RADIOLOGY OF
EMERGENCY &
TRAUMATOLOGI
Prof. Dr. dr. Bachtiar Murtala, Sp.Rad
(K)
Introductio
n:
Since Prof.W.C. Roentgen (1895) in Germany/
Europe discovered x-ray, medical science
developed rapidly both in diagnosis and
treatment.
The role of x-ray and other radiology modalities in
emergency cases, as well as traumatology, also
increased. It is very difficult to asses and make
precise diagnosis without radiology examinations.
Beside x-ray conventional, radiology has also
imaging machines such as CT-Scan, Ultrasound
(US), Magnetic Resonance Imaging (MRI) and
Nuclear medicine
Emergency and trauma cases may come
from the head and neck, chest, abdomen ,
and extremities regions.
In this topic, we focus to discuss about
conventional x-ray and the most common
cases in the daily practice.
US is the tool of choise in detecting free fluid
/ blood in the abdominal and chect cavities,
while,
CT scan for intracranial hemorrhages/injures
caused by trauma.
Emergency cases in the chest
region
Pneumothorax
Free air within pleural
cavity
Clinical signs : dyspnoe,
chest pain, etc
Chest x-ray :
- Avascular hyperluscent
- Shifting of mediastinal
organs and heart
toward contralateral.
- Additional exam. : CTScan
Pleural effusion
Pleural effusion:
- Light ( fluid volume
300 cc),
Detected in
erect/upright position
and Lateral Decubitus
(LD).
LD is more sensitive.
Radiological signs :
Opacification/fluid
accumulates in the lower
part of the chect cavity
Pleural effusion
- mild : Volume > 300 cc,
easily detected in
Posteroanterior (PA) or routine
position.
- Radiological signs :
Opacification
/Perselubungan in the
lower part of
hemithorax, blunting or
filled of sinus
costophrenicus,
obliterate of diaphragm
Notice: blunting of left
sinus ( Left Pl.eff.)
Pleural effusion :
- Severe/massive :
Radiological signs :
- Massive
opacification/Perselubungan
covers all region of the suffer
hemithorax.
- Mediastinal/heart shifting
toward contralateral side.
- intercostal space widening
Massive pl.eff.(R)
Hydropneumothorax
/ Hematothorax: free
air + fluid / blood in
the pleural cavity
Radiological signs:
-Free air
(hyperluscent) +
fluid level below (air
fluid level)
- Mediastinal shifting
toward contralateral
Air fluid level in L side
( Hydropneumothorax)
Atelectasis
Sinonim : Lung collapse
Clinical signs : dyspnoe, retraction of
thoracic cage
Mechanisms: Obstruction : by foreign bodies, tumor.
Compression : by free air/free fluid, mass.
Contraction : fibrosis, such as old Tb
Radiological signs : Opacification/perselubungan
hemithorax and mediastinal shifting toward
ipsilateral. Intercostal space narrowing
Pulmonary oedema :
Fluid accumulates inside
within alveoli/interalveoli.
May be found on heart
failure, cirrhosis hepatis,
intoxication,etc.
Radiological signs :
Opacification/haziness on
parahilar region
simmetrically.
(Batwing appearance,
butterfly apperance)
Lung oedema +
pl.effusion
Aspiration
pneumonia:
Commonly found on
baby, comatous and
postoperative pasients.
Radiological signs :
- Coarse
infiltrations mostly
in the lower part of
both lungs
Emergency in abdomen
Commonly known as acute abdomen
For examples:
-perforation,
-ileus obstructive and paralytic,
-free fluid or blood within abdominal cavity.
-peritonitis
It is recommended to perform cito foto
abdomen with positions :
1.Erect/half erect,
2.Supine,
3.Left Lateral Decubitus (LLD),
4. and Cross table position (optional).
Perforation
Could be come from:
Gastric ---ulcer,malignity
Small boweltyphoid fever,etc
Large bowelappendix, diverticulitis
From outside of abdominal wall---penetrans
trauma,etc
Perforation
Plain abdominal
radiography in 3
positions
Radiological signs :
Pneumoperitoneum,
free air just
below diaphragm
( subdiaphragm)
- The site of free air
depend on the
patients position.
Obstructive ileus
Sin : mechanical ileus, dynamic ileus
Caused by :
Invaginasi/intussusception
Tumor (intrinsic/extrinsic) of bowel
Volvulus, strangulation
Foreign bodies
Postoperative adhesion
etc
Obstructive ileus
Radiological signs
- Bowel dilatation
/distension in the
upper part of lesion.
- Lower part appears
opaque/lack of air.
- Air fluid levels (+),
- Step ladder
appeaarance
- Hearing bone
Appearance
Obstructive ileus :
Air fluid level
Air fluid levels
Paralytic ileus
Sin. : neurogenic ileus, adynamic ileus
Usually found in :
Peritonitis
Imbalance of electrolyte ;hypokalemia
Spasmolytic medicines
Postlaparotomi
Sequalae of longstanding dynamic ileus
Etc.
Radiological signs :
- Small and large
bowel distension. Air
appears in the entire
segmen of bowels, till
rectum.
- Long air fluid levels
(+)
- Disappear of
properitoneal fat line
in case of peritonitis
Distention of all parts of bowel, gas++
Air fluid level
Trauma
Can cause fracture,dislocation
Fracture : discontinuity of bone,
cartilage or both, associated with
soft tissue injury
Closed X open fracture
Complete X incomplete fracture
More important is the
impact of the fracture to
the soft tissue i.e. spinal
cord, brain tissue, etc
Types of shaft fractures
Bowing
Torus
Impaction/greenstick
Complete with two fragments
Comminuted fractures (>2
fragments)
etc
Types of skull fractures
Linear
Depressed
Brain or intracranial damage must be viewed
by CT-Scan or and MRI :
Epidural bleeding
Subdural bleeding
Intracerebral bleeding
Subarachnoid bleeding
Epidural hematoma
Subdural hematoma
Subarachnoid bleeding
Trauma of Spine
Cervical ( most important)
Thoracal
Lumbal
Sacrum
Fracture/dislocation of cervical
spine:
This fracture is very dangerous because of
the risk to the spinal cord injure /pressure
Routine position : AP and lateral view
Fracture of C1 or C7 T1, usually needed
special view :
- C 1 by Open mouth position
- C7 T 1 by swimmers position
Dislocation:
cervical dislocation
Anterior dislocation in
normal cervical, from
lateral view
C3 level ( lateral view )
C1 fracture
Fracture of C1 , as in
Jefferson fr. Can be
identified by open
mouth position
Fraktur
Jefferson:
Normal
Please look for more
information about :
Types of cervical fracture/dislocation
Types of thoraco-lumbal
fracture/dislocation
Traumatic intracranial hemorrhage
In : - Grainger and Allisons Diagnostic
Radiology
- Textbook of radiology (David Sutton)
- etc
Thank You
