Trauma Radiology Tools

Chapter 48 Trauma Radiology Tools



Jonathan R. Hiatt, MD, Michael Zucker, MD


The radiologic examination of the trauma victim provides important adjunctive information for early decision making and triage. For most injuries due to blunt trauma, plain films of the cervical spine, chest, and pelvis are obtained and sonographic evaluation of the abdomen and pericardium is undertaken. CT is used for diagnosis of specific injuries in the head, neck, chest, abdomen, and pelvis. Arteriography is used for suspected bleeding in association with pelvic fractures and sometimes for definitive diagnosis of injuries to the thoracic aorta.


The following is a brief description of the radiographic studies used most commonly in initial trauma management. The key features specific to each of the studies are emphasized, as are the major findings that should be sought.



Cross-Table Lateral Cervical Spine Film


The film should be inspected for alignment, major fractures, and major distraction injuries. See Figures 48-1 and 48-2.


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Figure 48-1 This pair of pictures demonstrates the inadequacy of a C-spine film when the C7 vertebra is not visualized (A). A repeat lateral x-ray shows a burst fracture of C7 (B).


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Figure 48-2 The lateral C-spine film should be inspected for alignment, major fractures, and major distraction injuries. Three lines should be drawn or imagined to assess alignment: a, anterior vertebral line; b, posterior vertebral line; c, spinolaminar line.


Look for loss of height of vertebral bodies or body fracture. Look for fractures in all bony parts, including pedicles, laminae, and spinous and transverse processes. Soft tissue swelling anterior to the anterior vertebral line is also a sign of spinal injury.



Anterior-Posterior Chest Film


The film should be inspected for injuries to bones, pleural spaces, lung parenchyma, and mediastinal structures. See Figures 48-3 to 48-5.


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Figure 48-3 Fractures of ribs, clavicles, humeral heads, spinal column, and scapulae may occur. The film shows multiple rib fractures.

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Mar 20, 2017 | Posted by in GENERAL SURGERY | Comments Off on Trauma Radiology Tools

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