RADIOLOGICAL INVESTIONS IN A TRAUMA VICTIM_113032.pptx

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1. RADIOLOGICAL INVESTIGATIONS IN A TRAUMA VICTIM MODERATOR: Dr. Nilufur Islam. PRESENTERS: Vaibhav Khatri (Roll no. 05)

2. IMPORTANCE OF RADIOLOGICAL INVESTIGATIONS IN TRAUMA CASES Radiological investigations are an essential component in the evaluation and management of traumatic injuries. These investigations provide valuable information to help identify and diagnose injuries that may not be immediately apparent on clinical examination. The following are some of the key reasons why radiological investigations are important in trauma: Identify hidden injuries: Radiological investigations such as X-rays, CT scans, and MRI can help identify injuries that are not visible on physical examination, such as fractures, dislocations, or internal organ damage.

3. Determine the extent of injury: Radiological investigations can help determine the extent of an injury, which can assist in determining the appropriate treatment plan. For example, a CT scan can help identify the severity of a head injury, which can guide decisions about the need for surgery or other interventions. Monitor treatment progress: Radiological investigations can be used to monitor the effectiveness of treatment and to identify any new or worsening injuries. Guide procedures: Radiological investigations can also guide procedures such as joint aspiration, biopsies, and drain insertions.

4. IMAGING MODALITIES Radiology plays a crucial role in evaluating and diagnosing trauma cases. It provides valuable information about the extent of injuries, helps guide treatment decisions, and assists in monitoring patient progress. Here are some common modalities of radiology used in trauma cases: X-ray: X-rays are often the initial imaging modality used in trauma cases. They are quick and readily available, making them suitable for assessing fractures, dislocations, and identifying the presence of foreign bodies. X-rays are commonly performed on the chest, spine, pelvis, and extremities. Ultrasound: Ultrasound is a real-time imaging modality that is often used in trauma cases for its ability to quickly evaluate specific regions of the body. It is commonly used to assess abdominal injuries, such as the presence of fluid or solid organ injuries. Ultrasound is also helpful for evaluating vascular injuries and detecting the presence of blood clots.

5. Computed Tomography (CT): CT scans are widely utilized in trauma cases due to their ability to provide detailed cross-sectional images of the body. CT scans are particularly useful for evaluating head injuries, spinal injuries, chest injuries, abdominal injuries, and pelvic fractures. They can detect injuries to organs, blood vessels, and bones. Magnetic Resonance Imaging (MRI): While MRI is not typically used as a first-line imaging modality in acute trauma situations, it can be valuable for evaluating specific injuries or complications. MRI provides detailed images of soft tissues, making it useful for assessing spinal cord injuries, ligamentous injuries, joint injuries, and soft tissue injuries. Angiography: Angiography involves the injection of a contrast dye into blood vessels to visualize their structure and identify any abnormalities. It is frequently used in trauma cases to evaluate vascular injuries, such as arterial bleeding or vascular dissection. Angiography can help guide interventional radiology procedures or surgical interventions.

6. X-RAY IN TRAUMA CASES X-rays are commonly used in trauma cases to assess and diagnose various types of injuries. Here are some key points about the use of X-rays in trauma cases: 1. Fracture detection 2. Dislocation identification 3.Joint evaluation 4. Alignment assessment 5. Evaluation of bone stability 6. Foreign body detection

7. COLLES FRACTURE The key X-ray findings associated with a Colles fracture are: 1.Distal Radius Fracture 2 .Dorsal Angulation (fractured end tilts upward or towards the back of the hand) 3. Radial Shortening (slight decrease in the overall length of the radius) 4. Articular Incongruity (irregularity or gap in the joint space) 5. Soft Tissue Changes (swelling or hematoma formation)

8. HANGMAN’S FRACTURE The Hangman's fracture, also known as traumatic spondylolisthesis of the axis, is a specific type of cervical spine fracture Fracture of the pars interarticularis of the C2 vertebra (axis) Bilateral or unilateral fracture of the pedicles of C2 Forward displacement of C2 (vertebral body or odontoid process) relative to C3 Loss of alignment between C2 and C3 vertebrae ( spondylolisthesis )

9. FRACTURE OF NECK OF FEMUR The fracture of the neck of the femur, also known as a hip fracture, is a common injury in the elderly population. Here are the key X-ray findings associated with a fracture of the neck of the femur : Disruption of the continuity of the neck of the femur Abnormal angulation or displacement of the fracture fragments Loss of trabecular bone pattern: The normal trabecular pattern seen in the neck of the femur may be disrupted or distorted due to the fracture. Varus or valgus deformity: Depending on the direction of displacement, the fracture may result in the proximal femur angling inward ( varus ) or outward ( valgus ) in relation to the shaft of the femur.

10. BOXER’S FRACTURE The key X-ray findings associated with a Boxer's fracture, which is a fracture of the metacarpal bone in the hand: Fracture of the fifth metacarpal bone (commonly referred to as the "pinky" or little finger metacarpal) Transverse or oblique fracture line across the metacarpal bone Angulation or apex dorsal angulation : The distal fragment of the metacarpal bone is displaced toward the back of the hand. Cortical disruption: The fracture line disrupts the smooth contour of the metacarpal bone's cortical surface.

11. RIB FRACTURE The findings of rib fractures on X-ray may include: Discontinuity or breaks in the normal contour of the ribs. Visible fractures lines or sharp angles in the ribs. Misalignment or displacement of fractured rib segments. Callus formation, which is the healing response characterized by new bone growth at the fracture site.

12. X-RAY FINDINGS IN ABDOMINAL TRAUMA Free air: Presence of free air under the diaphragm can indicate a perforation of the gastrointestinal tract, such as a ruptured stomach or bowel. It appears as a dark area on X-ray images. Abnormal gas patterns: Unusual gas patterns in the abdomen, such as air-fluid levels or abnormal distribution of gas, may suggest injury or perforation of the intestines or other abdominal organs.

13. USG IN TRAUMA CASES FAST(Focused Assessment with Sonography for Trauma) is specifically performed in trauma patients as a focused ultrasound examination to assess for the presence of free fluid in the abdomen and chest, which can be indicative of internal bleeding. It differs from a normal ultrasound (USG) in terms of its purpose, speed, and focused approach.

14. FAST is particularly useful in the initial assessment of trauma patients and can detect the presence of blood ( hemoperitoneum ) or other fluids. FAST can quickly identify potentially life-threatening injuries such as liver or splenic lacerations, intra-abdominal bleeding, or free fluid in the pelvis.

15. CT(COMPUTED TOMOGAPHY) SCAN IN TRAUMA CASES CT scans (Computed Tomography scans) are widely used in trauma cases due to their ability to provide detailed cross-sectional images of the body. Here's how CT scans are utilized in trauma cases: Rapid and comprehensive imaging Detection of internal injuries Fracture evaluation Evaluation of spinal injuries Evaluation of chest and abdominal injuries Visualization of traumatic brain injuries

16. TYPES OF CT SCAN CT (Computed Tomography) scans are versatile imaging techniques that can be used to examine various parts of the body. Here are some different types of CT scans commonly performed: Head CT (Cranial CT) Chest CT (Thoracic CT) Abdominal CT Pelvic CT Spine CT Sinus CT Extremity CT

17. CT SCAN IN HEAD INJURY CT scans play a crucial role in the evaluation of head injuries. They are often the imaging modality of choice for assessing traumatic brain injuries (TBIs). Here's how CT scans are utilized in the context of head injury: Detection of skull fractures Evaluation of intracranial hemorrhage Assessment of brain contusions Evaluation of brain swelling and edema Identification of other traumatic brain abnormalities

18. CT SCAN FINDINGS IN HEAD INJURY CT scan findings observed in head injuries: Skull fractures: CT scans can identify different types of skull fractures, such as linear fractures (simple cracks in the skull), depressed fractures (fragments of bone are pushed inward), and basilar fractures (fractures at the base of the skull). This is an image of brain showing bone window which shows fracture in squamous temporal bone.

19. Epidural hematoma: An epidural hematoma is a collection of blood between the skull and the outer covering of the brain ( dura ). On a CT scan, it appears as a lens-shaped or biconvex hematoma with a characteristic convex margin and compression of the underlying brain tissue.

20. Subdural hematoma: Subdural hematoma refers to bleeding between the brain and its outer covering ( dura ). On a CT scan, it typically appears as a crescent-shaped or concave hematoma with varying degrees of thickness and midline shift. Acute subdural hematomas may appear hyperdense , while chronic subdural hematomas may appear hypodense .

21. Subarachnoid hemorrhage: Subarachnoid hemorrhage involves bleeding into the space between the brain and its membranes ( arachnoid ). On a CT scan, it is characterized by diffuse or localized areas of high density, often seen around the brain sulci or within the cisterns.

22. Brain contusions: CT scans can reveal brain contusions, which are areas of bruised or damaged brain tissue. Contusions may appear as regions of increased density or focal swelling within the brain parenchyma.

23. RADIOLOGICAL INVESTIGATIONS IN THORAX Some common radiological investigations used in thoracic trauma: Chest X-ray: Chest X-ray is typically the initial imaging modality used in evaluating thoracic trauma. It provides a quick assessment of the bony structures, lungs, and mediastinum . Chest X-rays can help identify fractures, lung contusions, pneumothorax (collapsed lung), hemothorax (blood in the chest cavity), pleural effusion (abnormal fluid accumulation in the pleural space), and mediastinal widening. Computed Tomography (CT) Scan: CT scan provides detailed cross-sectional images of the thoracic region and is more sensitive in detecting various thoracic injuries. It is particularly useful in evaluating complex fractures, assessing the extent of pulmonary contusions, identifying vascular injuries, and detecting injuries to the mediastinum . CT angiography can be performed to evaluate for vascular injuries and identify sources of bleeding.

24. PNEUMOTHORAX FINDINGS When evaluating pneumothorax , which is the presence of air in the pleural space causing lung collapse, several radiological investigations can be used to confirm the diagnosis and assess the extent of the condition. Chest X-ray: Chest X-ray is often the initial imaging modality used to diagnose pneumothorax . It can reveal characteristic findings such as the absence of lung markings at the periphery of the lung, a visible pleural line (the visceral and parietal pleura separated by air), and lung collapse. Chest X-rays can help determine the size and location of the pneumothorax and can also identify associated complications such as tension pneumothorax or pneumomediastinum .

25. Computed Tomography (CT) Scan: CT scan is a more sensitive imaging modality and can provide detailed information about the presence and extent of a pneumothorax . It can accurately determine the size and location of the pneumothorax and can also help identify associated injuries or underlying lung pathology. CT scans are particularly useful in cases where the diagnosis is uncertain based on the chest X-ray findings or when additional information is needed for treatment planning

26. HEMOTHORAX FINDINGS Hemothorax is the accumulation of blood in the pleural space. It can result from trauma to the chest, causing injury to blood vessels, lung tissue, or the heart. Hemothorax can lead to decreased lung function and may require drainage. Chest X-ray: Chest X-ray is often the initial imaging modality used to evaluate hemothorax . It can reveal findings such as blunting of the costophrenic angle (where the diaphragm meets the ribcage), opacification of the affected hemithorax , and displacement or compression of the lung tissue. Chest X-rays can help determine the presence of hemothorax and assess the approximate amount of blood accumulation.

27. Computed Tomography (CT) Scan: CT scan provides detailed cross-sectional images of the chest and is more sensitive in detecting hemothorax compared to a chest X-ray. CT scans can accurately assess the location, extent, and underlying causes of hemothorax . They can also help identify associated injuries, such as rib fractures or organ damage. CT angiography may be considered if there is concern for active bleeding or vascular injury

28. CECT FOR ABDOMEN CECT stands for Contrast-Enhanced Computed Tomography. CECT abdomen refers to a specific imaging study that involves performing a computed tomography (CT) scan of the abdomen with the use of a contrast agent to enhance the visibility of certain structures and pathology. During a CECT abdomen, a contrast agent, usually iodine-based, is administered either orally or intravenously to highlight blood vessels, organs, and other structures in the abdomen. CECT abdomen is commonly performed in cases of abdominal trauma to assess for any internal injuries, such as organ lacerations, hematomas, or the presence of free fluid or gas. It helps guide surgical interventions or other management decisions.

29. MAGNETIC RESONANCE IMAGING (MRI) MRI is typically not done in trauma cases but in case of Diffuse Axonal Injury (DAI) of the brain which is not detected by CT scan, MRI helps in evaluation of such cases.

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