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Lewis BT, Herr KD, Hamlin SA, Henry T, Little BP, Naeger DM, Hanna TN. Imaging Manifestations of Chest Trauma. Radiographics 2021; 41:1321-1334. [PMID: 34270354 DOI: 10.1148/rg.2021210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Trauma is the leading cause of death among individuals under 40 years of age, and pulmonary trauma is common in high-impact injuries. Unlike most other organs, the lung is elastic and distensible, with a physiologic capacity to withstand significant changes in contour and volume. The most common types of lung parenchymal injury are contusions, lacerations, and hematomas, each having characteristic imaging appearances. A less common type of lung injury is herniation. Chest radiography is often the first-line imaging modality performed in the assessment of the acutely injured patient, although there are inherent limitations in the use of this modality in trauma. CT images are more accurate for the assessment of the nature and extent of pulmonary injury than the single-view anteroposterior chest radiograph that is typically obtained in the trauma bay. However, the primary limitations of CT concern the need to transport the patient to the CT scanner and a longer processing time. The American Association for the Surgery of Trauma has established the most widely used grading scale to describe lung injury, which serves to communicate severity, guide management, and provide useful prognostic factors in a systematic fashion. The authors provide an in-depth exploration of the most common types of pulmonary parenchymal, pleural, and airway injuries. Injury grading, patient management, and potential complications of pulmonary injury are also discussed. ©RSNA, 2021.
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Affiliation(s)
- Brittany T Lewis
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Keith D Herr
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Scott A Hamlin
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Travis Henry
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Brent P Little
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - David M Naeger
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Tarek N Hanna
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
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Ayoob AR, Lee JT, Herr K, LeBedis CA, Jain A, Soto JA, Lim J, Joshi G, Graves J, Hoff C, Hanna TN. Pancreatic Trauma: Imaging Review and Management Update. Radiographics 2020; 41:58-74. [PMID: 33245670 DOI: 10.1148/rg.2021200077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.
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Affiliation(s)
- Andres R Ayoob
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - James T Lee
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Keith Herr
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Christina A LeBedis
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Ashwin Jain
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Jorge A Soto
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Jihoon Lim
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Gayatri Joshi
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Joseph Graves
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Carrie Hoff
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Tarek N Hanna
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
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Thorisdottir S, Oladottir GL, Nummela MT, Koskinen SK. Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center. Acta Radiol 2020; 61:1309-1315. [PMID: 32046497 DOI: 10.1177/0284185120902389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. PURPOSE To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. MATERIAL AND METHODS Retrospective analysis (2013-2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. RESULTS Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16-88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only (P = 1). CONCLUSION Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.
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Affiliation(s)
- Sigurveig Thorisdottir
- Functional Unit for Trauma and Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gudrun L Oladottir
- Functional Unit for Trauma and Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mari T Nummela
- HUS Medical Imaging, Helsinki University Hospital, Helsinki, Finland
| | - Seppo K Koskinen
- Functional Unit for Trauma and Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Durso AM, Paes FM, Caban K, Danton G, Braga TA, Sanchez A, Munera F. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol 2020; 130:109187. [DOI: 10.1016/j.ejrad.2020.109187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
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Usefulness of CT-scan in the management of chest stab trauma: a prospective observational study. Eur J Trauma Emerg Surg 2019; 46:1385-1391. [PMID: 31407022 DOI: 10.1007/s00068-019-01203-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The management of chest stab wounds necessitates to perform an efficient imaging strategy. Compared to chest X-ray, computed tomography (CT) scan has a higher sensitivity. Nevertheless, the utility of diagnosing occult injuries remains controversial. Previous studies reported very different rates of management modifications induced by CT-scan. Indeed, no study specifically addressed the issue of ruling out traumatic diaphragmatic injury (TDI) in the specific population of chest stab trauma. The aim of the study was to evaluate the rate of thoracic procedures induced or guided by the results of thoracic CT-scan in the specific population of chest stab wounds. Secondary objective was to evaluate the utility of CT-scan for the diagnosis of TDI. METHODS We conducted a prospective observational study. All consecutive patients referred to the acute care unit were included. We recorded the general characteristics of patients, the localization of wounds, all imaging tests, the final injury diagnosis, and the patients' management. We compared patients with modifications of management induced by CT-scan results to other patients. We evaluated the performance of CT-scan for the diagnosis of TDI by calculating its sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). RESULTS 153 patients were included. There were 92 patients with normal chest X-ray. 67 of them received a CT-scan. 34 (51%) patients had an abnormal CT-scan, including 19 (21%) patients with thoracic new findings, with 3 (4.5%) modification of management. There were 50 patients who had an abnormal chest X-ray. 31 of them received a CT-scan, and 31 (100%) had an abnormal CT-scan, including 19 thoracic new findings, with 11 (36%) modifications of management. The diagnostic performance of CT-scan for TDI was: sensitivity 50%; specificity 95%; NPV 72%; PPV 88%. CONCLUSIONS In chest stab trauma, CT-scans may be unnecessary outside the thoracoabdominal zone when chest X-ray is normal. In other cases, CT-scan seems to have an impact on the decision-making. In case of thoracoabdominal wounds, CT-scan helps to detect intra-abdominal injuries. The performance of CT-scan to diagnose TDI is not high enough to reliably rule out all TDI.
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Balakrishnan S. Highlights from the scientific and educational abstracts presented at the ASER 2017 annual scientific meeting and postgraduate course. Emerg Radiol 2018; 25:219-225. [PMID: 29594817 DOI: 10.1007/s10140-018-1599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
The annual meeting of the American Society of Emergency Radiology (ASER) took place in Toronto, Canada, on September 6 through September 9, 2017. Attendees represented the USA as well as international emergency radiology communities, including those from academic, private practice, and teleradiology settings. There were several "members in training" in attendance as well. The meeting again featured the "Trauma Head to Toe" 2-day didactic course, highlighting various important topics on imaging of traumatic injuries. Scattered throughout the 4 days were several poster and case of the day presentations, scientific sessions, and self-assessment modules. The following is a summary of the educational posters and scientific papers.
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Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency Radiology, Keck Hospital of University of Southern California, Los Angeles, CA, USA.
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Matalon SA, Askari R, Gates JD, Patel K, Sodickson AD, Khurana B. Don't Forget the Abdominal Wall: Imaging Spectrum of Abdominal Wall Injuries after Nonpenetrating Trauma. Radiographics 2017; 37:1218-1235. [PMID: 28696855 DOI: 10.1148/rg.2017160098] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury). These injuries are often overlooked clinically because of (a) a lack of findings at physical examination or (b) distraction by more-severe associated injuries. However, these injuries are important to detect because they are highly associated with potentially grave visceral and vascular injuries, such as aortic injury, and because their detection can lead to the diagnosis of these more clinically important grave traumatic injuries. Failure to make a timely diagnosis can result in delayed complications, such as bowel hernia with potential for obstruction or strangulation, or misdiagnosis of an abdominal wall neoplasm. Groin injuries, such as athletic pubalgia, and inferior costochondral injuries should also be considered in patients with abdominal pain after nonpenetrating trauma, because these conditions may manifest with referred abdominal pain and are often included within the field of view at cross-sectional abdominal imaging. Radiologists must recognize and report acute abdominal wall injuries and their associated intra-abdominal pathologic conditions to allow appropriate and timely treatment. © RSNA, 2017.
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Affiliation(s)
- Shanna A Matalon
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Reza Askari
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Jonathan D Gates
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Ketan Patel
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Aaron D Sodickson
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Bharti Khurana
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
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