CHEST TRAUMA : CHEST TRAUMA
WHAT TO LOOK FOR : WHAT TO LOOK FOR Skeletal injury
Pulmonary contusions
Pulmonary lacerations
Abnormal collection of air
Abnormal collection of fluid
Widening mediastinum
SKELETAL INJURY : SKELETAL INJURY RIB FRACTURE
Important for what they are associated with or produce
4TH -9TH ribs -> pneumothorax, contusion
FLAIL CHEST
3 or more ribs broken in 2 or more places
Paradoxical or reverse motion of a chest wall segment
SKELETAL INJURY : SKELETAL INJURY RIB FRACTURE
1st – 3rd ribs fracture
possibility of damage to aorta, great vessels
10th – 12th ribs fracture
possibility of liver, kidneys or splenic injuries
Slide 9: STERNAL FRACTURE
injury to aorta, great vv, myocardium
Dislocation of sternoclavicular joint
Compression of trachea and great vessels
THORACIC SPINE INJURY
PULMONARY CONTUSION : PULMONARY CONTUSION Appears within 6 hours of injury
Rapid clearing ( Often resolved within 48 hours)
Diffuse alveolar infiltration, patchy or confluent shadowing in lungs
Distributed according to a shock wave ( Not lobar or segmental pattern)
PULMONARY LACERATION : PULMONARY LACERATION Usually not apparent at first because of surrounding contusion
PNEUMATOCELE
HEMATOMAS
May take some months to resolve
ABNORMAL AIR COLLECTION : ABNORMAL AIR COLLECTION PNEUMOTHORAX
PNEUMOMEDIASTINUM
PNEUMOPERICARDIUM
SUBCUTANEOUS EMPHYSEMA
PNEUMOTHORAX : PNEUMOTHORAX White margin of visceral pleura separated from parietal pleura
Absence of vascular markings beyond visceral pleural margin
Beware of skin folds, bullae, cyst
PNEUMOMEDIASTINUM : PNEUMOMEDIASTINUM BRONCHIAL / TRACHEAL RUPTURE
PULMONARY INTERSITIAL EMPHYSEMA
ESOPHAGEAL RUPTURE
PNEUMOMEDIASTINUM : PNEUMOMEDIASTINUM Medinastinal pleura is displaced from heart border
Visualization of central part of diaphragm :
“ Continuous diaphragm sign ”
PNEUMOMEDIASTINUM : PNEUMOMEDIASTINUM “ V-sign of Naclerio ” air between lower thoracic aorta, diaphragm
“ Spinnaker-sail” sign in children = air outlining the thymus
PNEUMOPERICARDIUM : PNEUMOPERICARDIUM Shearing mechanism of injury of the heart during blunt trauma
Direct penetration of the pericardium
Air appears around heart but does not extend above great vessels
SUBCUTANEOUS EMPHYSEMA : SUBCUTANEOUS EMPHYSEMA
ABNORMAL COLLECTION OF FLUID : ABNORMAL COLLECTION OF FLUID HEMOTHORAX
Loculation occurs early
CHYLOTHORAX
Torn thoracic duct
Appearance of pleural effusion several days after injury
One or both hemithoraces
Pleural tap yields lymph
DIAPHRAGM INJURY : DIAPHRAGM INJURY 4 % of blunt trauma patients
15% in penetrating thoracic trauma
Herniation : stomach, large bowel, small bowel, omentum, spleen
Slide 37: CXR
Indistinct or elevation of diaphragm
Often with pleural effusion and basilar consolidation
Confirmatory sign
“ intrathoracic bowel or NG tube above the diaphragm”
Slide 39: CT
Discontinuity or lack of visualization of diaphragm ( absent diaphragm sign)
Abdominal organs or peritoneal fat above the diaphragm
ACUTE TRAUMATIC INJURY OF AORTA : ACUTE TRAUMATIC INJURY OF AORTA ACUTE TRAUMATIC INJURY OF AORTA
Mechanism of injury
Rapid deceleration in vehicle
Shearing and torquing forces
Site of injury
95% in aortic isthmus region
1% distal descending aorta
<5% in the ascending aora
ACUTE TRAUMATIC INJURY OF AORTA : ACUTE TRAUMATIC INJURY OF AORTA PLAIN FILM FINDINGS
Widened mediastinum ( > 8 cm above aortic arch )
Indistinct aortic knob
Loss of the notch between aorta and top of pulmonary artery
ACUTE TRAUMATIC INJURY OF AORTA : ACUTE TRAUMATIC INJURY OF AORTA PLAIN FILM FINDINGS
Apical pleural cap usually on the left
Depression of left main bronchus
Paraspinal soft tissue thickening
Deviation of trachea and NG tube in esophagus away from aorta
Classification of aortic dissection : Classification of aortic dissection DEBAKEY
DeBakey Type I : entire aorta
DeBakey Type II : ascending aorta only
DeBakey Type III: descending aorta
Slide 50: STANFORD TYPE
TYPE A : ascending +/- arch
TYPE B : descending aorta only
Slide 52: THE END