usually occurs subpleural under point of maximum impact
 Half are solid, half are cystic
 Takes up to 6 months to clear

18. Abnormal Collections Of Air
 Pneumothorax
 Pneumomediastinum
 Pneumopericardium
 Subcutaneous emphysema

19. Pneumothorax
 Must see visceral pleural white line
 Absence of lung markings peripheral to pleural line
 Beware of skin folds
 Beware of bullae

22. Pneumomediastinum
 May develop after blunt trauma due to pulmonary
interstitial emphysema
 Mediastinal pleura is displaced from heart border
 Visualization of central part of diaphragm — continuous
diaphragm sign

24. Pneumopericardium
 Requires direct penetration of the pericardium
 Air appears around heart but does not extend above great
vessels
 Very difficult to differentiate from pneumomediastinum

25. Subcutaneous Emphysema
 Streaky air over lateral chest wall or neck
 Localized form implies penetrating injury
 Diffuse form associated with pulmonary interstitial
emphysema

26. • Subcutaneous emphysema

27. Abnormal Collections of Fluid
 Hemothorax
 Chylothorax

28. Hemothorax
 Indistinguishable from pleural effusion
 Loculation occurs early
 Bleeding from parenchyma usually self limiting
 Bleeding from intercostal arteries produces enlarging
effusions

30. Chylothorax
 Thoracic duct may be torn from blunt or penetrating
injuries
 Key is appearance of pleural effusion several days after
injury
 Effusion may occur in either or both hemithoraces
 Pleural tap yields lymph

31. Signs Of Mediastinal Hemorrhage
 Widening of the mediastinum
 Subjective, influenced by position
 Apical pleural cap on left
 Displacement of left paraspinal stripe
 Deviation of trachea to right
 Deviation of NG tube

32. Fractures of Trachea and Bronchi
 Severe trauma, usually blunt, frequently resulting in fxs to
ribs 1-3
 Mainstem bronchi affected more often than trachea

33. Fractures of Trachea and Bronchi
 Look for large pneumothorax which does not respond to
suction
 Mediastinal or subcutaneous emphysema
 Lobar atelectasis, especially developing a few days after trauma

34. Rupture of the Diaphragm
 Left hemidiaphragm affected almost always
 May not occur for weeks after trauma
 Hernia may contain omentum, stomach, large and
small bowel, spleen, kidney

35. Rupture of the Diaphragm
 X-ray shows bowel, soft tissue at left lung base
 Differentiation from eventration (no constricted loops) or
hernia (no stomach) may be difficult

36. Pneumoperitoneum
Air under diaphragm

37. "Elevated Diaphragm"
DD
•Supradiaphragmatic mass can be mistaken for elevated diaphragm

38. 
THANK YOU