Imaging chest trauma

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