Komala dewi

Koja hospital jakarta

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Radiology is the science that uses medical imaging to diagnose
and sometimes also treat disease within the body

Emergency in radiology departement may occur while handling

the traumatic, vulnerable patiens and some other critical
circumstances

Conventional radiography are still important to diagnose

emergency cases

Emergency imaging are divided for trauma and non trauma

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Trauma is sudden, Blunt, penetrating, explosive
unexpected, dramatic, and vehicle accident are
forcefull or violent event common cause of traumatic
injuries

TRAUMA

Radiographer must always Radiographers in radiology

be conscious not to remove department must be prepared
immobilization devices for variety of procedures on
patien in all age groups

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q speed : efficience in producing quality
images in shortest possible time
q accuracy : optimum image quality,
minimum repeats
q quality : do not use patient condition
as an excuse for poor quality image
q positioning
q Practice standard precaution

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 Linier fracture

Depressed fracture

SKULL Diastatic (widening suture lines in childhood)

Base os skull fracture

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 Depressed fracture
Linier fracture

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 Le fort fracture are fracture of the midface
which collective involve separation of all or a
portion of the of the midface from the skull
base

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CLASIFICATION DESCRIPTION NOTES
Type 1 Transverse fracture through the Direct horizontal
maxillary sinuses, lower nasal impact to the
septum, pterygoid plates upper jaw

Type 2 Oblique fracture crossing Direct impact to

zygomaticomaxilary suture, the central
inferior orbital rim, nasal bridge midface

Type 3 Fracture above the zygomatic Craniofacial

arch, through the lateral and dissociation
medial orbital walls and
nasofrontal suture

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10 – 20% patiens with head injury also have a cervical spine
injury

Most cervical fractures occur predominantly at two levels

One third of injuries occur at the level of C2 and one half of

injuries occur at the level of C6 or C7

The most common fracture mechanism in cervical injuries is

hyperflexion

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1 anterior subluxation : posterior ligament rupture :
stable fracture

Simple wedge fracture : pure flexion injury,

2 posterior ligament remain intact

Unstable wedge fracture : damage to both the

3 anterior column (anterior wedge fracture) as the
posterior column (interspinous ligament)

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 Unilateral interfacet dislocation : flexion and
4 rotation

5 Bilateral interfacet dislocation : extreme flection

and association with a high incidence of cord
damage

Flexion teardrop fracture : result of extreme

6 flection with axial loading, unstable and
association with a high incidence of cord damage

7 anterior atlantoaxial dislocation

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 anterior subluxation : posterior ligament
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rupture : stable fracture

2 extension teardrop fracture

hyperextension in preexisting spondylosis

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(open mouth fracture)

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Hangman’s fracture Extension tear drop fracture

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Jefferson fracture : Lateral displacement of both
articular masses of C1 from those of C2 on open mouth
v Clinical issues : upper neck pain after compression
trauma (e.g diving)

Burs fracture at lower cervical level

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Jefferson fracture Burst fracture

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 Wedging anterior vertebral body
 Focal kyposis
 Empty body sign
 Transversely oriented posterior elemen
fracture
 Etiology : vehicle accident or fall
 Clinical issue : back pain following high
speed injury, neurology deficit

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Chance fracture

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Blunt trauma or penetrating

Most common injury : rib fracture followed with

pulmonary contusion

Suspect flail chest if more than 5 contiguous rib

fracture or more than 3 contiguous segmental rib
fracture (2 or more fractures in each rib)

1st rib fracture signifies severity of trauma

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 Air outlines normal mediastinal
structure

Progressive enlargement
pneumomediastinum, persistent (and
progressive) pneumothoraks, pleural
effusion (rare with spontaneous
pneumomediastinum)

This sign suggestive of

tracheobronchial tear or esofageal
tear

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 Subcutaneus
Retrosternal emfisema
chest pain

Clinical
issues Dyspneu

Neck pain

Dysphagia

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 Pneumothorax

Cause by penetrating or blunt trauma

Colection air in the pleural space

resulting in partial or complete
collapse of the lung on the affected
side

Symptoms : chest pain and sometimes

dyspneu

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Best diagnose clue : air filled bowel above the hemidiafragma

Much more common on left (70%)

Etiology : high energy blunt torso trauma

Associated abnormalities : rib fracture 90%, liver or spleen

laceration 60%, pelvic fracture 50%, aortic tear

Clinical issues non specific, considers in any patient with blunt

torso trauma

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 Traumatic induced pulmonary hemorrhage filling
airspace from torn cappilaries
 Best clues : posterior peripheral lung opacity
following blunt chest trauma
 Almost always appears within 6 hours of trauma
 Maybe normal initially
 Clinical issues : non spesific dyspneu and chest pain,
hemoptisis, hypoxia marker of extent of contusion
 Most return to normal without long term sequela
 > 20% can be oredicted to go on to develop ARDS
 Long term dypsneu

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Lung contusion

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Flail chest

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 Splenic trauma :
- abdominal radiography : LUQ soft tissue
mass, sign of fluid with widening of distance
between flank strip and descending colon,
fluid in pelvis with prominent pelvis “dog ears”
- chest radiography : LLL atelektasis, left rib
fracture, left pneumothoraks, left pleural
effusion

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 Hepar injury, renal injury, pancreatic injury
best with CT
 Duodenal injury : pneumoperitoneum, ectopic
retroperitoneal gas
 GI series : duodenal lumen narrowing by
hematoma, contras ekstravasation
 Intestinal trauma : “Flank – stripe “ sign :
increase density zone (> 800ml abdominal
fluid) separated vertical colon segment from
peritoneal fat & peritoneal reflection

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Dog’s ear sign : pelvic fluid collection displace bowel from
urinary bladder

Clinical issues : most common sign :

a. abdominal pain, distension
b. hypotensi, tachycardia
c. lost of conciousness, shock

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Dog’s ear sign

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Copola sign Football sign

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Clavicle fraktur : consider nerve or vascular damage especially
with high mechanism

Shoulder dislocation :
1. anterior dislocation
2. posterior dislocation
3. luxatio erecta

Clinical issues : may have axillary nerve damage (lost of

sensation on lateral aspect os shoulder)

Humeral head /neck fractur : consider possible vascular injury to

axillary vessels, possible neurological injury to brachial plexus
or axilary nerve, associate injury of the chest wall, neck, head
or other site related to mechanism

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Clavicle fracture

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Humeral head fracture

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Luxatio erecta

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 Pelvic fracture

a. Stable : fracture sparing posterior arch; pelvic

ring able withstand normal physiological stress
without displacement

b. Unstable : complete loss of posterior

osteoligamentous integrity

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 Clinical issues

Most common sign/symptoms :

- leg length discrepancy
- ongoing pelvic bleeding

Bladder/urethral injury : inability to void despite a

full bladder; blood at the urethral meatus

Neurological complication :
- lost of rectal tone or bulbocavernosus reflex
- lost of lower extremity motor and sensory function

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Internal open pelvic fracture : blood in vaginal vault and/or
rectum

Represent a large area of hematoma and fat necrosis under

degloved skin

Association with high rates of bacterial contamination

Consider : open wounds must be identified because mortality

significant increases with involvement of bowel, vagina or
peritoneum; retroperitoneal hemorrhage in hemodynamically
unstable patiens if thoracic or abdominal source not found

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Courtesy radiopaedia

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Take home message

Conventional radiography is quick and

simple test that will detect abnormality in
trauma patiens

Conventional radiography is not sensitive

enough for special cases of trauma

Radiographer has important role to get the

best x ray for emergency cases

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