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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