Tears of the trachea and main bronchi caused by blunt trauma: radiologic findings

Although most of the radiologic changes that have been described in transection or laceration of the trachea or main bronchi are nonspecific, they can be of diagnostic importance in the appropriate clinical setting. In order to reassess the significance of these findings, and to determine the presence of any other changes that might lead to a definitive diagnosis, we retrospectively reviewed the chest radiographs of nine patients who had tears or transection of the trachea and/or main bronchi as a result of blunt chest trauma. The diagnosis was proved by bronchoscopy in all patients and reconfirmed at surgery in five. The predominant findings on the chest radiographs were related to air leak and included subcutaneous emphysema (seven patients), pneumomediastinum (seven patients), pneumothorax (six patients), and air surrounding a bronchus in one patient. Upper thoracic fractures that involved the clavicles, scapula, sternum, and ribs were present in four patients. Abnormalities in the appearance of an endotracheal tube in two patients (overdistention of the cuff or extraluminal position of the tip), and the presence of the fallen lung sign (collapse of the lung toward the lateral chest wall) in two others provided specific evidence of tracheobronchial injury. We conclude that, although the major importance of the chest radiograph in patients with tracheobronchial transection may be to verify the existence of air leak, the presence of the fallen lung sign and endotracheal tube abnormalities is a reliable indication of airway injury.     

VSD following blunt cardiac trauma: MRI findings

In this report, we describe the clinical and radiographic findings of ventricular septal defects (VSDs) following blunt cardiac trauma in two patients. VSDs following either penetrating or blunt cardiac trauma are a rare occurrence. The variable presentation and timing of symptom onset along with the common association of other injuries can make the diagnosis of a posttraumatic VSD difficult. Therefore, investigation should be initiated when elements from the history and physical examination (e.g., new onset murmur), laboratory tests (e.g., cardiac enzymes), EKG, and CT or echocardiography warrant it. The first patient was a 19-year-old male who was hemodynamically stable on initial presentation to this trauma center after a motor vehicle collision. A posttraumatic VSD was found by echocardiography on the day of admission and further defined on cardiac MRI (CMRI). The second patient was a 31-year-oid male who presented after a high-speed motorcycle accident and was found to have a VSD 40 days later on CMRI after a fluctuating clinical course and multiple normal echocardiograms. Both patients had good outcomes with subsequent surgical closure.     

Low-dose MDCT findings of blunt hepatobiliary trauma

This pictorial essay shows low-dose multi-detector computed tomography (MDCT) findings of blunt hepatobiliary trauma, and describes the indications and protocol for MDCT. Given the universal usage of MDCT in assessing the liver in blunt abdominal trauma, reduction of patient dose is essential. The new l0se MDCT protocol presented here can achieve up to 50% dose reduction while maintaining diagnostic image quality and thus facilitate dose sensitive patient management. Our institution’s blunt hepatobiliary MDCT imaging algorithm can help determine which patients require operative therapy. Injury to the liver is graded on various schemes, one being the Organ Injury Scale devised by the American Association for the Surgery of Trauma classification based on the extension of the lesion and bleeding.     

CT findings after embolization for blunt splenic trauma

PURPOSE: To determine complications after transcatheter embolization for blunt splenic injury as recognized with computed tomography (CT). MATERIALS AND METHODS: From March 1997 to January 2000, 80 patients underwent transcatheter embolization after blunt splenic injury, of whom 53 underwent abdominal CT examination before and after embolization. Preembolization CT scans were reviewed to determine grade of injury, and postembolization CT scans were reviewed to identify complications secondary to embolization. Arteriography results were reviewed to determine findings and method and location of embolization. RESULTS: Splenic infarcts occurred in 63% of patients after proximal embolization and in 100% of patients after distal embolization. Infarcts after distal embolization tend to be larger and occur just distal to the embolization material, whereas infarcts after proximal embolization tend to be smaller, multiple, and located in the periphery. Most infarcts resolved without sequelae. Seven patients developed gas within an infarct or subcapsular fluid collection. Two collections were drained and found to be sterile and one patient had a splenic abscess at laparotomy. CONCLUSIONS: Infarcts are common after splenic embolization. Gas may be present within an infarct after embolization with Gelfoam; however, the presence of air/fluid level is a better predictor of abscess.     

Spontaneous pyelosinus extravasation in blunt abdominal trauma: Radiographic findings and treatment implications

Spontaneous pyelosinus extravasation (SPE) occurs rarely. It is observed on intravenous urograms performed for the evaluation of “obstructive” processes. SPE is hypothesized to be caused by an acute or subacute increase in renal pelvic pressure secondary to a urinary calculus or other processes that leads to a sudden increase in hydrostatic pressure. Only two cases of SPE secondary to blunt abdominal trauma have been described. We report three additional cases, all of which demonstrated pyelosinus extravasation on their initial intravenous urograms. All patients were followed conservatively without surgical intervention, and each had a benign course without complication. Herein, we present the radiographic findings, pathophysiologic mechanisms, and treatment implications of SPE with the emphasis on expectant management.     

腹部钝性创伤中肠道及肠系膜损伤的CT表现

肠道及肠系膜损伤在腹部钝性伤中的发生率较高且易出现诊断延迟或漏诊。多层X线计算机断层成像具有较高的空间、时间和对比度分辨率,提高了肠道及肠系膜损伤诊断率。可显示腹腔内脏器损伤的直接和间接影像,指导非手术治疗或手术治疗的选择和效果评估。本文就肠道及肠系膜损伤在CT中特异性和非特异性征象作一论述。     

Colorectal hemangioma: radiologic findings

The authors correlated radiographs with the clinical and histologic data of 12 patients with colorectal hemangioma. All patients presented with rectal bleeding, which was chronic in seven. Phleboliths were also visible in seven cases, which correlated with chronic bleeding in five. On barium studies, three masses were soft and three produced rigid narrowing. The atypical features of rigid luminal narrowing, which might mimic a carcinoma, and hypovascularity correlated with chronic bleeding or visible phleboliths, which suggest the correct diagnosis of colorectal hemangioma.     

Bronchopulmonary sequestration: radiologic findings

Bronchopulmonary sequestration (BPS) is a nonfunctioning bronchopulmonary tissue that is separate from the tracheobronchial tree and receives arterial blood from the systemic circulation. BPS has a wide spectrum of imaging findings. Surgery is generally indicated for the treatment of BPS. It is important to demonstrate the arterial supply and venous drainage of the sequestered segment preoperatively. Today, with the help of noninvasive imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), preoperative diagnosis of BPS can be made easily, so, invasive techniques such as angiography are not required frequently. In this report, radiological findings of BPS were retrospectively reviewed.     

Lyme arthritis: radiologic findings

Lyme disease is a newly recognized, multi-system disorder that may be associated with chronic arthritis. Of 25 patients with severe arthritic manifestations the most frequent radiographic finding was knee joint effusion. Intra-articular edema was often accompanied by a continuum of soft-tissue changes involving the infrapatellar fat pad, periarticular soft tissues, and the entheses, which were sometimes thickened, calcified, or ossified. Later in the illness, the joints of some patients showed typical changes of an inflammatory arthritis, including juxta-articular osteoporosis, cartilage loss, and cortical or marginal bone erosions. Less commonly, other patients demonstrated changes more characteristic of degenerative arthritis, including cartilage loss, subarticular sclerosis, and osteophytosis. Joint involvement of Lyme disease has similarities to juvenile arthritis and Reiter syndrome, but can usually be distinguished clinically and serologically from these entities.     

Tomographic findings in traumatic globe evulsion caused by blunt head trauma

Evulsion of the globe as a result of trauma is a rarity; to the best of our knowledge, only four "evulsions of the globe" have been described. We present the case of a 35-year-old Hispanic woman with traumatic evulsion of the right eye and subarachnoid haemorrhage. The management of brain injury was the priority over preservation of globe structures. We briefly describe the tomographic features of this uncommon situation and the proposed "evulsion" mechanism.     

CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings

PURPOSE: To determine the contrast material-enhanced computed tomographic (CT) criteria for selection of hemodynamically stable patients with blunt hepatic injury for angiographic evaluation. MATERIALS AND METHODS: Seventy-two patients with blunt liver injury underwent CT and hepatic angiography. Hepatic injuries were graded with CT-based classification. Scans were assessed for evidence of contrast extravasation and laceration or contusion extending into the hepatic vein(s), inferior vena cava, porta hepatis, or gallbladder fossa. Medical, angiographic, and surgical records were reviewed to determine angiographic findings, surgical indications and findings, and outcomes. RESULTS: Compared with hepatic angiography, CT was 65% (11 of 17 patients) sensitive and 85% (41 of 48 patients) specific for detection of arterial vascular injury. When CT severity grades 2 and 3 were analyzed, the sensitivity and specificity of CT were 100% (three of three patients) and 94% (34 of 36 patients), respectively (P <.001). Injury involving at least one major hepatic vein was found in 15 (88%) of 17 patients who required liver-related surgery and in 23 (42%) of 55 of the other patients (P <.01). CONCLUSION: CT-based criteria, including hepatic injury grade, signs of arterial vascular injury, and presence or absence of major hepatic venous involvement assists in selecting patients for hepatic angiography and those at increased risk of ongoing or delayed hepatic bleeding or other posttraumatic complications.     

Incidental findings in blunt trauma patients: prevalence,follow-up documentation,and risk factors

Purpose

The frequency of computed tomography (CT) imaging of trauma patients has given rise to an increase in the discovery of incidental findings. The purpose of this study was to evaluate the frequency and documentation of follow-up recommendations of incidental findings during the initial trauma evaluation. Secondarily, trauma patients with and without incidental findings were compared. We hypothesized that there would be a high rate of incidental findings in trauma patients and that these findings would be poorly documented.

Methods

A retrospective review of CT imaging performed during trauma assessment at an urban level 1 trauma center was conducted. Prospectively documented incidental findings over a 6-month period were recorded. The frequency of incidental findings and follow-up referrals were analyzed. Mann-Whitney non-parametric test and Fisher’s exact test were used to compare patients with and without incidental findings, and logistic regression was performed to identify independent risk factors.

Results

Of the 1573 CT scans performed, 478 (30.4%) revealed incidental findings. The abdomen/pelvis had the highest rate of incidental findings (61.7%). Of the 416 patients, 295 (70.9%) had a total of 858 incidental findings, with an average of 3 findings per patient. Follow-up was required for 24 (2.8%) incidental findings, and admission/immediate intervention was required for 6 (0.7%) findings. Only 12 (1.4%) incidental findings were documented in the discharge note. Increasing age (p < 0.001), a higher body mass index (BMI) (p = 0.015), and receiving a pan-CT (p < 0.001) increased the odds of having an incidental finding.

Conclusion

A large percentage of trauma patients have incidental findings. Therefore, better documentation and follow-up are needed to determine the long-term outcomes of patients with clinically relevant incidental findings.