Professional Documents
Culture Documents
Skull Fracture
Tipe Fracture :
Liniar Depressed Basal Clinical signs:rhinorrhoea, otorrhoea, Battles sign (retro-auricular haematoma),Racoon Eyes
Facial Fracture-Maksilla
Facial Fracture-Mandibulla
Cerebral Contusion
Radiological features
Non-contrast
computed tomography (CT) useful in the early posttraumatic period. Contusions are seen as multiple focal areas of low or mixed attenuation intermixed with areas of increased density representing haemorrhage ( Salt & Pepper app) True extent becomes apparent over time with progression of cell necrosis and oedema. Magnetic resonance imaging (MRI) is the best modality for demonstration of oedema and contusion distribution.
Epidural Hematoma
Radiological features
CT signs include a biconvex hyperdense elliptical collection with a sharply defined edge. Mixed density suggests active bleeding. The haematoma does not cross suture lines. May separate the venous sinuses/falx from the skull; this is the only type of haemorrhage to do this. Mass effect depends on the size of the haemorrhage and associated oedema. Associated fracture line may be seen.
Subdural Hematoma
Radiological features
CT shows a crescentic fluid collection between the brain and inner skull. Concave inner margin with minimal brain substance displacement. In the acute phase high density; in the subacute phase (24 weeks postinjury) isodense to brain. in the chronic phase (4 weeks post-injury) low density.
Subdural Hematoma
acute
Sub acute
Chronic
Subarachnoid hematoma
Radiological features
Non-contrast CT is sensitive within 45 hours of onset. Look for acute haemorrhage (increased density) in the cortical sulci, basal cisterns, Sylvian fissures, superior cerebellar cisterns and in the ventricles. Older MRI macine is relatively less sensitive than CT Scan, but in modern MR Machine , using special sequences like GRE , FLAIR and DWI is comparable to CT Scan
Subarachnoid Hematoma
MRI FLAIR
CT Scan
CVD /Stroke
Ischemic Stroke Haemorrhage Stroke
Non-contrast CT in the first instance. CT is useful in detecting haemorrhage. Hyperacute/ acute infarct may not visible at CT Scan till > 24 Hours.
Ischemic Stroke
Haemorrhage stroke
Hangman Fracture
Chest
RIB/STERNAL FRACTURE FLAIL CHEST PNEUMOTHORAX HAEMOTHORAX AORTIC RUPTURE DIAPHRAGMATIC RUPTURE/HERNIA FOREIGN BODY PNEUMONIA PULMONARY EDEMA
Rib/sternal fracture
Consider associated injuries: Clavicle/1st or 2nd rib fractures suggest or indicate a significant force, often associated with great vessel, tracheo-bronchial or spinal injury. Sternal injuries may be associated with myocardial contusion. With lower rib fractures, abdominal visceral injury, such as liver, spleen or kidney, may occur.
Flail Chest
Radiological features: Multiple rib fractures. Costochondral separation may not be evident. Signs of secondary complications may be evident pneumothorax,haemothorax, pulmonary contusion, etc
Pneumothorax
Radiological features A luscent area with no vascular marking and Visceral pleural edge visible. Mediastinal shift to contralateral affected side A small pneumothorax may not be visualised on a standard inspiratory film.A expiratory film may be of benefit
HydroPneumothorax
Haemothorax
Accumulation of blood within the pleural space following blunt or penetrating trauma. Radiological features
Blunting of the costophrenic angles seen with approximately 200 ml of blood. General increased opacification of the hemithorax is seen on a supine film.
Haemothorax
Erect Film
Supine Film
Aortic Rupture
Radiological features Chest radiograph
Widened mediastinum
CT Thorax
Vessel wall disruption or extra-
Blurred aortic outline with loss of luminal blood seen in contiguity aortic knuckle. with the aorta is indicative of Left apical pleural cap. rupture. Left sided haemothorax. Depressed left/raised right main stem bronchus. Tracheal displacement to the right
Aortic rupture
Diaphragmatic rupture/hernia
Radiological features
In the acute phase, unless there is visceral herniation,
sensitivity is poor for all imaging modalities. CXR: Air filled or solid appearing viscus above the diaphragm.This may only be recognised following passage of an NG tube. Other features include mediastinal shift away from the affected side, diaphragmatic elevation, apparent unilateral pleural thickening or suspicious areas of atelectasis. In the non-acute setting contrast studies may be useful.
Diaphragmatic rupture/hernia
Diaphragmatic rupture/hernia
Pulmonary Edema
Cardiac : Heart Failure Non-Cardiac : renal failure, IV overload, ARDS, anaphylaxis, near drowning. Radiologic Features:
Alveolar edema :tiny nodular/acinar areas of increased opacity, frank consolidation, batwing appearance
Abdomen
ABDOMINAL AORTIC ANEURYSMS OBSTRUCTION LARGE BOWEL OBSTRUCTION SMALL BOWEL PERFORATION TRAUMA BLUNT ABDOMINALT RAUMA Spleen, Hepatic, and pancreas
CT SCAN USG - FAST Plain Abdomen Film
Radiological features
Abdominal X-ray (AXR): Look for curvilinear egg shell type calcification Ultrasound (US) can accurately determine size.Limited use in assessing rupture. CT is accurate in assessing aneurysm rupture as well as visualising adjacent structures.
(up)Ruptured aortic aneurysm. The arrowheads denote the breach in the wall of the aneurysm (A), with extensive associated retroperitoneal haemorrhage (H).
Obstruction-SBO
Key: disproportionate dilatation of SB, bowel sound Causes : Adhesions,Hernia, Volvulus, Gallstone ileus,Intussusception
Supine
Erect
Cross Table
Obstruction-LBO
Radiologic features
Dilated colon to point of obstruction Multiple air fluid level=Step Ladder Herring Bone appearances Little or no air in rectum/sigmoid Little or no gas in small bowel, Ileocecal valve remains competent. Distended small bowel shows incompetent ileocecal valve
Perforation
Perforation of an air containing hollow viscus will result in free intraperitoneal air Radiological features
AXR : Left Lateral DecubitusAir will then outline the lateral edge of the liver
Perforation
pneumoperitonium
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- Intrahepatic hematoma: * Hyperechoic in the first 24 hours * Hypoechoic & sonolucent thereafter
- Subcapsular hematoma: * Unilateral, along the area of laceration * Anechoic, hypoechoic, septated lenticular, or curvelinear (DD/ascitic fluid) - Capsular disruption - Intraperitoneal fluid
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Ultrasound findings
A crescent-shaped hyperechoic collection along the right lateral aspect of the liver consistent with subcapsular hematoma.
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Grade II
Grade III
Grade IV
Grade V
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Liver laceration with extravasation. An enhanced axial CT scan of the upper abdomen shows a large laceration through the right lobe of the liver (blue arrow), blood in the peritoneal cavity (black arrows) and active extravasation of the intravenous contrast (red arrow). The stomach is labeled "S."
SPLENIC INJURY
Most commonly injured Ultrasound findings: - Splenomegaly, with progressive enlargement - Irregular splenic border - Intrasplenic hematoma - Contusion (splenic inhomogeneity) - Subcapsular and pericapsular fluid collections - Free intraperitoneal blood (disappear 2-4 weeks) - Left pleural effusion - When the spleen returns to normal small irregular foci /normal parenchyma
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SPLENIC INJURY
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SPLENIC INJURY
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Grade V
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Extremities
Trauma : Plain X-Ray, CT Scan, MRI Rule of two (Plain X-Ray)
Clavicle fracture
AC Separation
Scapular Fracture
Galeazzi Fracture
Monteggia Fracture
Shentons line
ANY QUESTIONS??
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