Routine Radiology of the Trauma Patient Chantal VCA 440.
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Transcript of Routine Radiology of the Trauma Patient Chantal VCA 440.
What to look for in the thorax
Pulmonary contusionsHemothorax
PneumomediastinumPneumothorax
Traumatic diaphragmatic hernia
Pulmonary Contusions
•How it happens:
• Hemorrhage into the lung parenchyma
• Tearing and crushing injury
•Radiographic Signs:
• Patchy, focal or generalized
• Alveolar pattern
• May not be visible right away
•What’s next?
• Be conservative with fluids
• Respiratory support
• +/- Coagulation tests
Hemothorax
•How it happens:
• Trauma to arteries /veins
• Damage to heart, lungs, thymus, or diaphragm
• Ruptured herniated abdominal viscera
•Radiographic signs:
• Pleural effusion
• Diffuse or ventral
• Scalloping/fissures
•What’s next?
• Thoracocentesis
• +/- Surgical exploration
• Oxygen, transfusion, fluids
Pneumomediastinum
•How it happens:
• Ruptured alveoli, trachea, or esophagus
• Tracheal avulsion
•Radiographic signs:
• Distinction of structures normally not seen
• Tracheal wall outlined
• SQ emphysema
•What’s next?
• Repair rents
• Monitor for progression
Pneumothorax
•How it happens:
• Chest wall rent
• Lung rupture
• Extension of pneumomediastinum
•Radiographic signs:
• Retracted lungs
• +/- collapse
• Raised heart
• +/-Small heart
• +/-flat caudal diaphragm
• +/-mediastinal shift
•What’s next?
• Thoracocentesis
Traumatic Diaphragmatic Hernia
•How it happens:
• Rapid increase in intra-abdominal pressure
• Rent in the muscular portion
•Radiographic signs:
• +/-Pleural effusion• +/-Gas filled loops, liver
stomach,spleen• +/-Loss of diaphragmatic
outline• +/-Asymmetric on VD/DV• +/-Missing viscera from
abdomen
•What’s next?
• Contrast study to definitively diagnose
Hemoperitoneum
•How it happens:
• Ruptured spleen
• Ruptured liver
• Disrupted vasculature
• Avulsed bladder
•Radiographic signs:
• Peritoneal effusion
• Focal or diffuse
• Decreased serosal detail
•What’s next?
• U/S
• Abdominocentesis
Renal Avulsion
•Radiographic signs:
• Focal decreased serosal detail
• Missing kidney
• Mass in caudal abdomen
•What’s next?
• U/S
Uroperitoneum
•How it happens:
• Ruptured bladder
• Avulsed/torn ureter
• Urethral tear
•Radiographic signs:
• Diffuse decreased serosal detail
• Focal detail loss in the RPS
•What’s next?
• Abdominocentesis
• IVP (EU)
• Cystogram
• Urethrogram
Traumatic Hernia
•How it happens:
• Rapid increase in intra-abdominal pressure
• Rent in the body wall, inguinal canal, or perineal wall
•Radiographic signs:
• Extra-abdominal mass
• Disruption of the body wall
• +/-Containing gas-filled loops of intestines
• +/-Missing abdominal viscera
•What’s next?
• U/S mass
• Surgical repair