The document discusses the evaluation of thoracic and abdominal trauma using CT scans, highlighting the prevalence and types of injuries, such as pulmonary trauma from motor vehicle collisions and penetrating injuries. It details various imaging techniques, including chest radiography and contrast-enhanced CT, to assess injuries like pneumothorax, hemothorax, and lung contusions/lacerations. Additionally, it outlines the mechanisms of trauma, classifications of injuries, and diagnostic findings relevant to effective treatment and management of chest trauma.

1. CT SCAN IN EVALATUATION OF THORACIC
AND ABDOMINA TRAUMA
• MODERATORS: DR. L. NATH
(PROFESSOR & HOD) DR. P. BORAH
DR. D. J. BORPATROGOHAIN
DR. P N TAYE
DR. S. S. BISWAS
• PRESENTER : DR.VENKATESH

2. Trauma : leading cause of death under 40 years of age
pulmonary trauma : common in high-impact injuries.
Most common types of lung parenchymal injury :contusions,
lacerations
hematomas.
Chest radiography : first-line imaging modality.
CT images :accurate for the assessment of the nature and extent of pulmonary
injury.

3. TRAUMA MECHANISMS
• More than two-thirds of blunt thoracic trauma is caused by motor vehicle
collisions (MVCs), while the remainder result from falls from height or direct
impact to the chest.
• Penetrating injuries : gunshot/stab/blast injuries and penetration from other
objects.

4. ASSOCIATED INJURIES
Sternal fracture Heart injury
Rib fracture Pulmonary contusion, laceration
Upper rib fracture (first three ribs) Brachial plexus, subclavian vessels
Lower rib fractures (last four ribs) Intra-abdominal injury
Subcutaneous emphysema Airway injury, oesophageal injury
Pneumomediastinum Airway injury, lung injury, oesophageal injury
Sternoclavicular fracture (posterior sternoclavicular
dislocation)
Mediastinal vessels, tracheal injury, oesophageal injury
Scapular fracture Haemopneumothorax, lung injury, spine and clavicle
fracture, subclavian vessels, brachial plexus

5. IMAGING TECHNIQUES FOR PULMONARY
TRAUMA
 The chest radiograph is the primary initial screening examination performed in thoracic
trauma, although some centres also perform extended focused assessment in sonography
for trauma (eFAST).
 Chest radiography :1]Identify rib fractures
2] Foreign bodies/ballistic fragments
3] Contusions,
4] Pneumothorax
5] Hemothorax &mediastinal injuries
 Contrast-enhanced CT :standard imaging tool in the evaluation of trauma patients.
(Greater sensitivity and specificity)

7. PNEUMOTHORAX
• Most commonly associated with rib fractures that lacerate the lung.
•Tracheobronchial always associated with pneumothorax. CT is more sensitive.
•Radiographic signs :
(1)Increased lucency at the affected hemidiaphragm,
(2)An abnormally deep costophrenic sulcus sign,
(3)A sharply defined radiolucent border of the mediastinum or heart, and
(4)The “double diaphragm sign” caused by the presence of air outlining the dome and
insertion of the diaphragm.

8. PNEUMOTHORAX FOLLOWING BLUNT CHEST TRAUMA. (A) SUPINE AP CHEST RADIOGRAPH SHOWS DISPLACED LEFT RIB
FRACTURES, SUBCUTANEOUS EMPHYSEMA, AND SUBTLE PNEUMOTHORAX. THERE IS A SIGNIFICANT BASILAR PNEUMOTHORAX
WITH SEVERAL IMAGING CLUES: DEEP SULCUS SIGN, DOUBLE DIAPHRAGM SIGN, AND A WELL-DEFINED LEFT HEART BORDER WITH
FLOATING FAT PAD SIGN. MULTIPLE OPACITIES ARE DEPICTED THROUGHOUT THE LEFT LUNG, COMPATIBLE WITH A COMBINATION
OF CONTUSIONS AND LACERATIONS IN THE SETTING OF TRAUMA. (B) AXIAL CT IMAGE OBTAINED ON THE SAME DAY AS A SHOWS A
LARGE PNEUMOTHORAX; A RADIOGRAPH CAN SIGNIFICANTLY UNDERESTIMATE PNEUMOTHORAX SIZE. TWO INTRAPARENCHYMAL
LACERATIONS ARE DEPICTED IN THE LEFT LOWER LOBE, WITH PNEUMATOCELE AND HEMATOPNEUMATOCELE.

9. TENSION PNEUMOTHORAX
• A tension pneumothorax is due to a one-way valve mechanism that allows air into but not out
of the pleural space, thereby allowing the pleural pressure to exceed atmospheric pressure.
• Findings: collapse of the ipsilateral lung, contralateral mediastinal deviation, and inversion of
the ipsilateral diaphragm.
• Since tension pneumothorax is a clinical diagnosis, and patients may have mediastinal
deviation without clinical signs of tension physiology (impaired venous return to the heart),
likely due to loss of negative intrapleural pressure on the affected side.

10. TENSION PNEUMOTHORAX
• Erect AP/PA view is best
• Shift of mediastinum /heart/trachea away from pneumothorax side
• Depressed hemidiaphragm
• Degree of lung collapse is variable

11. Posteroanterior chest radiograph in a 29-
year-old man with shortness of breath shows
findings of tension pneumothorax, including
collapse of the ipsilateral lung, contralateral
mediastinal deviation, and inversion of the
ipsilateral diaphragm.

12. Tension haemopneumothorax. Axial contrast-
enhanced CT at mediastinal window shows a
right tension haemopneumothorax with
heterogeneous increased density due to
presence of blood clots and a significant shift
of the mediastinum contralaterally.

14. Tension pneumothorax. Sagittal reformatted CT image
at lung window showing tension pneumothorax with
significantly collapsed lung at the posterior part of the
hemithorax associated with ipsilateral pleural effusion.

15. HEMOTHORAX
• Haemothorax: In 50% of chest trauma cases. Blood pooling into the pleural space from
variable sources: the lung parenchyma, the chest wall, the great vessels, the heart or even
the liver and spleen through diaphragmatic rupture.
• Arterial bleeding more common.
• CT: very sensitive in detecting even a small haemothorax.

17. TRACHEA/BRONCHI INJURY
• Tracheobronchial injuries are rare, occurring in 0.2–8% of all cases of chest trauma.
• Bronchial injuries: more commonly than tracheal, usually on the right side and within 2.5 cm
from the carina.
• 85% of tracheal lacerations occur 2 cm above the carina.
• A direct CT finding of tracheobronchial injuries is the cutoff of the tracheal and bronchial wall
with extraluminal air surrounding the airway. Indirect findings are the “fallen lung” sign,
corresponding to the collapsed lung resting away from the hilum towards the dependent portion
of the hemithorax.

18. Bronchial transection. A 22-year-old
man involved in a car accident.
Volume-rendered image of the
tracheobronchial tree showing
complete transection of the right
intermediate bronchus.

19. TRACHEAL INJURY IN A 32-YEAR-OLD MAN AFTER A THORACIC GUNSHOT WOUND. (A) AP RADIOGRAPH
SHOWS ENTRY AND EXIT SITES. THE AP BULLET TRAJECTORY WOULD BE EXPECTED TO INVOLVE MIDLINE
STRUCTURES SUCH AS THE TRACHEA. PARAMEDIASTINAL HAZINESS IS DEPICTED, REFLECTING PULMONARY
CONTUSIONS. (B) AXIAL CONTRAST-ENHANCED CHEST CT IMAGE SHOWS EXTENSIVE DIFFUSE
PNEUMOMEDIASTINUM. NOTE THE SMALL ANTERIOR TRACHEAL WALL DEFECT. TRACHEAL INJURY FROM A
PENETRATING WOUND WOULD LIKELY BE ASSOCIATED WITH INJURY TO OTHER ADJACENT MEDIASTINAL
STRUCTURES AS WELL. (C) PARASAGITTAL CONTRAST-ENHANCED REFORMATTED CT IMAGE SHOWS
EXTENSIVE ANTERIOR AND POSTERIOR PNEUMOMEDIASTINUM FROM THE VISUALIZED NECK TO THE ROOT

21. PULMONARY CONTUSION AND
LACERATION
• Contusion: Blood in intact lung parenchyma
• Laceration: Blood in torn lung parenchyma
• Chest film cannot differentiate them.
Contusions peak in 2-3 days, begin to resolve in a week; lacerations
take much longer to resolve and may leave scars.

22. AAST
Organ
Injury
Scale for
Lung
Injury
Grade Injury Type Description of Injury
I Contusion Unilateral contusion, segmental or subsegmental involvement
II Contusion Unilateral contusion, lobar involvement
Laceration Peripheral laceration, with or without simple pneumothorax
III Contusion Unilateral contusion with more than single lobe involvement or bilateral
contusions
Laceration Persistent laceration (>72 hours); injury to distal airways, with or without air
leak
Hematoma Intraparenchymal hematoma (nonexpanding)
IV Laceration Major laceration (segmental or lobar) with imaging findings suggestive of air
leak
Hematoma Expanding intraparenchymal hematoma (expanding over consecutive imaging
examinations or with active contrast material extravasation)
Vascular injury Primary branch intrapulmonary vessel disruption
V Vascular injury Hilar vascular injury (contained, without active contrast material extravasation)
VI Vascular injury Transection of pulmonary hilum or hilar vessel injury with uncontained bleeding

23. PULMONARY
CONTUSION
• Lung contusion is a focal parenchymal injury caused by disruption of the capillaries of the
alveolar walls and septa, and leakage of blood into the alveolar spaces and interstitium.
• It is the most common type of lung injury in blunt chest trauma.
• Main mechanism: compression and tearing of the lung parenchyma at the site of impact
against osseous structures, rib fractures or pre-existing pleural adhesions.
• Lung contusion occurs at the time of injury, but it may be undetectable on chest
radiography for the first 6 h after trauma.
• The pooling of haemorrhage and oedema will occur at 24 h, rendering the contusion
radiographically more evident, although CT may readily reveal it from the initial imaging.

24. • The appearance of consolidation on chest radiography after the first 24 h should
raise suspicion of other pathological conditions such as aspiration, pneumonia and
fat embolism.
• Contusions appear as geographic, non-segmental areas of ground-glass or nodular
opacities or consolidation on CT that do not respect the lobar boundaries and may
manifest air bronchograms if the bronchioles are not filled with blood.
• Subpleural sparing of 1–2 mm may be seen, especially in children. Clearance of an
uncomplicated contusion begins at 24 to 48 h with complete resolution after 3 to 14
days.
• Lack of resolution within the expected time frame should raise the suspicion of
complications such as pneumonia, abscess or ARDS.

25. Lung contusion. Axial (a, b) and coronal
(c) CT images at lung window show
nodular opacities of ground-glass
opacity that do not respect the lung
boundaries of the right upper lobe. (A),
diffuse areas of ground-glass opacity in
the upper lobes bilaterally with
subpleural sparing (b) and multiple
areas of consolidation with air
bronchograms and small lacerations in
both lungs consistent with lung
contusions.

26. PULMONARY LACERATIONS
• Pulmonary laceration occurs in major chest trauma when disruption and tearing of the lung parenchyma follows
shearing forces, caused by direct impact, compression or inertial deceleration.
• Classified into the following four types according to the mechanism of injury:
• type I - compression rupture: most common type of laceration that usually occurs as a 2-8 cm lesion in the
central lung.
• type II - compression shear: occurs after sudden compression of the lower chest when the lung suffers from a
shear injury to the spine; the lung is compressed by lateral compression, against the spine leading to a
paravertebral tubular lesion in lower part of the lung.
• type III - direct puncture / rib penetration: occur with a penetrating fractured rib; these lesions are commonly
multiple.
• type IV - adhesion tears: occurs in sudden injuries of the chest wall where prior pleuropulmonary adhesions
have been created.

27. Pulmonary laceration in a 38-year-old man after a thoracic gunshot wound. (A) AP chest radiograph obtained at
presentation shows a hazy opacity in the left upper lobe, reflecting laceration obscured by pulmonary contusions. (B)
axial CT image obtained on the same day better shows the pulmonary laceration cavity filled with blood and air, with
surrounding contusion. (C) AP radiograph obtained 8 days later shows that the laceration is visible as a well-
circumscribed opacity, as the contusions have resolved. Note the persistent pneumothorax, possibly from a
bronchopleural fistula, a potential complication of large pulmonary lacerations.

28. Pulmonary laceration types 1–3. (A)
axial CT image in a 27-year-old man
shows three centrally located
intraparenchymal lacerations type 1,
compression rupture (pneumatocele
and hematopneumatocele). The
surrounding ground-glass
attenuation, reflecting contusions and
moderate pneumothorax.
(B) axial CT image in a 33-year-old
man shows a paravertebral air-filled
laceration (pneumatocele) type 2,
compression shear laceration
(pneumatocele).
(C) axial CT image in a 24-year-old
man shows a peripheral air-filled
laceration (pneumatocele) subjacent
to the thoracic ribs, type 3, rib
penetration tear.

29. LUNG LACERATION, TYPE II. CORONAL REFORMATTED CT IMAGE AT LUNG WINDOW (A) SHOWS
A LOBULATED PARASPINAL PNEUMATOCELE SURROUNDED BY GROUND-GLASS OPACITY
(CONTUSION) IN THE RIGHT LUNG CONSISTENT WITH LUNG LACERATION (TYPE II?). ON
MEDIASTINAL WINDOW LUNG LACERATION IS SEEN TO HAVE BEEN COMPLICATED BY ACUTE
PULMONARY EMBOLISM.

30. LUNG LACERATION, TYPE IV.
AXIAL CT IMAGE OF THE LEFT
LUNG AT LUNG WINDOW
SHOWS A SMALL PERIPHERAL
LACERATION BENEATH A RIB
FRACTURE SURROUNDED BY
GROUND-GLASS OPACITY
(LUNG CONTUSION) AND
ASSOCIATED WITH A SMALL
IPSILATERAL
PNEUMOTHORAX.

31. PNEUMOMEDIASTINUM
• Usually from ruptured alveoli
• Can also be from trachea, bronchi,
esophagus, bowel and neck injuries

32. SIGNS
• Linear paratracheal lucencies
• Air along heart border
• “V” sign at aortic-diaphragm
junction
• Continuous diaphragm sign

33. CHEST XRAY FOLLOWING TRAUMA SHOWING AIR OUTLINING
MEDIASTINAL STRUCTURES AND SUBCUTANEOUS EMPHYSEMA

35. V SIGN OF
NECLERIO

36. PNEUMOMEDIASTINUM: CT

37. PNEUMOMEDIASTINUMWITH SUBCUTANEOUS EMPHYSEMA

38. Pneumopericardium

39. HEMOPERICARDIUM
• Hemopericardium refers to the presence of blood within the pericardial cavity. Can occur
from blunt/penetrating/deceleration trauma.
• Plain radiograph
• enlargement of the cardiac silhouette may be present but chest x-rays are insensitive and
non-specific.
• the "straight left heart border" is an infrequent sign with low sensitivity (~40%) for
hemopericardium in penetrating trauma patients.
• ​
the Oreo cookie sign on lateral CXR.

41. HEMOPERICARDIUM: CT

42. RIBS FRACTURE
• Rib fractures are the most common injury in blunt chest trauma. A single rib fracture is
usually not clinically significant, whereas multiple rib fractures indicate severe injury.
• Fractures of the first three ribs imply high-energy trauma that may be associated with
injury of the brachial plexus or subclavian vessels.
• Fractures of the fourth up to the eighth ribs are the most common, while fractures of the
last four ribs are usually associated with intra-abdominal injury.

43. • Flail chest: An injury that occurs typically
following a blunt trauma to the chest.
When three or more ribs in a row have
multiple fractures [atleast two] within each
rib, it can cause a part of your chest wall to
become separated and out of sync from the
rest of your chest wall.
• The diagnosis is clinical based on the
paradoxical motion during respiration,
which may result in ventilatory
compromise. More than 50% of cases
require surgical treatment and prolonged
mechanical ventilation.

44. CORONAL MIP CT
IMAGE SHOWING
MULTIPLE
CONTIGUOUS LEFT
RIB FRACTURES.

45. CORONAL (A) AND SAGITTAL (B) RECONSTRUCTED CT IMAGES SHOW
FRACTURES OF THREE CONTIGUOUS RIGHT RIBS (ARROWS) THAT WERE
ASSOCIATED WITH PARADOX MOTION OF THE CHEST DURING RESPIRATION.

46. SPINE INJURY
• Thoracic spine fractures account for up to 30% of all spine fractures.
• 62% of spine fractures will result in neurological deficits. The most vulnerable site is
between the ninth and twelfth vertebra.
• The main mechanism is hyperflexion and axial loading.
• Sagittal and coronal MDCT reformats readily reveal even small spinal fractures.
• MDCT of the spine is highly indicated for spinal survey for possible fractures and
determine the type of fracture. However, in the case of suspected compressive myelopathy,
MRI is the method of choice.

47. Thoracic spine fracture.
Coronal (a) and sagittal (b) CT
reconstructed images of two different
patients show fractures of the upper
thoracic vertebrae.

48. STERNUM FRACTURE
• Sternal fractures: 3–8% in blunt chest trauma.
• Main mechanism: deceleration injury/direct blow to the anterior chest wall.
• Difficult to detect on lateral chest radiographs .
• Almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat
plane with the aorta, as opposed to an anterior mediastinal haemorrhage secondary to aortic
injury, which will present with a lost fat plane with the aorta.

49. STERNAL FRACTURE. SAGITTAL
RECONSTRUCTED CT IMAGE SHOWS
MULTIPLE FRACTURES OF THE
MANUBRIUM AND THE BODY OF THE
STERNUM ACCOMPANIED BY
EXTENSIVE RETROSTERNAL
HAEMATOMA.

50. STERNAL FRACTURE. AXIAL CT IMAGE AT MEDIASTINAL WINDOW SHOWS STERNAL
FRACTURE ASSOCIATED WITH RETROSTERNAL HAEMATOMA. NOTE THE PRESERVED
FAT PLANE WITH THE AORTA, EXCLUDING THE PRESENCE OF AORTIC INJURY.

51. CLAVICLE INJURIES

52. STERNO-CLAVICLE DISLOCATION: CT

53. SHOULDER INJURIES
•Scapular fracture is uncommon, occurring
in 3.7% of cases of blunt chest trauma.
•It indicates a high energy force trauma
with a direct blow to the scapula or force
transmitted through the humerus.
Associated injuries are pneumothorax,
haemothorax, clavicular fracture and
injuries of the lung parenchyma,
subclavian vessels, brachial plexus or
spine.

54. CT Needed if Scapula Fracture Seen

55. DIAPHRAGM INJURIES
• 5% of major blunt trauma.
• Left clinically injured more than right 60/40.
• CT is a sensitive modality.

56. • Signs of diaphragmatic injury:
• The collar sign (or hourglass sign) : a waist-like constriction of the herniating hollow viscus
from the abdomen into the chest at the site of the diaphragmatic tear, which is classical for
diaphragmatic rupture.
• The dependent viscera sign: when a patient with a ruptured diaphragm lies supine at ct
examination, the herniated viscera (bowel or solid organs) are no longer supported
posteriorly by the injured diaphragm and fall to a dependent position against the posterior
ribs.
• Segmental non-recognition of the diaphragm.
• Focal diaphragmatic thickening.

59. POSITION OF NG TUBE

61. VASCULAR INJURY
• Thoracic aortic injury can result from either blunt or penetrating trauma:
1.blunt trauma (more common)
1.rapid deceleration (eg. motor vehicle accident, fall from great height)
2.crush injury
2.penetrating trauma
1.stab wound
2.gunshot wound

62. THORACIC AORTIC INJURY
• Grading
• Thoracic aortic injury can be graded according to the severity of
injury. One grading system is
• grade 1: intimal tear
• grade 2: intramural hematoma
• grade 3: pseudoaneurysm formation
• grade 4: free rupture

63. VASCULAR INJURY: SIGNS
• Signs of mediastinal hematoma
Widened mediastinum
Indistinct or abnormal aortic contour
Deviation of trachea or NGT to the right
Depression of left main bronchus
Widened paraspinal stripe

64. X RAY: VASCULAR
INJURY

65. CT
Indirect signs of aortic injury:
Mediastinal hematoma
Periaortic fat stranding
CT Angiography:
100% sensitivity and specificity
Signs of mediastinal hematoma
Abnormal soft tissue density around mediastinal structures
Location – periaortic hematoma than isolated mediastinal hematoma remote from the
aorta.

66. SIGNS OF AORTIC
INJURY:
Intraluminal filling defect (intimal
flap or clot)
Abnormal aortic contour (mural
hematoma)
Pseudoaneurysm & extravasation
of contrast

70. TRAUMATIC ESOPHAGEAL RUPTURE
• Can occur secondary to both blunt or
penetrating trauma.
• CT is the preferred modality.
• Signs on CT:
• extraluminal gas locules in the
mediastinum or abdominal cavity,
adjacent to the esophagus: highly
suggestive.
• pleural or mediastinal fluid.
• pneumomediastinum or pneumothorax.
• pericardial or pleural effusions can be
seen.

72. TRAUMATIC LUNG HERNIATION
• Herniation of the lung beyond the confines of the thoracic cage.
• Usually associated with rib fracture.
• Results in subcutaneous emphysema.

74. SUBCUTANEOUS EMPHYSEMA
• Causes:
• Usually from ruptured
alveoli
• Can also be from
trachea, bronchi,
esophagus, bowel and
neck injuries

76. IMAGING OF ABDOMINAL
TRAUMA

77. ABDOMINAL TRAUMA
• Trauma causes I0% of deaths worldwide
• Blunt trauma is more common

78. ROLE OF CT SCAN
• More accurate for solid visceral assessment
• Quantification of hemorrhage
• Assessment of retroperitoneal injuries
• Most sensitive and imaging modality o choice for evaluation of
abdominal trauma

79. SPLEEN
• Most common injured organ in blunt trauma (40% of all solid organ injuries)
• CECT is the investigation of choice
Integrity of organs
Extent of injury / Localization of parenchymal contusions, hematoma

80. SPLENIC HEMATOMA
• Parenchymal
• Subcapsular

81. SUBCAPSULAR
HEMATOMA
• Indents splenic
parenchyma

82. DELAYED SPLENIC RUPTURE
• Bleeding due to splenic injury occurring more than 48 h after blunt
trauma
• Due to ruptures of subcapsular splenic hematomas.

83. SPLENIC LACERATION
• Linear low attenuation
defects between high
attenuation vascular
spleen.

84. SPLENIC CLEFT
• Superiorly located
• Absence of
hemoperitoneum

85. SENTINEL CLOT SIGN

87. SPLENIC
INFARCT
• pyramidal wedge shaped
• apex pointing towards the hilum
• base on the splenic capsule.

88. IMAGING CONSIDERATIONS
• Images should be take 50-60 seconds after contrast for uniform
enhancement of the spleen

89. CONTRAST BLUSH
• The differential diagnosis is:
• Active arterial extravasation
• Post-traumatic pseudo-aneurysm
• Post-traumatic AV fistula

90. AMERICAN ASSOCIATION FOR THE
SURGERY OF TRAUMA (AAST) GRADE
I
• Subcapsular hematoma <10%
• capsular laceration <1 cm depth

91. GRADE II
• Subcapsular hematoma 10-50%
• Parenchymal hematoma <5 cm
• Laceration 1-3 cm depth

92. GRADE III
• Subcapsular hematoma >50%
• Intraparenchymal hematoma >5 cm
• Laceration >3 cm

93. GRADE IV
• laceration hilar vessels
• major devascularisation
(>25% of spleen)

94. GRADE V
• Shattered spleen
• Hilar vascular injury with splenic
devascularisation

95. • Axial CECT scan shows
nonenhancing spleen

96. LIVER
• Second most commonly injured organ (20-30%)
• Right lobe most commonly affected (4:1)
• Penetrating injury

97. HEPATIC INJURIES
• Laceration (most common)
• Hematoma - subcapsular or intraparenchymal
• Active hemorrhage
• Major hepatic vein injury

98. LIVER LACERATION
• Low attenuation defects in linear or
stellate pattern.

99. PERIPORTAL TRACKING
• Blood tracking along periportal
connective tissue

100. Grade I
•Subcapsular hematoma : <10%
•Laceration: capsular tear <1 cm

101. •Subcapsular hematoma: 10-50%
•Intraparenchymal hematoma <10 cm
•Laceration: 1-3 cm in parenchymal depth
Grade II

102. •Subcapsular hematoma: >50%
•Intraparenchymal hematoma >10 cm
•Laceration: capsular tear >3 cm
parenchymal depth
Grade III

103. GRADE IV
•Parenchymal disruption
involving 25-75% hepatic lobe
•Active bleeding

104. GRADE V
•Laceration: parenchymal
disruption involving >75% of
hepatic lobe or involves >3
Couinaud’s segments (one lobe)

105. PANCREAS
• Least commonly injured solid organ (3-12 %).
• Seatbelt injuries : Compression against the vertebral column.
• Rarely an isolated injury

106. CLINICAL AND BIOCHEMICAL FINDINGS
• Epigastric pain
• Elevated serum amylase in 60 %
• ( 95% Negative Predictive Value)

107. CT FINDINGS
• 40 % of pancreatic injuries may not
be visible on CT in first 12 hrs

108. • laceration/transection involving neck/proximal body of pancreas

109. • Grade I- Minor contusion or laceration
without duct injury
• Grade II- Major contusion or
laceration without duct injury

110. GRADE III
Distal pancreatic transection
with duct injury

111. • Grade IV :Proximal transection
• Grade V : Massive disruption of pancreatic head

112. FINDINGS THAT MAY SUGGEST
PANCREATIC TRAUMA
• Localized edema
• Retroperitoneal hematoma / fat infiltration.
• Fluid in lesser sac
• Thickening of anterior pararenal fascia

113. BOWEL AND MESENTERY INJURY
• Bowel and mesenteric injuries in 5% of blunt trauma
• MDCT is more sensitive than Clinical exam, USG, DPL

114. DIRECT FINDINGS –PNEUMOPERITONEUM OR
PNEUMO-RETROPERITONEUM

115. DIRECT FINDINGS
• Contrast extravastation
• Interloop fluid
• Bowel wall discontinuity

116. LESS COMMON
SIGNS
• Focal bowel wall
thickening greater than 3
mm
• Mesenteric infiltration,
thickening
• Abnormal bowel wall
enhancement

117. SHOCK BOWEL
• Hypoperfusion state

118. MESENTERIC
INJURY
Signs
• Contrast extravasation
• Beaded mesenteric
vessels
• Hematoma
• Infiltration

119. VASCULAR INJURY – CT FINDINGS
• IVC injuries lumen is irregular
and compressed by hematoma
• Active contrast extravasation.

120. AORTIC INJURIES
• Contrast extravasation
• Large psoas or mesenteric hemorrhage, pseudo-aneurysm.
Pelvic vasculature injuries are associated with pelvic fractures.

121. IMAGING OF RENAL TRAUMA
• Computed tomography (CT) is the modality of choice
• Injury to the kidney is seen in approximately 8%– 10% of patients with blunt or
penetrating abdominal injuries

122. SUBCAPSULAR HEMATOMA (CATEGORY I)
Crescent shaped hyperdensity, located
in the periphery of the kidney

123. LACERATION
• Hypodense, irregularly linear areas, typically distributed along the vessels and filled
with blood.
• They are best analyzed at arterial phase
• Superficial (<1 cm from the renal cortex)
• Deep (>1 cm from the renal cortex)

124. SIMPLE RENAL LACERATION (CATEGORY I)

125. MAJOR RENAL LACERATION WITHOUT INVOLVEMENTOF
THE COLLECTING SYSTEM (CATEGORY II <1 CM)

126. MAJOR RENAL LACERATION INVOLVING
THE COLLECTING SYSTEM (CATEGORY II)

127. MULTIPLE RENAL LACERATIONS
(CATEGORY III >1 CM)

128. SHATTERED KIDNEY (CATEGORY III)

129. SEGMENTAL RENAL INFARCTION
(CATEGORY II)

130. TRAUMATIC
OCCLUSION OF THE
MAIN RENAL ARTERY
(CATEGORY III)

131. ACTIVE ARTERIAL EXTRAVASATION
(CATEGORY III)

132. VEIN PEDICLE INJURY
• Incomplete or absent opacification of the renal vein
• Persistent nephrogram
• Reduction in excretion
• Nephromegaly

133. LACERATION OF THE RENAL VEIN (CATEGORY III)

134. URINOMA/UROHEMATOMA
• Presence of a more or less significant breach of the collecting tube
system, with urine escape reflected by extravasation of contrast medium
on delayed imaging, in an extrarenal location

135. AVULSION OF THE URETEROPELVIC
JUNCTION (CATEGORY IV)