This document discusses imaging of the chest in trauma patients. It describes the use of chest radiographs and CT scans to evaluate for fractures, pneumothorax, hemothorax, pulmonary contusions, diaphragm injuries, and vascular injuries. Specific signs on imaging that indicate various injuries are outlined. CT is highlighted as more sensitive than chest x-ray for detecting many injuries like small pneumothoraces or diaphragm injuries. The document provides an overview of diagnostic imaging of common chest trauma injuries.

1. Imaging the chest in traumaImaging the chest in trauma

2. Chest traumaChest trauma
Blunt
Penetrating

3. Trauma Chest RadiographTrauma Chest Radiograph
Usually AP,
often supine,
frequently in
poor
inspiration.

4. CT ChestCT Chest

5. Fractures and DislocationsFractures and Dislocations
Spine
Ribs
Clavicles
Sternum
Shoulders

6. Spine InjuriesSpine Injuries
Loss of alignment,
fractures and
paraspinal hematoma.

7. Rib FracturesRib Fractures
Indicator of underlying
pleura, lung, liver,
spleen, kidney injuries.

8. Flail ChestFlail Chest
Multiple rib fractures,
especially if individual
ribs fractured more
than once, may cause
paradoxical motion.
Associated pulmonary
contusion.

9. Clavicle InjuriesClavicle Injuries

10. Sterno-clavicle joint dislocationSterno-clavicle joint dislocation

11. Sterno-clavicle dislocation: CTSterno-clavicle dislocation: CT

12. Shoulder InjuriesShoulder Injuries
dislocations and
scapula fractures

13. CT Needed if Scapula Fracture SeenCT Needed if Scapula Fracture Seen

14. Sternum FracturesSternum Fractures

15. AIR where it shouldnAIR where it shouldn’’t bet be
Pneumothorax
Pneumomediastinum
Subcutaneous emphysema
Systemic venous air embolism
Pneumopericardium
Pneumoperitoneum/retroperitoneum

16. pnxpnx

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. PNEUMOTHORAX: CTPNEUMOTHORAX: CT

19. Pneumothorax: SimplePneumothorax: Simple
Erect AP/PA view best
Visceral pleural line
No vessels or markings
Variable degree of lung collapse
No shift

20. PNEUMOTHORAX: SimplePNEUMOTHORAX: Simple

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. PNEUMOTHORAX: TensionPNEUMOTHORAX: Tension

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

26. 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.

27. PNEUMOMEDIASTIUMPNEUMOMEDIASTIUM
Usually from ruptured alveoli.
Can also be from trachea, bronchi,
esophagus, bowel and neck injuries.

28. SignsSigns
Linear paratracheal
lucencies
Air along heart
border
“V” sign at aortic-
diaphragm junction
Continuous
diaphragm sign

29. Continuous diaphragm signContinuous diaphragm sign

30. V sign of naclerioV sign of naclerio

31. PNEUMOMEDIASTINUM: CTPNEUMOMEDIASTINUM: CT

32. Trachea/bronchi injuriesTrachea/bronchi injuries
Tears occur
within 2cm of
carina
Persistant
pneumothorax
Large
pneumomediastin
um
“Fallen lung”

33. Subcutaneous EmphysemaSubcutaneous Emphysema
Causes: Same as
pneumomediastin
um

34. PneumopericardiumPneumopericardium

35. PneumoperitoneumPneumoperitoneum
Pneumoperitoneum
and sometimes
pneumo-
retroperitoneum are
seen on upright chest
film, but occasionally
are visible on supine
chest radiograph.

36. HEMOTHORAXHEMOTHORAX
Venous or arterial bleeding
Can miss hundreds of cc’s on supine film

37. HEMOTHORAXHEMOTHORAX

39. CT: HEMOTHORAXCT: HEMOTHORAX

40. 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

41. Pulmonary Contusion andPulmonary Contusion and
LacerationLaceration

42. Marked contusionsMarked contusions

43. ContusionsContusions

44. CT: Pulmonary ContusionCT: Pulmonary Contusion

45. 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

46. Position of NG TubePosition of NG Tube

47. Gut in ChestGut in Chest

48. 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

50. 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