بسم هللا الرحمن الرحيم

قالوا

العلم لن سبحانك ا إال ماعلمتنا

كيم إنك أنت العليم الح

صدق هللا العظيم(32اآلية –سورة البقرة )

Body Trauma –

Radiological viewBy

Hossam MassoudNational cancer institute - cairo

university

Manifestations;

Primary manifestation

Secondary manifestation

Vascular effect of trauma

Primary manifestation

Skull fractures Fissure fractures

Depressed fractures

Extracerebral

haematomas Extradural haematoma

Subdural haematoma

Subarachnoid haematoma

Intraaxial lesions Cerebral parenchymal

contusion

White matter shearing

injury (DAI)

Secondary manifestation Major secondary effect

of trauma

Cerebral herniation

midline shift

Traumatic ischaemia

/ infarction

Diffuse cerebral

oedema

Hydrocephalus.

Brain death

Vascular effect of trauma Primary vascular injuries

Laceration and intimal tear

Dissection and transection.

Thrombosis and occlusion.

Arteriovenous fistula

Dural sinus / cortical veins laceration or occlusions

Seconday vascular effects Occlusion caused by cerebral herniations (ACA, PCA or

lenticulostraite arteries)

Flow reduction caused by marked increase of intracranial pressure

CT Indication Loss of consciousness or amnesia

Glasgow coma scale score below 15

Focal neurological abnormality

Intoxication.

Depressed skull fracture / penetrating injury

Patient age below 2 and above 60y

Bleeding disorder / anticoagulation

Skull fractures

Types

Linear

Depresed

Diastatic

Extra axial haemorrhage

Types

Epidural haematoma

Subdural haematoma

Subarachnoid haematoma

Epidural haematoma Etiology

Forceful impact of calvarium

fracture

Transient depression of skull

fragment lacerates dural artery

Blood collects between inner

table and outer layer of dura

Dural is stripped away from

inner table forming biconvex

mass

Epidural haematoma- CT

findings

Oftenly accompanied with fracture.

Biconvex / lenticular

Extra axial

Hyperdense mass

Few cases might be hypodense Rapid / active bleeding

Aneamia

Epidural haematoma- CT

findings

Biconvex

Extra axial

Hyperdense mass

Subdural haematoma Etiology

Sudden deceleration of head

stretch & tear cortical

veins as they cross the

potential subdural space

Incidence 10-20%

Location

Between dura and arachnoid

Frontoparietal

may be bilateral

Subdural haematoma- CT

findings

Acute;

Sub acute;

Chronic;

Subdural haematoma- CT

findings

AcuteCrescent shaped

Hyperdense

or

mixed (active

bleeding)

Subdural haematoma- CT

findings

Subacute

Crescent isodense with

underlying cortex

Chronic

Crescent

Hypodense

May have

sepitations.

Subarachnoid haematoma

Moderate to severe head injury

Worse prognosis.

Similar to aneurysmal SAH blood filling the

cisterns and sulci

Subarachnoid haematoma

CT Findings

Hyperdensity

smearing the

cisterns and sulci

Associated diffuse

axonal injury

Diffuse axonal injury

(DAI-Shearing effect)

About 50% of all primary intra-axial injuries are

DAI.

most common cause of significant morbidity in

CNS trauma.

Etiology

Acceleration / deceleration / rotation forceso Deform

o Tear axons

o Tear penetrating vessel

Diffuse axonal injury

(DAI-Shearing effect)

Location

Subcortical white matter

Posterior limb internal

capsule

Corpus callosum

Dorsolateral midbrain

CT Findings may be normal despite

the patient's presentation with a profound neurological deficit.

ill-defined areas of high density or hemorrhage in the characteristic locations

Cerebral Contusion

Brain impacts an

osseous ridge or a

dural fold

Foci of punctate

hemorrhage or edema

are located along

gyral crests

Locations

Frontal lobe - anterior

pole, inferior surface

Dorsolateral midbrain

Inferior cerebellum

Intraventricular Hemorrhage

Commonly associated

with associated with

Diffuse axonal injury

Deep gray matter

injury

Brainstem contusion

Proportionate inter-spinouts distances

Neural arch fracture of C1

DD

Stable with less neurological injuries

5

Pitfall

Burst fracture

Facet joints

Normally;

Facet Injury (perched / locked

facets)

Unilateral locked

facet

Bowtie

Bilateral locked

facet;

Anterolistheisis with

neurological deficit

Thoracic trauma may involve

injuries to:

1- chest wall / Thoracic cage.

2- Diaphragm.

3- Lung and pleura.

4- Tracheobronchial tree.

5- heart and Mediastinum

1

2

34

5

1- Chest wall injuries

–Chest wall contusion

–Rib fractures

–Flail chest (more than 2 ribs in more

than 2 sites)

–Sternal fractures

–Fractures of the clavicle and shoulder

girdle

–Fracture spine.

•Multiple rib fractures

Rib Fractures

• Associations;

• First Rib 1 only facial fractures

• Ribs 1, 2 and 3 Serious Trauma

Ruptured bronchus

• Ribs 4 to 9 pneumothorax, contusion

• Ribs 10 to 12 lacerations of liver/spleen

Complications

• Abnormal Collections Of blood & Air

– Pleura == hemothorax & Pneumothorax

– Mediastinum== hemo & Pneumomediastinum

– Pericardium == hemo & Pneumopericardium

– Subcutaneous emphysema

– Others

•==

Complications

Sternal fractures;•high-morbidity, with a mortality 25-45%.

•Usually complicated.

Post.rib Fracture

contusions

Sternal

Fracture

Fractured sternum (arrowed)

Pulmonary Contusion

• Most common finding in

blunt chest injury

• It presents mild Hemorrhage

into lungs

• Appears within 6 hours of

injury

• Clears in 48 hours

• Usually at point of impact

The 3 components of a

pulmonary contusion include

edema, hemorrhage, and

atelectasis .

•Sternal Fx.

•Retrosternal hge

•Lung contusion

•HT

Pulmonary Laceration

(Traumatic Lung Cyst)

• 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

Pneumothorax

• A pneumothorax refers to a collection of gas in the pleural space resulting in collapse of the lung on the affected side.

• A tension pneumothorax is air within the pleural space that is under pressure; displacing mediastinal structures and compromising cardiopulmonary function.

• A traumatic pneumothorax results from blunt or penetrating injury that disrupts the parietal or visceral pleura.

Traumatic Pneumothorax

• Must see visceral pleural white line

• Absence of lung markings peripheral to

pleural line

Pneumomediastinum & pneumopericardium

Continuous diaphragm sign

Pneumopericardium

# above great Vs

Hemomediastinum

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

• DD == eventration & hernia.

Radiological features

• Air-fluid levels or abnormal air collection above diaphragm

• Abnormal elevation of one (usually left) hemidiaphragm with or without herniated gastric fundus or colon

• Contralateral tension displacement of mediastinum

• Abnormal location of NG tube

• DD of herniation by coronal +/- contrast images

Introduction

Trauma is the leading cause of death

under the age of forty.

Of all traumatic deaths, abdominal

trauma is responsible for 10%.

Initial clinical examination and 1st aid

management followed by other

diagnostic options.

Diagnostic tools

Physical

examination

Laboratory tests

Observation

Diagnostic imaging

Exploratory

labarotomy

Diagnostic

Imaging; Plain Radiography

Ultrasound

CT

Contrast studies

Plain Radiography

•Fractures

•Air under the diaphragm

•Foreign bodies

Ultrasonographphy•Parenchymal

injuries (less

sensitive)

••Fluid collections

Findings to look for;

Hemoperitoneum

Pneumoperitoneum

Organ Laceration

Contusions

Hematomas (peri , Subcapsular or intra)

Devascularization of organs or parts of organs

Contrast blush =active extravasation

Spleen

The spleen is the most commonly injured

solid organ in about 25% of all patients

with abdominal trauma

IIIIII

IIIIV Shattered

Hemoperitonium

Contrast blush

Contrast blush

DD;Active arterial extravasation

Post-traumatic Pseudoaneurysm

Post-traumatic AV fistula

laceration

hematoma

Hge

Liver

Liver 2nd most commonly involved solid organ in the

abdomen after the spleen.

Liver injury is the most common cause of death (many

major vessels in the liver, like the IVC, hepatic veins,

hepatic artery and portal vein).

Posterior segment of the right liver lobe is the most

frequently injured part (involves the bare area and this

can lead to retroperitoneal bleeding rather than bleeding

into the peritoneal cavity).

I-IIII

IIIIII

G-V

>10 cm Subcap. He + C. blush

Stellate laceration

Branching laceration

Avulsed right hepatic vein

G-V

Active bleedingActive bleeding

Similar to spleen + G-VI due to 2 lobes of liver

Pancreas Pancreatic injuries account for 3-10% of all abdominal

injuries.

The mechanism of injury usually involves

compression between the spine and abdominal

wall during a forceful blow to this area.

Pancreatic injuries are often associated with other

injuries and carry a relatively high mortality rate,

approximately 25%.

50% of pancreatic trauma related deaths are due to

hypovolemic shock from major visceral hemorrhage.

For this reason, rapid and accurate diagnosis of

pancreatic injury is vital.

Pancreatic laceration is often subtle particularly

laceration

Contusion +hge

Avulsion + hge

Ductal # +pseudo cyst

Pancreatitis + dudenal hge

pseudo cyst +gerota’s F

Associations &

complications

Kidneys