Imaging in Abdominal and Spine Trauma

Imaging in trauma

Abdomen and Spine​

Dr Joshua Lauder

​​https://forms.gle/xmBoHveQd1WJVvUe6

1. CT vs MRI

2. Be able to identify common fractures of the spine on CT

Spine

1. eFAST scanning vs CT

2. Be able to recognize common injuries on CT​

​

Abdominal

Session content

Multiple Choice

Which type of abdominal trauma has the highest mortality?

• Penetrating

• Blunt

Multiple Choice

Which abdominal organ is most commonly injured?

• Spleen

• Liver

• Bowel

• Kidneys

• Quickest

• Repeatable

• Good for picking up free fluid

eFAST - Ultrasound

​How do we investigate abdominal trauma?

• Cannot identify active bleeding

Multiple Choice

What abnormality is shown on this ultrasound scan?

• Spleen laceration

• Liver laceration

• Free fluid

• Aortic rupture

Free fluid (intraperitoneal)

​Normal comparison

• Pools in the dependent recesses

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• In the context of trauma it suggests injury to an intraperitoneal organ

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• Fluid can be blood, bowel contents or urine

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• Used in both ultrasound and CT interpretation​

Free fluid (intraperitoneal)

• Still quick

• Visualizes all abdominal structures*

• Can identify active bleeding if contrast is used​

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Trauma CT

​How do we investigate abdominal trauma?

• Requires patient to be relatively stable

1. ​Anatomical planes - normal anatomy

2. Hounsfield Units

3. Windowing

4. Intravenous contrast​

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Reminder of CT concepts

Multiple Choice

What is the organ labelled X ?

• Liver

• Spleen

• Left kidney

• Right kidney

• Pancreas

Multiple Choice

What is the HU of water?

• -1000

• 0

• +50

• +300

Active bleeding

​Interventional Radiology

Multiple Choice

What is the injury?

• Aortic rupture

• Splenic haematoma

• Pancreatic laceration

• Liver laceration

Multiple Choice

This patient presented following abdominal trauma. What is the pathology?

• Rib fractures

• Pericardial effusion

• Haemothorax

• Traumatic perforation

Multiple Choice

Which of part of the bowel is retroperitoneal?

• 1st part of duodenum

• Transverse colon

• Ileum

• Descending colon

Multiple Choice

Which CT window should be used to look for free gas?

• Soft tissue window

• Lung window

• Bone window

• Liver

• Spleen

• Bowel

​

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Commonly injured organs

• Pancreas

• Kidneys

• Bladder​

• Major vessels​

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Rarely injured organs

• ​Rarely an isolated injury

• Trauma can cause pancreatitis, which may develop over days.

• Amylase and lipase wont be elevated for several hours​

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​Pancreas

• Usually associated with blows to the flank

• Often tamponades due to confined retroperitoneal space.​

• Trauma c​an disrupt the renal arteries causing renal infarct

• +/- Haematuria

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​Kidney

• Caused by blunt trauma with a full bladder

• Large volume of free fluid

​

• ​Can be diagnosed with a delayed contrast CT

​Bladder

​Practical review of abdominal trauma CT

1. Look for free fluid

2. Check the solid organs

3. Look for signs of perforation

4. Check t​he retroperitoneum, including vessels

5. Check the bones*​

Password - anatomy

https://www.postdicom.com?Share=30f1c22e-b948-475d-ad10-9b91a655f756&Lang=0

Spine anatomy and movements

Spine trauma mechanism

Multiple Choice

Which vertebra is labelled?

• C4

• C5

• T4

• C3

• C7

Xray

• Used in patients with traumatic neck pain provided the patient is alert and stable with no neurology

• Lateral view is most useful​

Multiple Choice

Name the bony structure

• Spinous process C7

• Transverse process C6

• Transverse process T1

• Facet joint C6/7

• Vertebral body T1

​Thoracic Lumbar

Intrepretation ​System

​

1. ​Alignment

2. Bones

3. Cartilage (discs)

4. Disability (sp​inal canal)

Multiple Select

What type of mechanism could have caused this fracture?

• Extension

• Flexion

• Rotation

• Lateral

• Osteoporosis

​Chance fracture

Multiple Choice

At what level is the injury?

• C1/2

• C2/3

• C3/4

• C4/5

• C5/6

Facet joint dislocation - rotation

​CT vs MRI

Better bone detail

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Quicker scan​

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Less claustrophobic​

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Less contraindications​

Can see the cord

​

Can see the discs​

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Can see oedema

Ligaments

Cord injury

Bone bruising​

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​Practical review of trauma CT - your go

​Abdomen

​

1. Look for free fluid

2. Check the solid organs

3. Look for signs of perforation

4. Check t​he retroperitoneum, including vessels

5. Check the bones*​

Password - anatomy

Spine

​

1. ​Alignment

2. Bodies (vertebral)

3. Cartilage (discs)

4. Disability (sp​inal canal)

https://www.postdicom.com?Share=484c7828-6b0d-4319-8657-0b72c620fa57&Lang=0

Bonus case

Password - anatomy

https://www.postdicom.com?Share=6b03ee0d-72b1-4d25-acbb-5e948e1359b1&Lang=0