8. radiologi kedaruratan & traumatologi-prof. dr. bachtiar m

7/25/2019 8. Radiologi Kedaruratan & Traumatologi-Prof. Dr. Bachtiar M

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RADIOLOGY OFEMERGENCY &

TRAUMATOLOGI

Prof. Dr. dr. Bachtiar Murtala, Sp.Rad

(K)


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Introduction:

Since Prof.W.C. Roentgen (!"#) in $er%an&'urope dico*ered +ra&, %edical ciencede*eloped rapidl& -oth in diagnoi andtreat%ent.

he role of +ra& and other radiolog& %odalitie ine%ergenc& cae, a /ell a trau%atolog&, aloincreaed. It i *er& di0cult to ae and %a1eprecie diagnoi /ithout radiolog& e+a%ination.

Beide +ra& con*entional, radiolog& ha alo

i%aging %achine uch a CScan, 2ltraound(2S), Magnetic Reonance I%aging (MRI) and3uclear %edicine


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%ergenc& and trau%a cae %a& co%efro% the head and nec1, chet, a-do%en ,and e+tre%itie region.

In thi topic, /e focu to dicu a-outcon*entional +ra& and the %ot co%%oncae in the dail& practice.

2S i the tool of choie in detecting free 4uid

' -lood in the a-do%inal and chect ca*itie, /hile,C can for intracranial he%orrhage'in5ure

caued -& trau%a.


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%ergenc& cae in the chetregion

Pneu%othora+ 6ree air /ithin pleural

ca*it&

Clinical ign : d&pnoe,chet pain, etc

Chet +ra& :

7*acular h&perlucent

Shifting of %ediatinalorgan and heart

to/ard contralateral. 7dditional e+a%. : CScan


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Pleural e8uionPleural e8uion:

9ight( 4uid *olu%e

;


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Pleural e8uion

mild: ?olu%e @ ;cation'Perselubunganin thelo/er part ofhe%ithora+, -lunting or>lled of inucotophrenicu,o-literate of diaphrag%

3otice: -lunting of leftinu ( 9eft Pl.e8.)


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Pleural e8uion : Se*ere'%ai*e:

Radiological ign :

Mai*eopaci>cation'Perselubungan

co*er all region of the u8erhe%ithora+.

Mediatinal'heart hiftingto/ard contralateral ide.

intercotal pace /idening

Mai*e pl.e8.(R)


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A&dropneu%othora+' Ae%atothora+:freeair 4uid ' -lood inthe pleural ca*it&

Radiological ign:6ree air(h&perlucent)

4uid le*el -elo/(air4uid le*el)

Mediatinal hiftingto/ard contralateral

7ir 4uid le*el in 9 ide

( A&dropneu%othora+)


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7telectaiSinoni% : 9ung collape

Clinical ign : d&pnoe, retraction of

thoracic cageMechanisms: Obstruction: -& foreign -odie, tu%or.

Compression: -& free air'free 4uid, %a.

Contraction: >-roi, uch a old -

Radiological ign : =paci>cation'perelu-unganhe%ithora+ and %ediatinal hifting to/ardipsilateral.Intercotal pace narro/ing


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Pul%onar& oede%a :

6luid accu%ulate inide/ithin al*eoli'interal*eoli.Ma& -e found on heart

failure, cirrhoi hepati,into+ication,etc.

Radiological ign :

=paci>cation'haine onparahilar region

i%%etricall&.(Bat/ing appearance,-utter4& apperance)

9ung oede%a pl.e8uion


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7pirationpneu%onia:

Co%%onl& found on

-a-&, co%atou andpotoperati*e paient.

Radiological ign :

Coare

in>ltration %otl&in the lo/er part of-oth lung


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%ergenc& in a-do%enCo%%onl& 1no/n a acute a-do%en

6or e+a%ple:

perforation,ileu o-tructi*e and paral&tic,

free 4uid or -lood /ithin a-do%inal ca*it&.

peritoniti


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It i reco%%ended to perfor% cito fotoabdomen/ith poition :

.rect'half erect, E.Supine,

;.9eft 9ateral Decu-itu (99D),

F. and Cro ta-le poition (optional).


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PerforationCould -e co%e fro%:

$atric ulcer,%alignit&

S%all -o/elGt&phoid fe*er,etc9arge -o/elGappendi+, di*erticuliti

6ro% outide of a-do%inal /allpenetrantrau%a,etc


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Perforation

Plain a-do%inalradiograph& in ;poition

Radiological signs : -

Pneu%operitoneu%,free air 5ut

-elo/ diaphrag%

( u-diaphrag%) he ite of free airdepend on thepatientH poition.


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=-tructi*e ileuSin : %echanical ileu, d&na%ic ileu

Caued -& :

In*aginai'intuuceptionu%or (intrinic'e+trinic) of -o/el

?ol*ulu, trangulation

6oreign -odie

Potoperati*e adheion etc


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=-tructi*e ileuRadiological signs Bo/el dilatation

'ditenion in theupper part of leion.

9o/er part appearopaue'lac1 of air.

7ir 4uid le*el (),

Step ladderappeaarance

JAearing -one7ppearance J


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=-tructi*e ileu :


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7ir 4uid le*el


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7ir 4uid le*el


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Paral&tic ileuSin. : neurogenic ileu, ad&na%ic ileu

2uall& found in :

Peritoniti I%-alance of electrol&te h&po1ale%ia

Spa%ol&tic %edicine

Potlaparoto%i

Seualae of longtanding d&na%ic ileu tc.


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Radiological ign :

S%all and large-o/el ditenion. 7irappear in the entire

eg%en of -o/el, tillrectu%.

9ong air 4uid le*el()

Diappear ofproperitoneal fat line

in cae of peritoniti


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Ditention of all part of -o/el, ga


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7ir 4uid le*el


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rau%aCan caue fracture,dilocation

6racture : dicontinuit& of -one,cartilage or -oth, aociated /ithoft tiue in5ur&

Cloed L open fracture

Co%plete L inco%plete fracture


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More i%portant i thei%pact of the fracture tothe oft tiue i.e. pinalcord, -rain tiue, etc


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&pe of haft fracture

Bo/ing

oru

I%paction'greentic1

Co%plete /ith t/o frag%ent

Co%%inuted fracture (@Efrag%ent)

etc


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&pe of 1ull fracture9inear

Depreed

Brain or intracranial da%age %ut -e *ie/ed-& CScan or and MRI :

pidural -leeding

Su-dural -leeding

Intracere-ral -leeding Su-arachnoid -leeding


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pidural he%ato%a


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Su-dural he%ato%a


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Su-arachnoid -leeding


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rau%a of SpineCer*ical ( %ot i%portant)

horacal

9u%-al

Sacru%


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6racture'dilocation of cer*ical

pine:hi fracture i *er& dangerou -ecaue of

the ri1 to the pinal cord in5ure 'preure

Routine poition : 7P and lateral *ie/6racture of C or C N, uuall& needed

pecial *ie/ :

C -& =pen %outh poition

C N -& /i%%erH poition


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Di l ti


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Dilocation:

nor%al cer*ical, fro%lateral *ie/

7nterior dilocation inC; le*el ( lateral *ie/ )

cer*ical dilocation


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C fracture6racture of C , a in

Oe8eron fr. Can -eidenti>ed -& open%outh poition

6ra1turOe8eron:

3or%al


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Pleae loo1 for %oreinfor%ation a-out :&pe of cer*ical fracture'dilocation&pe of thoracolu%-alfracture'dilocation

rau%atic intracranial he%orrhage

In : $rainger and 7llionH JDiagnotic

Radiolog& e+t-oo1 of radiolog& (Da*id Sutton)

etc


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han1 Qou

8. radiologi kedaruratan & traumatologi-prof. dr. bachtiar m

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