PENCITRAAN PADA

KEADAAN GAWAT DARURAT

(EMERGENCY RADIOLOGI

dr.Yanto Budiman , Sp.Rad, M.Kes

Bagian Radiologi FKUAJ/RSAJ

Head

and face
Cervical spine
Chest
Abdomen
Extremities

Head and Face

Skull

Fracture
Facial Fracture
Cerebral contusio
Epidural Hematoma
Subdural Hematoma
Sub Arachnoid Hematoma
CVD /Stroke

Skull Fracture
Tipe

Fracture :

Linear
Depressed
Diastatic
Basal Clinical signs:rhinorrhoea,
otorrhoea, Battles sign (retroauricular haematoma),Racoon Eyes

Facial Fracture-Maksilla

Facial Fracture-Infra
Orbital
*

Tear drop sign

Facial Fracture-Mandibulla

Cerebral Contusion
Radiological features
Non-contrast

computed tomography (CT)

useful in the early posttraumatic period.
Contusions are seen as multiple focal areas
of low or mixed attenuation intermixed with
areas of increased density representing
haemorrhage.
True extent becomes apparent over time
with progression of cell necrosis and
oedema.
Magnetic resonance imaging (MRI) is the
best modality for demonstration of oedema
and contusion distribution.

Epidural Hematoma
Radiological features
CT

signs include a biconvex hyperdense

elliptical collection with a sharply defined
edge. Mixed density suggests active
bleeding.
The haematoma does not cross suture lines.
May separate the venous sinuses/falx from
the skull; this is the only type of
haemorrhage to do this.
Mass effect depends on the size of the
haemorrhage and associated oedema.
Associated fracture line may be seen.

Subdural Hematoma
Radiological features
CT

shows a crescentic fluid collection

between the brain and inner skull.
Concave inner margin with minimal
brain substance displacement.
In the acute phase high density;
in the subacute phase (24 weeks
post-injury) isodense to brain.
in the chronic phase (4 weeks postinjury) low density.

Subdural Hematoma

acute

Sub acute

Chronic

Subarachnoid hematoma
Radiological features
Non-contrast

CT is sensitive within 45
hours of onset.
Look for hyperdensity in the cortical
sulci, basal cisterns, Sylvian fissures,
superior cerebellar cisterns and in the
ventricles.
Older MRI macine is relatively less
sensitive than CT Scan, but in modern
MR Machine , using special sequences
like GRE , FLAIR and DWI is
comparable to CT Scan

Subarachnoid Hematoma

Subarachnoid bleeding, MRI

FLAIR Sequence

CVD /Stroke
Ischemic

Stroke
Haemorrhage Stroke
Non-contrast

CT in the first
instance. rule out
haemorrhage.
Hyperacute/ acute infarct
may not visible at CT Scan till
> 24 Hours.

Ischemic
Stroke

Haemorrhage stroke

Cervical spine injury

Classified according to mechanism
of trauma:
Flexion injuries
Rotational injuries
Extension injuries
Vertical compression injuries
CT Scan
X-ray

Clay shovelers
fracture

Tear drop fracture

Hangman Fracture

Comminuted compression fracture

Chest
RIB/STERNAL
FLAIL

FRACTURE

CHEST
PNEUMOTHORAX
HAEMOTHORAX
AORTIC RUPTURE
DIAPHRAGMATIC RUPTURE/HERNIA
FOREIGN BODY
PNEUMONIA
PULMONARY EDEMA

Rib/sternal fracture
Consider associated injuries:
Clavicle/1st or 2nd rib fractures suggest or indicate a
significant force, often associated with great vessel,
tracheo-bronchial or spinal injury.
Sternal injuries may be associated with myocardial
contusion.
With lower rib fractures, abdominal visceral injury,
such as liver, spleen or kidney, may occur.

Rib/sternal fracture (2)

Radiological features
A CXR/lateral sternal/ top lordotik
/ oblique view are performed to
assess for both complications and
to identify any underlying
fracture.
Preferebly 2 views
Signs of secondary complications
may be evident
pneumothorax,haemothorax,

Flail Chest
Radiological features:
Multiple rib fractures.
Costochondral separation may not be
evident.
Signs of secondary complications may be
evident pneumothorax,haemothorax,
pulmonary contusion, etc

Pneumothorax
Radiological features
A luscent area with no vascular
marking and Visceral pleural
edge visible.
Mediastinal shift to contralateral
affected side
A small pneumothorax may not
be visualised on a standard
inspiratory film.A expiratory film
may be of benefit

Flail Chest

Right pneumothorax with right lung collapse

HydroPneumothorax

Multiple right ribs fracture

Right Clavicle fracture
Right pneumothorax
Emfisema subcutan

Haemothorax
Accumulation of blood within the
pleural space following blunt or
penetrating trauma.
Radiological features
Blunting

of the costophrenic angles

seen with approximately 200 ml of
blood.
General increased opacification of the
hemithorax is seen on a supine film.

Haemothorax

Erect Film

Supine Film

Aortic Rupture
Radiological features
Chest radiograph
Widened mediastinum
Blurred aortic outline with loss of aortic knuckle.
Left apical pleural cap.
Left sided haemothorax.
Depressed left/raised right main stem bronchus.
Tracheal displacement to the right

CT Thorax
Vessel wall disruption or extra-luminal blood seen in contiguity with
the aorta is indicative of rupture.

Aortic rupture

Radiological features
In

Diaphragmatic
rupture/hernia

the acute phase, unless there is visceral herniation,

sensitivity is poor for all imaging modalities.
CXR:
Air filled or solid appearing viscus above the
diaphragm.This may only be recognised following
passage of an NG tube.
Other features include mediastinal shift away from the
affected side, diaphragmatic elevation, apparent
unilateral pleural thickening or suspicious
areas of atelectasis.
In the non-acute setting contrast studies may be
useful.

Diaphragmatic rupture/hernia

Diaphragmatic rupture/hernia

Foreign body Inhaled/ingested

foreign bodies

Pulmonary Edema
Cardiac : Heart Failure
Non-Cardiac : renal failure, IV overload, ARDS,
anaphylaxis, near drowning.
Radiologic Features:
Alveolar edema :tiny nodular/acinar areas of
increased opacity, frank consolidation, batwing
appearance

Interstitial edema : appearance of Kerley

lines

Pulmonary interstitial edemaheart failure

Cardiac pulmonary edema

Non cardiac Pulmonary edema-ARDS

Abdomen
ABDOMINAL AORTIC ANEURYSMS
OBSTRUCTION LARGE BOWEL
OBSTRUCTION SMALL BOWEL
PERFORATION
TRAUMA BLUNT ABDOMINAL TRAUMA
Spleen, Hepatic, and pancreas

CT SCAN
USG - FAST
Plain Abdomen Film Supine,erect, and LLD

Abdominal aortic aneurysms

Radiological

features

Abdominal X-ray (AXR): Look for curvilinear

egg shell type calcification
Ultrasound (US) can accurately determine
size.Limited use in assessing rupture.
CT is accurate in assessing aneurysm
rupture as well as visualising adjacent
structures.

(up)Ruptured aortic aneurysm. The

arrowheads denote the breach in the
wall of the aneurysm (A), with extensive
associated retroperitoneal
haemorrhage (H).

(Left)Calcification in the left lateral wall of an

aortic aneurysm (arrowheads).

Obstruction-SBO
Radiologic

Features: AXR (3pos.)

Dilated small bowel, multiple airfluid

level
Bowel wall Thickening, Herring Bone
appearances
Little gas in colon, especially rectum
Key:

disproportionate dilatation of
SB, bowel sound
Causes : Adhesions,Hernia,
Volvulus, Gallstone
ileus,Intussusception

Mechanical Small Bowel

Obstruction

Erect

Supine

Cross Table

Obstruction-LBO
Radiologic

features

Dilated colon to point of obstruction

Multiple air fluid level=Step Ladder
Herring Bone appearances
Little or no air in rectum/sigmoid
Little or no gas in small bowel,
Ileocecal valve remains competent.
Distended small bowel shows
incompetent ileocecal valve

Large bowel Obstruction

Perforation
Perforation

of an air containing
hollow viscus will result in free
intraperitoneal air
Radiological features
CXR : free sub-diaphragmatic air
AXR

: Left Lateral DecubitusAir

will then outline the lateral edge
of the liver

Perforation

pneumoperitonium

AXR , LLD position

BLUNT HEPATIC TRAUMA

The

third most common organ injured in the

abdomen.

The

need for surgery is determined by the

size
of the laceration, the amount of
hemoperitoneum,
& the patients clinical status.

Ultrasound

findings:
- Laceration (right lobe > left lobe)
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- Intrahepatic hematoma:
* Hyperechoic in the first 24 hours
* Hypoechoic & sonolucent thereafter
- Subcapsular hematoma:
* Unilateral, along the area of
laceration
* Anechoic, hypoechoic, septated
lenticular,
or curvelinear (DD/ascitic fluid)
- Capsular disruption
- Intraperitoneal fluid
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Ultrasound findings

A crescent-shaped hyperechoic collection along the right lateral

aspect of the liver consistent with subcapsular hematoma.

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BLUNT HEPATIC TRAUMA

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BLUNT HEPATIC TRAUMA

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BLUNT HEPATIC TRAUMA

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BLUNT HEPATIC TRAUMA

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SPLENIC INJURY
Most

commonly injured
Ultrasound findings:
- Splenomegaly, with progressive enlargement
- Irregular splenic border
- Intrasplenic hematoma
- Contusion (splenic inhomogeneity)
- Subcapsular and pericapsular fluid collections
- Free intraperitoneal blood (disappear 2-4 weeks)
- Left pleural effusion
- When the spleen returns to normal small
irregular
foci /normal parenchyma
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SPLENIC INJURY

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SPLENIC INJURY

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HAEMOPERITONEUM (FRAGMENTED
SPLEEN)

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BLUNT PANCREATIC INJURY

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BLUNT PANCREATIC INJURY

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GIT Bleeding

Mesenterica bleeding embolizations

Extremities
Trauma

: Plain X-Ray, CT Scan,

MRI
Rule of two (Plain X-Ray)
Two views
Two joints
Two sides

Clavicle fracture

AC Separation

Scapular Fracture

AP position
Lateral position

Posterior dislocation
shoulder

Colles Fracture
nonarticular radial fracture in distal 2 cm
dorsal displacement of distal fragment + volar
angulation of fracture apex
ulnar styloid fracture

silver-fork deformity

Smith Fx
nonarticular distal radial fracture
ventral displacement of fragment
radial deviation of hand
garden spade deformity

Galeazzi Fracture

Monteggia Fracture

Posterior hip dislocation

Left Acetabulum Fracture- CTScan 2D -3D

Shentons line

Left femoral neck Fracture

Lateral Femoral Condylus Fracture

Fibula Shaft Fracture Butterfly fragment

Fracture-Dislocation
of the right ankle

Fracture fragment ?
thats Fabella

ANY QUESTIONS??

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THANK YOU