Journal 1 ppt rib injury trauma - Copy.pptx

rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatment
rib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, Complications,
and Treatmentrib trauma
thorax
rib injury
complication
treatment
Traumatic Rib Injury: Patterns,
Imaging Pitfalls, c

1. Introduction The ribs are an important component of the thoracic cage ; rib trauma can jeopardize the lungs, mediastinum, and other vital thoracoabdominal organs , which are otherwise protected by the bony thorax. Thoracic trauma accounts for approximately 25% of total trauma-associated mortality in the United States. For patients in the emergency department, it is vital to not only identify the different patterns of rib injuries but also alert the clinician about organ-specific injury and the potential for associated complications . Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

2. Rib Anatomy Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

3. Ribs in the Physiology of Respiration Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

4. Imaging for Suspected Rib Injuries

5. Ultrasonography Figure 3. US image shows a superficial hematoma (between calipers ) associated with cortical disruption of the rib (arrowhead). Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

6. Magnetic Resonance Imaging Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

7. Congenital Malformations and Anatomic Variants of Ribs Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

8. Supernumerary Rib Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

9. Bifid Rib Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

10. Vestigial Rib & Bone Bridging Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

11. Nontraumatic Mimics Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

12. Fibrous Dysplasia Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

13. Paget Disease Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 10. Axial CT image shows a thickened cortex (arrowhead) and disorganized and thickened matrix trabeculations (arrow) of the rib, findings typical of Paget disease, which does not commonly involve the ribs.

14. Metastatic Disease Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 12. Axial CT image through the lung bases shows diffusely sclerotic osseous structures, including the ribs. This appearance is consistent with metastases to bone, in this case secondary to prostate cancer. Careful examination is warranted to identify pathologic fractures in patients with widespread metastatic disease.

15. Langerhans Cell Histiocytosis Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 11. Axial CT image through the lung base and upper abdomen shows a subtle lucent expansile bone lesion that demonstrates a subtle periosteal reaction (arrow), compared with normal rib on the contralateral side (arrowhead). Langerhans cell histiocytosis was diagnosed on the basis of histopathologic examination of a tissue sample.

16. Chondrosarcoma Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

17. Osteosarcoma Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

18. Patterns of Rib Injury Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

19. Lower rib injury Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

20. Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Imaging Features of Rib Fracture

21. Stress Rib F ractures (SRFs) Stress rib fractures (SRFs) are overuse injuries that occur when there is abnormal force on normal underlying bone. These begin with a small stress on the bone, which with repeat injury results in micro trabecular fracture that may progress to rib fracture. These injuries are rare, although possibly underdiagnosed, and are most often seen in workers who perform repetitive motions and in athletes, including rowers, golfers, tennis players, and baseball players.

22. Stress Fracture Figure 16. Axial T2-weighted MR image of the thorax shows a nondisplaced fracture of the anterior rib, with disruption of the cortex (arrow) seen as low signal intensity. Subtle high signal intensity indicates edema at the site of patient pain. A stress injury would lack the linear low-signal-intensity line and may be evidenced only by high-signal-intensity edema at T2-weighted MR imaging. Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

23. Buckle Fracture Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

24. Nondisplaced Rib Fracture Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 18. Axial CT image shows a nondisplaced fracture indicated by a sharp, low-attenuation, thin line through the cortices and matrix (arrow). There are no displaced fragments. Treatment for this type of injury is conservative management.

25. Displaced Rib Fracture Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 19. Volume-rendered CT image shows a significantly displaced posterior fragment of bone, with the anterior segment projecting toward the soft tissue of the chest wall (arrow) and the posterior segment projecting toward the thoracic cavity. Displaced fractures demonstrate cortical disruption in association with alignment abnormalities.

26. Segmental Rib Fracture (Including Flail Chest) Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 20. Axial contrast-enhanced CT image in a trauma patient shows two separate fractures (arrows) in the same rib, which are termed segmental rib fractures , and an extrapleural hematoma (arrowheads).

27. Pathologic Rib Fracture Figure 21. Axial CT image at the level of the right pulmonary artery in a woman with primary right breast cancer who underwent mastectomy and reconstruction shows metastatic disease involving the lymph nodes and osseous structures. There is an osseous metastasis with soft tissue involving the inner cortex and matrix (arrowhead) and pathologic fracture of the abnormal rib (arrow). Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

28. Costochondral Injury Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 22. Coronal CT image shows chondrosternal rib disruption of the right first rib (arrow) and dislocation of the sternoclavicular joint (arrowhead). Injuries can occur at the costochondral and chondrosternal junctions; those involving the chondrosternal junction are termed rib disruptions .

29. Child Abuse/Nonaccidental Injury–related Rib Fractures Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 32. Chest radiograph in a child with suspected nonaccidental trauma shows multiple fractures (arrow indicates one example) along the lateral aspect of the right side of the chest. The multiple fractures are highly specific findings for abuse, as is the posteromedial fracture (arrowhead).

30. COMPLICATION

31. Pneumothorax Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 24. Frontal chest radiograph shows fractures of the first through third ribs, with extra pleural hematoma and right-sided pneumothorax. A common complication of blunt traumatic injury with rib fractures is pneumothorax. Estimation of the percentage of volume in the thoracic cavity occupied by pneumothorax can be performed with findings from a frontal chest radiograph and use of the following formula: Y = 4.2 + [4.7 · ( A + B + C )] , where Y is the percentage of pneumothorax volume in the thoracic cavity, A is the distance of the visceral pleura to the apex, B is the distance of the visceral pleura to the chest wall above the line demarcating the middle of the collapsed lung, and C is the distance of the visceral pleura to the chest wall below the line demarcating the middle of the collapsed lung.

32. Hemothorax Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 23. Axial CT images show sequelae of trauma. (a) Bone window image shows an intermediate- grade buckle fracture (arrowhead). (b) Soft-tissue window image at the same level shows a moderate-sized right hemopneumothorax (arrowhead) with subcutaneous emphysema. There were additional displaced fractures in the anterior aspect of the thorax below the level of this section (not shown).

33. Hematoma Extra pleural Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 20. Axial contrast-enhanced CT image in a trauma patient shows two separate fractures (arrows) in the same rib, which are termed segmental rib fractures , and an extra pleural hematoma (arrowheads).

34. Figure 25. Axial contrast-enhanced CT image at the level of the left atrium shows several traumatic injuries, including a subcutaneous chest wall hematoma (arrowheads), a minimally displaced fracture (black arrow), and a subtle extrapleural hematoma (white arrow). Low-attenuation fluid seen posteriorly is consistent with layering pleural effusion. Hematoma Extra pleural

35. Parenchymal Contusion & Laceration Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

36. Vascular Injury Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Figure 27. Vascular injury in a patient who fell from a significant height and landed on his left side. Axial contrast enhanced CT image (mediastinal window) at the lung bases shows a displaced left rib fracture. There is a blush of contrast agent (arrow) in the pulmonary parenchyma, with a small tract toward the cortex of the fractured rib. The finding was presumably due to a lacerated intercostal artery. Additional findings at this level included an abnormal cardiac contour suggesting tamponade physiology due to a large pneumothorax (not shown) that could not be identified with this window setting.

37. Vascular Injury Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

38. Subacute Rib Injury Complications Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

39. Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Heterotopic Ossification

40. Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Callus Formation

41. Radiation Changes Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

42. Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651. Management of Rib Injuries

43. Surgical Treatment

44. Conclusion Rib trauma is a complex and important topic. Attention to appropriate pitfalls, patterns, and complications will allow improved diagnostic accuracy and added value in the care of thoracic trauma patients. Talbot, B. S., Gange Jr, C. P., Chaturvedi, A., Klionsky , N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment.  Radiographics ,  37 (2), 628-651.

45. THANK YOU