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Imaging In Trauma

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Dr. Himadri Sikhor Das
Dr. Himadri Sikhor Das
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IMAGING IN TRAUMA
SCOPE OF DISCUSSION: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Initial Assessment (Primary Survey) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Primary Survey ,[object Object],[object Object],[object Object],[object Object],[object Object]
Initial Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Detailed Exam (Secondary Survey) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rules of Triage ,[object Object],[object Object],[object Object],[object Object],[object Object]
MST: Until proven otherwise: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Where should the patient go? ,[object Object],Not necessarily the closest one!
BRAIN & SPINE TRAUMA
Injuries to Brain
Craniocerebral Trauma ,[object Object],[object Object],[object Object],[object Object]
Assessment of Head Injury ,[object Object],[object Object]
Assessment of Head Injury ,[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Skull Fractures ,[object Object],[object Object],[object Object]
Types of Skull Fracture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of Skull Fracture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Skull Fractures DO NOT TRY TO STOP FLOW OF BLOOD, FLUID FROM NOSE OR EARS MAY CAUSE INCREASED INTRACRANIAL PRESSURE AND BRAIN INFECTION
Concussion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cerebral Contusion ,[object Object],[object Object],[object Object],[object Object]
Trauma ,[object Object],[object Object],[object Object],[object Object]
Epidural Hematoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Subdural Hematoma ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Cerebral Laceration ,[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma ,[object Object],[object Object],[object Object],[object Object]
SAH ,[object Object]
 
 
Spinal Injuries
Most important spinal injury indicator… MECHANISM
Common Mechanisms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suspect spinal injury with... ,[object Object],[object Object],[object Object],[object Object],Significant Head Injury = Neck Injury Until Proven Otherwise
Or, there may be no signs at all. . . ,[object Object],[object Object]
STABILITY: A Word or Two ,[object Object],[object Object]
Three Column Theory of Denis ,[object Object],[object Object]
ANTERIOR COLUMN ,[object Object]
MIDDLE COLUMN ,[object Object]
POSTERIOR COLUMN ,[object Object]
DOES IT WORK? ,[object Object],[object Object]
HOW DO YOU IMAGE THE CERVICAL SPINE? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Imaging Minor Trauma ,[object Object],[object Object],[object Object],[object Object]
MINOR TRAUMA: Views
Imaging Major Blunt Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object]
MAJOR TRAUMA: Imaging ,[object Object],[object Object]
Swimmer’s View in Major Trauma ,[object Object],[object Object]
CT ,[object Object],[object Object],[object Object]
CT: Sagittal Reformatting ,[object Object],[object Object]
CT: Coronal Reformatting ,[object Object],[object Object]
MRI ,[object Object],[object Object],[object Object]
NEUROLOGIC DEFICIT In my view, ANY neurologic deficit, extant or transient, is MAJOR trauma, and will need CT followed by MRI.
Any abnormality on Plain Films or worrisome examination: do CT! Remember: Fractures often come in 2’s and 3’s. The more serious injury may be the one that is occult.
Remember: The lesions are the SAME regardless of the imaging modality Plain films are still the most common modality. If you learn on them, you can translate your knowledge to CT and MRI.
PLAIN FILM Series ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LATERAL view ,[object Object],[object Object],[object Object]
LATERAL View: First Survey ,[object Object],[object Object],[object Object]
LATERAL View: Prevertebral Soft Tissues ,[object Object],[object Object]
LATERAL View: Alignment ,[object Object],[object Object],[object Object]
LATERAL View: Alignment ,[object Object]
LATERAL View: Spaces ,[object Object],[object Object],[object Object]
LATERAL View: C1 and C2 ,[object Object],[object Object],[object Object]
LATERAL VIEW: Predental Space ,[object Object],[object Object]
LATERAL VIEW: Predental Space
LATERAL View: C3-T1 ,[object Object],[object Object]
LATERAL VIEW: Child ,[object Object],[object Object],[object Object],[object Object]
SWIMMER’S View ,[object Object],[object Object]
ANTERIOR-POSTERIOR View ,[object Object],[object Object],[object Object],[object Object],[object Object]
The ODONTOID Views ,[object Object],[object Object]
OMO ,[object Object],[object Object],[object Object],[object Object]
The INJURIES ,[object Object],[object Object],[object Object]
The Atlas and the Axis ,[object Object],[object Object]
Occipital-atlantic Injuries ,[object Object],[object Object]
The ATLAS: C1 ,[object Object],[object Object],[object Object]
C1: Isolated Arch Fractures ,[object Object],[object Object],[object Object]
JEFFERSON Fracture: C1 ,[object Object],[object Object],[object Object],[object Object],[object Object]
JEFFERSON Fracture: C1 ,[object Object],[object Object],[object Object]
JEFFERSON Fracture CT ,[object Object],[object Object]
The AXIS: C2 ,[object Object],[object Object],[object Object]
DENS Fractures ,[object Object],[object Object],[object Object],[object Object]
TYPE II Dens Fracture ,[object Object],[object Object],[object Object]
TYPE II Dens Fracture ,[object Object]
TYPE III Dens Fracture ,[object Object],[object Object],[object Object]
C2: PARS Fracture ,[object Object],[object Object],[object Object],[object Object]
C2: Extension Teardrop Fracture ,[object Object],[object Object],[object Object]
C3 to T1 These levels are so similar they will be considered as a unit. The injuries are grouped by mechanism into “families”.
The “FAMILIES” Flexion Flexion-rotation Extension Axial loading
“FAMILY FLEXION” Motto: “Anterior impaction, posterior distraction.” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Wedge Compression Fracture ,[object Object],[object Object],[object Object],[object Object]
Hyperflexion Sprain ,[object Object],[object Object],[object Object],[object Object]
Flexion-Extension Films ,[object Object],[object Object],[object Object]
Flexion-Extension films ,[object Object]
It is an Active, patient-generated STRESS TEST ,[object Object],[object Object]
MRI ,[object Object],[object Object]
Bilateral Interfacetal Dislocation ,[object Object],[object Object],[object Object],[object Object]
Hyperflexion Teardrop Fracture- dislocation ,[object Object],[object Object],[object Object]
Hyperflexion Teardrop Fracture-dislocation ,[object Object]
Spinous Process Fracture ,[object Object],[object Object],[object Object]
Spinous Process Fracture ,[object Object]
FLEXION-ROTATION Injuries Unilateral Interfacetal Dislocation and Fracture-dislocation
Unilateral Interfacetal Dislocation ,[object Object],[object Object],[object Object]
CT: This is a normal facet joint, normal “hamburger sign”
UID ,[object Object],[object Object]
UID ,[object Object],[object Object]
EXTENSION INJURIES Family motto: “Anterior distraction, posterior impaction ” Posterior arch fractures Extension teardrop fractures Extension fracture-dislocations
Posterior Arch Fractures ,[object Object],[object Object],[object Object],[object Object],[object Object]
Extension Teardrop Fracture ,[object Object],[object Object],[object Object],[object Object]
EXTENSION Fracture- dislocation ,[object Object],[object Object]
AXIAL Loading ,[object Object],[object Object],[object Object]
BURST Fractures ,[object Object],[object Object]
BURST Fractures ,[object Object]
The CXR: Revisited
CXR ,[object Object],[object Object],[object Object],[object Object]
Normal Chest X-ray ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Chest X-ray ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Chest X-ray ,[object Object],[object Object],[object Object],[object Object]
Normal Chest X-ray ,[object Object],[object Object],[object Object],Lungs
Abnormal Chest X-ray ,[object Object],[object Object]
CXR: Positions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Positions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Positions P-A view Rt’ Lateral view Rt’ Lateral decubitus view
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],IDEAL Kv EXPOSURE:
IDEAL Kv & EXPOSURE factors: small pneumothorax present on the radiograph to the left.
The importance of exposure factors
Anatomy & projection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lobar anatomy
MEDIASTINUM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SUPERIOR MEDIASTINUM - PA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MEDIASTINUM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neck and Cervical spines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thoracic spine and Rib cage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thoracic spine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thoracic spine
Ribs 1. Posterior Rib 2. Anterior Rib
Ribs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The shoulder girdle
Pathophysiology of Thoracic Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Trauma.org
Pathophysiology of Thoracic Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gunshot Wound ,[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma.org
Injuries Associated with Penetrating Thoracic Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contusion
Hemothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Gas under diaphragm
The CXR: Check List (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Check List (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lastly remember the A-B-C-D-E-F-G-H of CXR !! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pelvi-acetabular Fractures ,[object Object]
BASIC PRINCIPLES IN RADIOLOGY OF BONE TRAUMA ,[object Object],[object Object],[object Object],[object Object]
BASIC PRINCIPLES IN RADIOLOGY OF BONE TRAUMA ,[object Object],[object Object],[object Object]
Normal pelvic bone anatomy. ,[object Object]
Normal Pelvic X-Ray ,[object Object]
Illustrations of classification of five most common acetabular fractures.
Common acetabular fractures can easily be classified using disruption of the obturator ring as the basis of a decision tree  ,[object Object],[object Object],[object Object],[object Object]
T-shaped fracture
T-shaped fracture ,[object Object]
Transverse fracture.
Transverse fracture.
Transverse with posterior wall fracture
Transverse with posterior wall fracture
Isolated posterior wall fracture.
Isolated posterior wall fracture.
both-column acetabular fracture
both-column acetabular fracture
both-column acetabular fracture
both-column acetabular fracture and spur sign ,[object Object]
THANK YOU !!

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Imaging In Trauma

Editor's Notes

  1. Blunting of costalphrenic or costocardiac angles suggests plueral effusion