Radiographic Findings in Blunt Chest Trauma

Soft Tissue Radiographic Findings in Blunt Chest Trauma
By:Jonathan Yarris MSIV

Trauma
* Trauma is the leading cause of death in patients < 40 years
* 4th leading COD overall
* 80% of trauma is due to blunt mechanisms

Blunt Chest Trauma (BCT)
* Seen in about ½ of blunt trauma cases
* ~20% of trauma deaths attributable to BCT
* Etiology: typically deceleration injury
* Radiographic evaluation should begin immediately after initial trauma team assessment

Approach to Trauma Radiographs
* Initial exclusion of life threatening injuries
* Followed by search for less critical injuries
* Life threatening Injuries:
Pneumothorax
Deep Sulcus Sign
Tension Pneumothorax
Tension PTX
Pulmonary Contusion
Laceration
Laceration with Pneumatocele
Hematoma
Pulmonary hematoma
Pneumatocele
Pulmonary Contusion with pneumatocele
Blunt Cardiac Injury (BCI)
Hemopericardium
Great Vessel Injury
Thoracic Aorta Injury
Intimal Flap with double lumen
Airway Injury
* Tracheobronchial tears are uncommon
* Leads to persistent PTX
* Specific Symptom: persistent PTX after chest tube placement
* Finding: “Fallen Lung Sign”, pneumomediastinum, pneumopericardium, sub cut. Emphysema
* ET Tube balloon inflation >2.8cm implies tracheal rupture
Pneumomediastinum
* Etiology: alveolar, tracheobronchial or esophageal rupture
* Most common cause: alveolar rupture due to sudden increased intra-alveolar pressure (Macklin Effect) with air tracking centrally
* Findings:
o Air outlining mediastinal soft tissues and parietal pleura.
o Continuous diaphragm sign
Pneumomediastinum
Pneumopericardium with tamponade
Esophageal Injury
Other
* Skeletal injuries:
* Diaphragm injuries:

Radiographic Findings in Blunt Chest Trauma.ppt

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Lung Examination: Abnormal

Lung Examination: Abnormal
By:Arcot J. Chandrasekhar, M.D.

Illustrative Pathological problems
* Consolidation
* Atelectasis
* Pleural effusion
* Pneumothorax
* Mass
* Diffuse lung disease

Steps
* General Examination
* Mediastinal position
* Chest expansion
* Lung resonance
* Breath sounds
* Adventitious sounds
* Voice transmission
* Respiratory rate
* Pattern of breathing
* Cyanosis
* Clubbing
* Weight
* Cough
* Hospital setting
* Effort of ventilation
* Shape of thorax

Respiratory Rate
* Bradypnea: rate less than 8 per minute
* Tachypnea: rate greater than 25 per minute

Pattern of Breathing
* Kussmals
* Sleep apnea
* Cheyne strokes
* Pursed lip breathing
* Orthopnoea: Short of breath in supine position, gets some relief by sitting or standing up.

Sleep apnea syndrome
Central Cyanosis
Corpulmonale
Clubbing
Significance: Clubbing Observed In:
* Intrathoracic malignancy: Primary or secondary (lung, pleural, mediastinal)
* Suppurative lung disease: (lung abscess, bronchiectasis, empyema)
* Diffuse interstitial fibrosis: Alveolar capillary block syndrome
* In association with other systemic disorders
Effort of Ventilation
* Person appears uncomfortable. Breathing seems voluntary.
* Accessory muscles are in use, expiratory muscles are active and expiration is not passive any more.
* The degree of negative pleural pressure is high.
* The respiratory rate is increased.

Resting Size and Shape of Thorax
* Barrel chest
* Kyphosis
* Scoliosis
* Pectus excavatum
* Gibbus
Barrel Chest
AP Diameter = Transverse Diameter
Tracheal Position: Mediastinum
Chest Expansion
Percussion: Decreased or Increased Resonance is Abnormal
* Dullness
* Hyper resonance
* Traube's space

Breath Sounds: Diminished or Absent
* Intensity of breath sounds, in general, is a good index of ventilation of the underlying lung.
* Breath sounds are markedly decreased in emphysema.
* Symmetry: If there is asymmetry in intensity, the side where there is decreased intensity is abnormal.
* Any form of pleural or pulmonary disease can give rise to decreased intensity.
* Harsh or increased: If the intensity increases there is more ventilation and vice versa.
* Bronchial breathing anywhere other than over the trachea, right clavicle or right inter-scapular space is abnormal.
* In consolidation, the bronchial breathing is low pitched and sticky and is termed tubular type of bronchial breathing.
* In cavitary disease, it is high pitched and hollow and is called cavernous breathing. You can simulate this sound by blowing over an empty coke bottle.

Bronchial breathing
Rhonchi
Pleural Rub
Crackles
Voice Transmission (tactile fremitus, vocal resonance)
* Asymmetrical voice transmission points to disease on one side.
* Increased:
* Decreased
* Qualitative alteration:
Voice Transmission
Bronchophony
Whispering Pectoroliquy
Normal whisper
Egophony

Lung Examination: Abnormal.ppt

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Thoracic Trauma

Thoracic Trauma

Dave Lloyd, MD
Introduction to Thoracic Injury
* Vital Structures
* 25% of MVC deaths are due to thoracic trauma
* Abdominal injuries are common with chest trauma.
* Prevention Focus

Anatomy and Physiology of the Thorax
* Thoracic Skeleton
* Diaphragm
* Associated Musculature
* Physiology of Respiration
* Trachea, Bronchi & Lungs
* Mediastinum
* Heart
* Contraction Cycle
* Great Vessels
* Esophagus
* Blunt Trauma
* Penetrating Trauma
Pathophysiology of Thoracic Trauma
Injuries Associated with Penetrating Thoracic Trauma
* Closed pneumothorax
* Open pneumothorax (including sucking chest wound)
* Tension pneumothorax
* Pneumomediastinum
* Hemothorax
* Hemopneumothorax
* Laceration of vascular structures
* Tracheobronchial tree lacerations
* Esophageal lacerations
* Penetrating cardiac injuries
* Pericardial tamponade
* Spinal cord injuries
* Diaphragm trauma
* Intra-abdominal penetration with associated organ injury

Pathophysiology of Thoracic Trauma Chest Wall Injuries
* Contusion
* Rib Fractures
* Sternal Fracture & Dislocation
* Flail Chest
* Simple Pneumothorax
* Open Pneumothorax
* Tension Pneumothorax
* Dyspnea
* Progressive ventilation/perfusion mismatch
* Hypoxemia
* Hyperinflation of injured side of chest
* Hyperresonance of injured side of chest
* Diminished then absent breath sounds on injured side
* Cyanosis
* Diaphoresis
* AMS
* JVD
* Hypotension
* Hypovolemia
* Tracheal Shifting
* Hemothorax
* Blunt or penetrating chest trauma
* Shock
* Dull to percussion over injured side
* Pulmonary Contusion
* Myocardial Contusion
* Bruising of chest wall
* Tachycardia and/or irregular rhythm
* Retrosternal pain similar to MI
* Associated injuries
* Chest pain unrelieved by oxygen
* Pericardial Tamponade
* Dyspnea
* Possible cyanosis
* Beck’s Triad
* Weak, thready pulse
* Shock
* Kussmaul’s sign
* Pulsus Paradoxus
* Electrical Alterans
* PEA
* Myocardial Aneurysm or Rupture
* Traumatic Aneurysm or Aortic Rupture
* Other Vascular Injuries
* Traumatic Esophageal Rupture
* Tracheobronchial Injury
* Traumatic Asphyxia
* Scene Size-up
* Initial Assessment
* Rapid Trauma Assessment
* Ongoing Assessment
* Ensure ABC’s
* Anticipate Myocardial Compromise
* Shock Management
* Rib Fractures
* Sternoclavicular Dislocation
* Flail Chest
* Open Pneumothorax
* Tension Pneumothorax
* Hemothorax
* Myocardial Contusion
* Pericardial Tamponade
* Aortic Aneurysm
* Tracheobronchial Injury
* Traumatic Asphyxia

Thoracic Trauma.ppt

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