RADIOLOGI PADA

KASUS TRAUMA
Eveline Stephanie Lay, dr.
 Infeksi

Trauma
Tumor

Kegawatdaruratan Penyakit metabolik

Non trauma

Kongenital
HAL YANG HARUS DIKETAHUI

• Pemilihan modalitas pencitraan yang tepat untuk menjawab pertanyaan klinis secara
spesifik:
• Mengetahui indikasi pemeriksaan
• Mengetahui evaluasi struktur apa yang diharapkan pada masing-masing modalitas pencitraan
• Mengetahui kemampuan alat-alat radiologi yang dimiliki oleh IGD

• Mengecek kontraindikasi pemeriksaan radiologi

• Berdiskusi dengan dokter jaga radiologi/radiolog
• Mempersiapkan pasien
DAN YANG PALING PENTING

• Pastikan identitas benar (dan sesuaikan dengan permintaan)

• Pastikan marker R/L sudah sesuai
• “One view is no view”
TRAUMA KEPALA
KEGAWATDARURATAN CNS

• Patah Tulang Kepala

• Foto polos kepala (Skull X-ray)
• CT scan kepala dengan bone window

• Perdarahan (trauma atau non trauma)

• CT scan
Copper Beaten
Skull
 Epidural Subdural Subarachnoid
Hematoma Hemorrhage Hemorrhage
Intracerebral Hemorrhage
intracerebral () and intraventricular () hemorrhage
CASE 1

A 57-year-old male with history of hypertension and seizures secondary to alcohol dependence
presented as a trauma activation to the emergency department (ED) after being found down on
the cement while working as a car mechanic. On initial presentation to ED, the patient was
awake but altered. He had a right parietal scalp hematoma with an overlying abrasion but no
palpable skull fracture. His eyes was open, but he did not answer questions or follow commands
giving a GCS of 10 (4-1-5). Both pupils were symmetric and reactive, and he appeared to be
moving all extremities symmetrically. No other traumatic injuries were found.
CASE 1

A 57-year-old male with history of hypertension and seizures secondary to alcohol dependence
presented as a trauma activation to the emergency department (ED) after being found down on
the cement while working as a car mechanic. On initial presentation to ED, the patient was
awake but altered. He had a right parietal scalp hematoma with an overlying abrasion but no
palpable skull fracture. His eyes was open, but he did not answer questions or follow commands
giving a GCS of 10 (4-1-5). Both pupils were symmetric and reactive, and he appeared to be
moving all extremities symmetrically. No other traumatic injuries were found.
CASE 2

Mrs. X was a 62 years old lady who presented to an emergency department at a peripheral
hospital. She arrived with her husband with sudden onset of severe headache. Her husband
reported she had brief loss of consciousness and mild confusion.
HR 75 bpm
BP 158/ 70 mmHg
RR 20 Pupil 3mm/3mm
Temp 36.9 symmetric
SaO2 95% (room air) GCS 3-4-6
CASE 2

Mrs. X was a 62 years old lady who presented to an emergency department at a peripheral
hospital. She arrived with her husband with sudden onset of severe headache. Her husband
reported she had brief loss of consciousness and mild confusion.
HR 75 bpm
BP 158/ 70 mmHg
RR 20 Pupil 3mm/3mm
Temp 36.9 symmetric
SaO2 95% (room air) GCS 3-4-6
CASE 3

• Male, 40 years old, fall from second storey

TRAUMA WAJAH
MODALITAS

• Foto Skull AP/lateral

• CT scan kepala dengan bone window
• CT scan kepala rekonstruksi 3D
• Foto waters
Horizontal maxillary fracture
Separating teeth from upper face
à Floating palate
• Alveolar ridge
• Lateral nose
• Inferior wall of maxillary sinus
Pyramidal fracture
Can pass through nasofrontal
junction à frontal process of
maxilla
à Floating maxilla (pyramidal)
• Posterior alveolar ridge
• Lateral wall of maxillary sinus
• Inferior orbital rim
• Nasal bones
Craniofacial disjunction
Risk of temporalis muscle
impingement due to zygomatic
arch involvement
à Floating face (transverse)
• Nasofrontal suture
• Maxillofrontal suture
• Orbital wall
• Zygomatic
arch/zygomaticofrontal suture
PRACTICAL POINTS

• Tepi anterolateral dari fossa nasalis

• If fractured à type I fracture
• If intact à excludes the type I fracture

• Margo infraorbitalis
• If fractured à type II fracture
• If intact à excludes the type II fracture

• Arcus zygomaticus
• If fractured à type III fracture
• If Intact à excludes the type III fracture
Le Fort
II
TRAUMA LEHER DAN SPINAL
MODALITAS

• Foto Cervical/Thoracolumbar/Lumbosacral AP/Lateral

• Corpus vertebra
• Musculus
• Jenis fraktur

• CT Scan rekonstruksi 3D
• (tidak semua RS bisa mengerjakan)
Lateral Open mouth Anteroposterior
Normal retropharyngeal space (diukur dari anterior
corpus C2) = 1-7 mm

Normal retrotracheal space (diukur dari anterior

corpus C6) = 9-22 mm
THE THREE CERVICAL
LINES

1. (dotted black line) spinolaminar white lines

2. (solid black line) posterior aspect of vertebral bodies
3. (dotted white line) anterior aspect of vertebral
bodies

1. Ligamentum flavum
2. Posterior longitudinal ligament
3. Anterior longitudinal ligament

4. Interspinous ligament
5. Supraspinous ligament
Jefferson Fracture
Burst fracture of the atlas
Fractures through anterior and
posterior arch
C5-C6 luxation
Extension tear drop fracture
Extension tear drop fracture
Foto Thoracolumbar
Foto Lumbosacral
CASE 1

• Male, 31 years old, was working on a roof and fell approximately 5 meters landing on his
feet.
He complained of pain in left lower extremity and lower back. 
Hyperflexion injury

Anterior wedge
fracture corpus VL 1
CASE 2

• 21-year-old female presented after sustaining a seatbelt type injury. 

She had an exploratory laparotomy for repair of a ruptured duodenum. There was no
neurologic deficit.
Chance fracture

Fraktur corpus dan pedicle

VL 3