chest trauma2

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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

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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

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CXR Indistinct or elevation of diaphragm Often with pleural effusion and basilar consolidation Confirmatory sign “ intrathoracic bowel or NG tube above the diaphragm”

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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

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STANFORD TYPE TYPE A : ascending +/- arch TYPE B : descending aorta only

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THE END

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