17 thoracic trauma andrelated topics
TRANSCRIPT
17 Thoracic Trauma andRelated Topics
Dr. Muhammad Bin ZulfiqarPGR IV FCPS Services Institute of Medical Sciences / [email protected] & ALLISON’S DIAGNOSTIC RADIOLOGY
• FIGURE 17-1 Haemopericardium and acute ■traumatic aortic injury. CT image following blunt trauma with a haemopericardium (A). The patient also sustained an acute traumatic injury with a dissection visible on axial images (B, C) and on a coronal reformatted image (D).
• FIGURE 17-1 Haemopericardium and acute ■traumatic aortic injury. CT image following blunt trauma with a haemopericardium (A). The patient also sustained an acute traumatic injury with a dissection visible on axial images (B, C) and on a coronal reformatted image (D).
• FIGURE 17-2 Cardiac herniation. Chest radiograph ■following a fall from a height which resulted in traumatic pericardial rupture with herniation of the heart into the right hemithorax. Other injuries including rib and spinal fractures are present.
• FIGURE 17-3 Aortic injury with mediastinal haematoma. Chest ■radiograph in a patient with a post-traumatic aortic rupture and mediastinal haematoma. Features present include a widened mediastinum, filling in of the aortopulmonary bay and the development of a left apical pleural cap. (Courtesy of Dr L. C. Morus, Birmingham, UK.)
• FIGURE 17-4 Pneumomediastinum. Chest radiograph (A) with ■axial (B) and coronal reformatted CT (C) images demonstrating pneumomediastinum following blunt chest trauma.
• FIGURE 17-4 Pneumomediastinum. Chest ■radiograph (A) with axial (B) and coronal reformatted CT (C) images demonstrating pneumomediastinum following blunt chest trauma.
• FIGURE 17-5 ‘Fallen lung sign’. Chest radiograph ■in a boy with complete rupture of the right main bronchus following blunt chest trauma. The right lung is seen sagging to the floor of the right hemithorax.
• FIGURE 17-6 Pneumothorax on supine chest radiograph. Left sided ■pneumothorax seen on a supine chest radiograph demonstrating the deep sulcus sign and an unusually sharp left heart border.
• FIGURE 17-7 Lung contusion, haemothorax and rib ■fractures. Axial (A) and coronal reformatted (B) CT images demonstrating airspace opacity due to post-traumatic contusion. Also seen is an associated haemothorax and axial bone window images reveal associated rib fractures (C).
• FIGURE 17-7 Lung contusion, haemothorax and rib ■fractures. Axial (A) and coronal reformatted (B) CT images demonstrating airspace opacity due to post-traumatic contusion. Also seen is an associated haemothorax and axial bone window images reveal associated rib fractures (C).
• FIGURE 17-8 Pulmonary haematoma. Chest ■radiograph demonstrating extensive contusion in the right lung (A). A repeat radiograph one week later (B) reveals clearing of the contusion along with a right lower zone pulmonary haematoma.
• FIGURE 17-9 Traumatic pneumatocele. Axial CT ■image in a patient who sustained a blunt injury to the left side of the chest with bilateral contusion and a left-sided haemothorax and pneumothorax. There are post-traumatic pneumatoceles in the right lung which occurred as a countercoup injury.
• FIGURE 17-10 Lung ■herniation. CT image following blunt trauma to the left side of the chest demonstrating an anterior lung herniation. This can be seen on axial (A) and coronal reformatted (B) images.
• FIGURE 17-11 Extra-pleural haematoma. ■CT image demonstrating extra-pleural haematoma in association with right-sided rib fractures (arrowhead).
• FIGURE 17-12 Diaphragmatic rupture. Chest radiograph ■ showing a left-sided diaphragmatic rupture. Bowel can be seen herniating into the left hemithorax, the mediastinum is displaced to the right and there is a nasogastric tube seen coiled within an intrathoracic stomach. (Courtesy of Dr. L.C. Morus, Birmingham, UK.)
• FIGURE 17-13 Right hemidiaphragmatic rupture. Axial (A) ■and coronal reformatted (B) CT images demonstrating rupture of the right hemidiaphragm following blunt trauma. The liver herniates into the right hemithorax. Rib fractures and low-density regions in the liver indicating hepatic contusion are also noted on the axial image.
• FIGURE 17-14 Left hemidiaphragmatic rupture. Rupture of the ■left hemidiaphragm following blunt trauma due to a road accident. The chest radiograph reveals left mid-zone contusion (A). CT images in the axial plane (B) and a sagittal reformatted image (C) reveal a ruptured diaphragm on the left side with the stomach herniating through into the thorax. The stomach is constricted as it passes through the diaphragmatic tear—the so-called ‘collar sign’.
• FIGURE 17-14 Left hemidiaphragmatic rupture. Rupture of the ■left hemidiaphragm following blunt trauma due to a road accident. The chest radiograph reveals left mid-zone contusion (A). CT images in the axial plane (B) and a sagittal reformatted image (C) reveal a ruptured diaphragm on the left side with the stomach herniating through into the thorax. The stomach is constricted as it passes through the diaphragmatic tear—the so-called ‘collar sign’.
• FIGURE 17-15 Aspiration. CT image of ■multifocal air-space opacity due to aspiration.
• FIGURE 17-16 Acute respiratory distress ■syndrome (ARDS). Chest radiograph showing bilateral air-space opacity in a patient with ARDS related to trauma.
FIGURE 17-17 CT findings in ARDS. ■CT images of two patients with acute respiratory distress syndrome (ARDS). In the first image (A) the patient’s ARDS was due to an extra-pulmonary cause and the CT shows increased opacification in the posterior, dependent portions of the lungs and ground-glass opacity more anteriorly. A right-sided intercostal tube is also present and part of a Swan–Ganz catheter can be seen in the left main pulmonary artery. In the second patient (B) whose ARDS was related to pulmonary infection there is patchy air-space opacity present with no gradation from dependent to non-dependent lung being seen.
• FIGURE 17-18 Post-recovery ARDS. CT ■image following recovery from ARDS. Reticular opacities and traction bronchiectasis can be seen anteriorly indicating fibrosis.
• FIGURE 17-19 ■Bronchopleural fistula. A chest radiograph series (A–C) in sequential order showing an initial rise in the air–fluid level in the left hemithorax following pneumonectomy but then a sudden fall due to the development of a postoperative bronchopleural fistula.
• FIGURE 17-19 Bronchopleural fistula. A chest ■radiograph series (A–C) in sequential order showing an initial rise in the air–fluid level in the left hemithorax following pneumonectomy but then a sudden fall due to the development of a postoperative bronchopleural fistula.
• FIGURE 17-20 Bronchopleural fistula. CT image ■demonstrating a right-sided bronchopleural fistula following a pneumonectomy. A track of air close to the right main bronchus can be seen due to the presence of the fistula (arrow).
• FIGURE 17-21 Post-■lobectomy infection. A postoperative CT image demonstrates a pleural fluid collection with pleural thickening and contrast enhancement indicating a postoperative empyema (A). The infection progressed and invaded the chest wall (B).
• FIGURE 17-22 ■Recurrence of original disease. An early CT image following a left pneumonectomy for non-small cell lung cancer demonstrates a normal post-pneumonectomy space (A). On a later follow-up examination there is a soft-tissue mass within the pneumonectomy space, which was shown by biopsy to represent recurrent tumour (B).
• FIGURE 17-23 Appearances following lung ■volume reduction surgery. Postoperative CT image after lung volume reduction surgery. The staple line with bovine pericardium buttresses can be seen (arrowhead).
• FIGURE 17-24 Post-lung transplant obliterative ■bronchiolitis. The lungs are overinflated with mild cylindrical bronchiectasis and attenuation of pulmonary vessels. Areas of patchy ground glass opacity in the periphery of the lung were thought to be due to cytomegalovirus pneumonitis. The patient died within a month of this examination.
