Chapter 17 Recognizing the Imaging Findings of Trauma
Trauma is the leading cause of death, hospitalization, and disability in Americans from the age of 1 year through age 45. The major imaging findings of most organ system’s trauma will be discussed as a group in this chapter. Table 17-1 summarizes some of the traumatic injuries that are discussed in other chapters.
TABLE 17-1 OTHER MANIFESTATIONS OF TRAUMA
| Injury | Discussed in |
|---|---|
| Pleural effusion/hemothorax | Chapter 6 |
| Aspiration | Chapter 7 |
| Pneumothorax, pneumomediastinum and pneumopericardium | Chapter 8 |
| Fractures and dislocations | Chapter 22 |
| Head trauma | Chapter 25 |
Chest Trauma
Chest injuries in trauma patients are very common and are responsible for one out of four trauma-related deaths. The overwhelming majority of chest trauma is the result of motor vehicle accidents.Rib Fractures
The severity of underlying visceral injury is usually more important than the rib fractures themselves, but their presence might provide clues to unsuspected pathology.
Fractures of the first three ribs are relatively uncommon and, if they occur following blunt trauma, indicate a sufficient amount of force to produce other internal injuries (Fig. 17-1).
In cases of minor trauma, it is not unusual for rib fractures to be undetectable on the initial examination but to become visible in several weeks after callus begins to form.
Rib fractures are important primarily for the complications they might produce or the unsuspected pathology they might herald. Fractures of the first three ribs (solid white arrows) are relatively uncommon; following blunt trauma, their presence is a clue that the force to the chest may have been sufficient to produce other internal injuries. Don’t mistake the normal costovertebral junction (solid black arrow) for a fracture.
Pulmonary Contusions
Pulmonary contusions are the most frequent complications of blunt chest trauma. They represent hemorrhage into the lung, usually at the point of impact.
Recognizing a pulmonary contusion
Airspace disease that lingers more than 72 hours should raise suspicions of another process such as aspiration pneumonia or a pulmonary laceration.
Figure 17-3 Pulmonary contusions, chest radiograph and CT.
A, Pulmonary contusions tend to be peripherally placed most frequently at the point of maximum impact (dotted white arrow). Air bronchograms are usually not present because blood fills the bronchi as well as the airspaces. B, A second patient, who was in an unrestrained passenger in an automobile accident, also has a large contusion (solid white arrow) associated with multiple rib fractures (solid black arrows).
Pulmonary Lacerations (Hematoma or Traumatic Pneumatocele)
Pulmonary hematomas result from a laceration of the lung parenchyma and, as such, may accompany more severe blunt trauma or penetrating chest trauma.
They are sometimes masked by the airspace disease from a surrounding pulmonary contusion, at least for the first few days until the contusion resolves.
Recognizing a pulmonary laceration
Figure 17-4 Pulmonary lacerations, conventional radiograph, and CT.
Lacerations are sometimes masked, at least for the first few days, by the airspace disease in a surrounding pulmonary contusion. A, If they are completely filled with blood, they will appear as an ovoid mass (dotted white arrow). B, If they are partially filled with blood and partially filled with air, they may contain a visible air-fluid level (solid black arrow). Unlike the neighboring pulmonary contusion (solid white arrow), pulmonary lacerations, especially if they are blood filled, may take weeks or months to completely clear. The top of the left hemidiaphragm (D) is seen in this image.
Aortic Trauma
Trauma to the aorta is most frequently the result of deceleration injuries in motor vehicle accidents. Although the survival rates are improving, most patients with rupture of the thoracic aorta die before reaching the hospital and, of those who survive an aortic injury, the likelihood of death increases the longer the abnormality remains untreated. Only those with incomplete tears in which the adventitial lining prevents exsanguination (producing a pseudoaneurysm) survive to be imaged.
The most common site of injury is the aortic isthmus, which is the portion of the aorta just distal to the origin of the left subclavian artery. Seat-belt injuries may involve the abdominal aorta, but such injuries are far less common than the deceleration injuries to the thoracic aorta.
Only emergency surgery will prevent approximately 50% of patients with blunt aortic injuries from dying within the first 24 hours if left untreated.
Recognizing aortic trauma
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