Radiology in Trauma

Created on Fri, 01/01/2016 - 19:54
Last updated on Wed, 01/13/2016 - 18:10

Trauma radiology comes up fairly frequently in the exam. For instance, recently Question 12.1 from the second paper of 2014 showed the candidates a CT with a racture through the sella turcica, and Question 20 from the second paper of 2013 showed them a ruptured liver with lots of intraperitoneal blood. It is probably impossible to formally prepare for such image-based questions, given the randomness and improbability of what may be thrown before you. All one can do is know what has already happened. Ergo, this chapter presents the discussion points from previous trauma radiology questions.

Sella turcica injury and pituitary trauma

  • A cause of haemodynamic instability after head injury, in spite of optimal resuscitation
  • Associated with base of skull fracture
  • Managed with hydrocortisone

Merits of CT scanning in the assessment of blunt abdominal trauma.

A good recent article discusses these points as well as offering tables of injury severity grading.

  • Advantages of CT:
    • Rapid
    • Non-invasive
    • Readily available
    • Allows assessment of clinically undetectable injuries
    • Good sensitivity for solid organ damage
    • Contrast extravasation can suggest the source of bleeding
  • Disadvantages of CT:
    • Radiation exposure
    • Contrast exposure
    • Exposure of the patient to the risk of transfer
    • Poor sensitivity for hollow organ damage
    • limitations in morbid obesity- either they wont fit in the scanner, or the artifact degrades image quality

 

References

Fang, Jen-Feng, et al. "Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients." World journal of surgery 30.2 (2006): 176-182.

Soto, Jorge A., and Stephan W. Anderson. "Multidetector CT of blunt abdominal trauma." Radiology 265.3 (2012): 678-693.

Ross I Baker, Paul B Coughlin, Hatem H Salem, Alex S Gallus, Paul L Harper and Erica M WoodWarfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis Med J Aust 2004; 181 (9): 492-497.

There is also this local policy document.