Trauma Radiology Companion: Methods, Guidelines, and Imaging Fundamentals PDF
Preview Trauma Radiology Companion: Methods, Guidelines, and Imaging Fundamentals
Trauma Radiology C O M PA N I O N Methods, Guidelines, and Imaging Fundamentals SE COND EDIT ION Martin L. Gunn, M.B.Ch.B., FRANZCR. Assistant Professor of Radiology University of Washington Seattle, Washington Joel A. Gross, M.S., M.D. Associate Professor of Radiology Director of Emergency Radiology University of Washington Seattle, Washington Michelle M. Bittle, M.D. Assistant Professor of Radiology University of Washington Seattle, Washington Eric J. Stern, M.D. Professor of Radiology Adjunct Professor of Medicine Adjunct Professor of Medical Education and Bioinformatics Adjunct Professor of Global Health University of Washington Seattle, Washington BBiittttllee__FFMM..iinndddd ii 44//3300//22001111 44::0011::1199 PPMM Executive Editor: Charles W. Mitchell Product Manager: Ryan Shaw Vendor Manager: Bridgett Dougherty Senior Manufacturing Manager: Benjamin Rivera Senior Marketing Manager: Angela Panetta Design Coordinator: Stephen Druding Production Service: SPi Global © 2012 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individu- als as part of their official duties as U.S. government employees are not covered by the above- mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Bittle, Michelle M. Trauma radiology companion : methods, guidelines, and imaging fundamentals. —2nd ed. / Michelle M. Bittle, Joel A. Gross, Martin L. Gunn. p. ; cm. Rev. ed. of: Trauma radiology companion / edited by Eric J. Stern. c1997. Includes bibliographical references and index. ISBN 978-1-60831-378-5 1. Wounds and injuries—Imaging. 2. Wounds and injuries--Diagnosis. I. Gross, Joel A. II. Gunn, Martin L. III. Trauma radiology companion. IV. Title. [DNLM: 1. Wounds and Injuries—radiography. 2. Diagnostic Imaging—methods. WO 700] RD93.7.T734 2011 617.1'0754—dc22 2011004309 Care has been taken to confirm the accuracy of the information presented and to describe gener- ally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Admin- istration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638- 3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 BBiittttllee__FFMM..iinndddd iiii 44//3300//22001111 44::0011::2200 PPMM This second edition of Trauma Radiology Companion is dedicated to the memory of Robert L. Bree, M.D. Robert L. Bree, M.D., an internationally respected physician and professor of radiol- ogy at the Harborview Medical Center, University of Washington, died in 2010 at the age of 66. Dr. Bree earned his medical degree from the University of Michigan in 1966. After 10 years at Beaumont Hospital in Detroit, Dr. Bree became a pro- fessor of radiology and director of ultrasound at the University of Michigan Hospi- tal. His dedication to the fi eld of radiology and ultrasound, in particular, resulted in many landmark articles and innovations in ultrasound imaging. He served as chair of Radiology at the University of Missouri and continued to be a leader in Aca- demic Radiology through research and teaching and as an examiner for the Ameri- can Board of Radiology. In addition to being a tremendous academician, he was a devoted family man and moved to Everett, Washington, to be closer to his family and grandchildren and took a position with Radia Inc. Fortunately for Harborview Medical Center and the University of Washington, he returned to academics and he joined our staff in 2005. While continuing academic pursuits at Harborview Medical Center, he devel- oped a passion for utilization management and was instrumental in passing the landmark 2009 Washington State legislation, Advanced Imaging Management, designed to ensure appropriate utilization of imaging procedures and ultimately reduce medical costs and unnecessary radiation. BBiittttllee__FFMM..iinndddd iiiiii 44//3300//22001111 44::0011::2211 PPMM CCoonntteennttss Contributors xii Foreword xiv Foreword to the First Edition xv Preface xvi 1 Overview of Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Epidemiology of Trauma 2 Ken F. Linnau Blunt Trauma Resuscitation Imaging: The Radiologic ABC’s 5 Michelle M. Bittle and Leila Bender Trauma Severity Scoring 8 Ken F. Linnau Medical-Legal Issues in Trauma and Emergency Radiology 11 Annemarie Relyea-Chew Special Procedures in the Emergency Room 15 Charles A. Rohrmann Gunshot Wounds 18 Zachary Ashwell and Michelle M. Bittle Gunshot Wounds: Low-Velocity Bullet Injury 22 Zachary Ashwell and Michelle M. Bittle Gunshot Wounds: Shotgun Injury 24 Zachary Ashwell and Michelle M. Bittle Contrast Reactions and Extravasation 28 Martin L. Gunn 2 Brain and Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Cerebral Contusion 30 Robert B. Carr and Kathleen R. Fink Diffuse Axonal Injury 32 Robert B. Carr and Kathleen R. Fink Epidural Hematoma/Hyperacute Intracranial Hemorrhage 34 Robert B. Carr and Kathleen R. Fink Acute Subdural Hematoma 36 Robert B. Carr and Kathleen R. Fink Chronic Subdural Hematoma/Acute Rehemorrhage 38 Robert B. Carr and Kathleen R. Fink Linear Skull Fracture 40 Robert B. Carr and Kathleen R. Fink Depressed Skull Fracture 42 Robert B. Carr and Kathleen R. Fink Delayed Posttraumatic Intracranial Hemorrhage 44 Kathleen R. Fink and Carrie Marder iivv BBiittttllee__FFMM..iinndddd iivv 44//3300//22001111 44::0011::2211 PPMM Contents v Child Abuse 46 Angelisa Paladin Gunshot Wound to Head 48 Sung E. LoGerfo Blunt Carotid and Vertebral Artery Injuries 50 Martin L. Gunn and Sung E. LoGerfo Acute Intracranial Hemorrhage: Intraventricular Hemorrhage and Traumatic Subarachnoid Hemorrhage 54 Robert B. Carr and Kathleen R. Fink Herniation: Uncal 56 Sung E. LoGerfo Herniation: Subfalcine 58 Sung E. LoGerfo Herniation: Upward (Cerebellar Hemorrhage) 60 Sung E. LoGerfo Diffuse Anoxic Changes 62 Sung E. LoGerfo Cerebral Perfusion SPECT in Traumatic Brain Injury 64 David H. Lewis Cerebral Blood Flow Imaging for Brain Death 66 David H. Lewis Facial Trauma: Orbital Floor Fracture 68 Robert B. Carr and Kathleen R. Fink Facial Trauma: Tripod Fracture 70 Robert B. Carr and Kathleen R. Fink Facial Trauma: Le Fort Fracture 72 Robert B. Carr and Kathleen R. Fink Cervical Spine Injury: Occipital Condyle Fractures 74 Ken F. Linnau Cervical Spine Injury: Atlanto-Occipital Dissociation 76 Ken F. Linnau Cervical Spine Injury: Jefferson Fracture 78 Ken F. Linnau Cervical Spine Injury: Transverse Atlantal Ligament Injury 80 Ken F. Linnau Cervical Spine Injury: Dens Fracture 82 Ken F. Linnau Cervical Spine Injury: Traumatic Spondylolisthesis of the Axis 84 Ken F. Linnau Cervical Spine Injury: Flexion-Teardrop Fracture (aka Hyperflexion Injuries) 86 Quynh T. Nguyen Lower Cervical Spine Injury: Unilateral Jumped Facet 88 Quynh T. Nguyen Lower Cervical Spine Injury: Bilateral Jumped Facets 90 Quynh T. Nguyen BBiittttllee__FFMM..iinndddd vv 44//3300//22001111 44::0011::2211 PPMM vi Contents Lower Cervical Spine Injury: Isolated Posterior Ligamentous Injury 92 Quynh T. Nguyen Lower Cervical Spine Injury: Burst Fracture 94 Quynh T. Nguyen Thoracic/Lumbar Spine Injury: Compression and Burst Fractures 96 Quynh T. Nguyen Thoracic/Lumbar Spine Injury: Flexion-Distraction and Chance Injuries 98 Quynh T. Nguyen Thoracic/Lumbar Spine Injury: Hyperextension Injuries 100 Quynh T. Nguyen Thoracic/Lumbar Spine Injury: Fracture-Dislocations 102 Quynh T. Nguyen Radionuclide Detection of Cerebrospinal Fluid Leaks 104 David H. Lewis 3 Torso . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Scapulothoracic Dissociation 106 Martin L. Gunn Scapula Fracture 108 Eric J. Stern Rib Fractures 110 Eric J. Stern Sternoclavicular Dislocation 112 Martin L. Gunn Sternal Fractures 114 Martin L. Gunn Airway Rupture/Laceration 116 Eric J. Stern Esophageal Rupture/Laceration 118 Martin L. Gunn Esophageal Intubation with Gastric Perforation 120 Martin L. Gunn Traumatic Aortic Injury: Overview 122 Martin L. Gunn Traumatic Aortic Injury: Chest Radiography 124 Martin L. Gunn Traumatic Aortic Injury: Minimal Aortic Injury 126 Martin L. Gunn Traumatic Aortic Injury: Computed Tomography 128 Martin L. Gunn Traumatic Aortic Injury: Endovascular Repair 132 Martin L. Gunn Injury to the Great Vessels 136 Martin L. Gunn Peripheral Vascular Trauma 138 Martin L. Gunn BBiittttllee__FFMM..iinndddd vvii 44//3300//22001111 44::0011::2211 PPMM Contents vii Myocardial Contusion 140 Martin L. Gunn and Christopher Ingraham Cardiac Perforation and Rupture 142 Martin L. Gunn and Christopher Ingraham Diaphragm Injury 144 Martin L. Gunn and Eric J. Stern Pulmonary Contusion 148 Eric J. Stern Pulmonary Laceration 150 Eric J. Stern Pulmonary Laceration: Penetrating Injuries 154 Eric J. Stern Pulmonary Laceration: Pulmonary Hematoma 156 Eric J. Stern Lung Injury: Blast Effect 158 Eric J. Stern Traumatic Pneumothorax 160 Ken F. Linnau Intrathoracic Ectopic Air Collections 164 Eric J. Stern Aspiration of Foreign Body 166 Eric J. Stern Near-Drowning 168 Eric J. Stern Intraperitoneal Fluid in Trauma 170 Leila Bender and Martin L. Gunn Focused Assessment with Sonography for Trauma (FAST) 174 Martin L. Gunn Extraperitoneal Fluid in Trauma 178 Leila Bender and Martin L. Gunn Intraperitoneal and Retroperitoneal Gas 180 Leila Bender and Martin L. Gunn Active Bleeding: Findings on CT Scan 182 Leila Bender and Martin L. Gunn Liver Injury: Acute 184 Leila Bender and Todd Kooy Liver Injury: Follow-Up and Natural History 190 Leila Bender and Todd Kooy Biliary Injury 192 Leila Bender and Todd Kooy Splenic Trauma 196 Leila Bender and Michelle M. Bittle Solid Organ Injury: Indications for Angiography 200 Matthew Kogut and Christopher Ingraham Pancreatic Injury 204 Michelle M. Bittle and Leila Bender BBiittttllee__FFMM..iinndddd vviiii 44//3300//22001111 44::0011::2211 PPMM viii Contents Gastrointestinal and Mesenteric Injury 206 Michelle M. Bittle and Leila Bender Duodenal Injury 210 Michelle M. Bittle and Leila Bender Colorectal Injury 212 Michelle M. Bittle Adrenal Hemorrhage 214 Michelle M. Bittle Renal Injuries 216 Joel A. Gross and John P. O’Brien Renal Injuries: Imaging 220 Joel A. Gross and John P. O’Brien Renal Injuries: Clinical Management Issues 226 John P. O’Brien and Joel A. Gross Renal Laceration with Urinary Extravasation 228 John P. O’Brien and Joel A. Gross Ureteral Injuries 230 Joel A. Gross and Lorenzo Mannelli Bladder Injuries: Extraperitoneal Rupture 234 Lorenzo Mannelli and Joel A. Gross Bladder Injuries: Intraperitoneal Rupture 240 Joel A. Gross and Lorenzo Mannelli Urethral Injuries 244 Robert L. Bree Anterior Urethral Laceration 248 Robert L. Bree Imaging The Gravid Uterus 250 Claudia Sadro Testicular Trauma 254 Robert L. Bree 4 Upper Extremity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Clavicle Fractures 256 Emily Albrecht Acromioclavicular Joint Dislocation 258 Emily Albrecht Shoulder Joint Dislocation 260 Emily Albrecht Shoulder Dislocation: Posterior 264 Emily Albrecht Proximal Humeral Fractures 266 Emily Albrecht Humeral Shaft Fractures 268 Michelle M. Bittle and Michael McBain Distal Humeral Fractures 270 Emily Albrecht Humerus: Epicondyle Injury 272 Emily Albrecht BBiittttllee__FFMM..iinndddd vviiiiii 44//3300//22001111 44::0011::2211 PPMM Contents ix Elbow Dislocation 274 Emily Albrecht Radial Head Fractures 276 Emily Albrecht Radius and Ulna Shaft Fractures 278 Michelle M. Bittle and Issac Reeve Distal Radius and Ulna Fractures 280 Michelle M. Bittle and Issac Reeve Carpal Fractures 284 Michelle M. Bittle and Brian Dontchos Carpal Dislocations 288 Michelle M. Bittle and Brian Dontchos Metacarpal Fractures 290 Emily Albrecht Phalangeal Fractures 296 Emily Albrecht 5 Pelvis/Lower Extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 Overview of Pelvic Fractures 300 Robert Nathan and Claire Sandstrom Pelvic Apophyseal Avulsions 302 Robert Nathan and Claire Sandstrom Lateral Compression Pelvic Injury 304 Robert Nathan and Claire Sandstrom Anteroposterior Compression Pelvic Injury 306 Robert Nathan and Claire Sandstrom Vertical Shear Pelvic Injury 308 Robert Nathan and Claire Sandstrom Pelvic Ring Disruption and Arterial Injury 310 Robert Nathan and Claire Sandstrom Sacral Fracture 312 Robert Nathan and Claire Sandstrom Basic Acetabular Anatomy 314 Robert Nathan and Claire Sandstrom Anterior Hip Dislocation 316 Robert Nathan and Claire Sandstrom Posterior Hip Dislocation 318 Robert Nathan and Claire Sandstrom Posterior Wall Acetabular Fracture 320 Robert Nathan and Claire Sandstrom Transverse Acetabular Fracture 322 Robert Nathan and Claire Sandstrom Both Column Acetabular Fracture 326 Robert Nathan and Claire Sandstrom Intracapsular Femoral Neck Fracture 330 Michelle M. Bittle and Claudia Sadro Occult Hip Fracture 332 Michelle M. Bittle and Claudia Sadro BBiittttllee__FFMM..iinndddd iixx 44//3300//22001111 44::0011::2222 PPMM x Contents Stress and Insufficiency Fractures of the Femoral Neck 334 Michelle M. Bittle and Claudia Sadro Extracapsular Proximal Femur Fractures: Intertrochanteric Femur Fracture 338 Michelle M. Bittle and Claudia Sadro Extracapsular Proximal Femur Fractures: Subtrochanteric Femur Fracture 340 Michelle M. Bittle and Claudia Sadro Femoral Shaft Fracture 342 Michelle M. Bittle and Claudia Sadro Supracondylar Fracture of the Femur 346 Michelle M. Bittle and Claudia Sadro Patella Fracture 348 Michelle M. Bittle Tibial Plateau Fracture 352 Michelle M. Bittle Anterior Cruciate Ligament Avulsion Fracture 356 Michelle M. Bittle Posterior Cruciate Ligament Avulsion Fracture 358 Michelle M. Bittle Collateral Ligament Injuries of the Knee 360 Michelle M. Bittle Anterior Cruciate Ligament Tear 362 Claudia Sadro Meniscal Tears 364 Michelle M. Bittle and Alice S. Ha Segond Fracture: Lateral Capsular Avulsion 366 Michelle M. Bittle Patellar Dislocation 368 Michelle M. Bittle and Christopher Ingraham Knee Dislocation 370 Michelle M. Bittle and Christopher Ingraham Tibial Stress Fracture 372 Michelle M. Bittle and Christopher Ingraham Tibial And Fibular Shaft Fractures 374 Michelle M. Bittle and Christopher Ingraham Tibial Plafond Fracture (Pilon Fracture) 376 Robert Nathan and Christopher Ingraham Ankle Mortise Injuries: Classification 378 Robert Nathan and Christopher Ingraham Calcaneal Fracture 384 Robert Nathan and Christopher Ingraham Talus Fracture 388 Robert Nathan and Christopher Ingraham Talar and Subtalar Dislocations 394 Robert Nathan and Christopher Ingraham BBiittttllee__FFMM..iinndddd xx 44//3300//22001111 44::0011::2222 PPMM
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