Hip/Proximal Femur Alan Rogers Joseph S. Yu The hip is a common site of trauma and when injured can have a significant impact on the patient’s well-being. Worldwide the total number of hip fractures is expected to exceed 6 million by the year 2050. In 2003 over 300,000 patients were hospitalized with hip fractures in the United States, accounting for 30% of all hospitalized patients according to data…
Shoulder Hamid Torshizy Tudor H. Hughes Christine B. Chung The shoulder girdle is a general term describing a complex network of soft tissue and osseous structures, demarcated by numerous joints, which serve to both suspend and connect the upper extremity to the torso. Injuries of the shoulder girdle are common, with sites of injury varying with the age of the patient. In general, whereas fractures of the clavicle are…
Gastric and Duodenal Emergencies Vincent M. Mellnick Christine Menias The upper gastrointestinal (GI) tract, including the esophagus, stomach, and duodenum, is a common but potentially overlooked site of disease that may prompt presentation to the emergency department (ED), including inflammation and infection, obstruction, and perforation. Although these organs have traditionally been evaluated by fluoroscopy, which offers mucosal detail, computed tomography (CT) is now the first-line imaging modality in…
Firearm-related injury is the second leading cause of death following motor vehicle collision. For every firearm death it is estimated that there are three to five other nonfatal firearm injuries. These injuries have become a major public health problem, creating a devastating impact on U.S. society with substantial emotional and financial cost. This chapter will describe the role of imaging in evaluating patients admitted with penetrating…
Computed Tomography Protocols and Scan Optimization Thorsten R. Fleiter Krystal Archer-Arroyo Trauma is one of the leading causes of mortality in the United States, responsible for approximately 100,000 deaths per year. The majority of the trauma cases are due to blunt force, with more than two thirds of these caused by motor vehicle collisions. Additional causes of blunt trauma include falls and assaults. Penetrating trauma, including stab and…
With chest pain representing one of the most common presenting symptoms in the emergency department (ED), radiologists are frequently called upon for the noninvasive evaluation of aortic and pulmonary vascular diseases. Adequate assessment relies on the ability to understand the spectrum of the pathologic conditions and the significance of each of these entities. Thoracic Aorta Anatomy The thoracic aorta begins at the level of the aortic…
Use of imaging services in the emergency department (ED) continues to outpace the growth of actual ED patient visits. This imaging surge places the emergency radiologist at the forefront of acute care. Chest imaging constitutes a large percentage of examinations generated through the ED. In the time-sensitive acute care environment, efficiency is paramount; conventional radiographs are a common triage screening tool. It is not uncommon for…
Nonmediastinal Injury Chest trauma is directly responsible for 25% of all trauma deaths and is a major contributor in another 50% of all trauma mortality. Chest trauma may be blunt (90% of cases) or penetrating. Blunt thoracic injuries are the third most common injuries in polytrauma patients, following those of the head and extremity. Although 50% of blunt chest injuries are minor, 33% will require hospital…
Infection of the vertebral column represents up to 20% of all osteomyelitis and is the most common infection of the axial skeleton. The presentation is often insidious. It is not uncommon for symptoms to be present for 6 to 8 weeks before being diagnosed. If ignored or misdiagnosed, infection of the spine can have a chronic, destructive, and significantly debilitating course. The general characteristics of spinal…
Cervical Spine Emergencies Mark Bernstein Alexander B. Baxter F.A. Mann Each year in North America approximately 3 million patients are evaluated for spinal injury. Although the incidence of vertebral fracture and spinal cord injuries is low, the consequences of a missed injury or delayed diagnosis can be devastating. Although most cervical spine fractures are localized to a single vertebra, two or three noncontiguous injuries are often seen in high-energy…
Midfacial Trauma Ken F. Linnau Indications and Rationale for Repair The overt physical manifestation of facial trauma often causes acute psychologic distress and long-term psychologic sequelae in addition to the loss of facial organ function. The use of modern surgical repair procedures, including internal reduction, microplate fixation, and the use of bone and allograft material has led patients to expect near normal if not normal appearance and…
Intracranial Hemorrhage Arash Meshksar Wayne S. Kubal Nontraumatic Intracranial Hemorrhage Initial Diagnosis Although many cases of intracranial hemorrhage (ICH), including intra-axial and extra-axial hemorrhage, are due to trauma, this discussion will be limited to atraumatic intracranial hemorrhage. Abrupt onset of neurologic symptoms in any patient should be considered to be of vascular origin until proven otherwise. It is not possible to differentiate ischemic from hemorrhagic accidents based on…
Traumatic Brain Injury Monique Anne Meyer Wayne S. Kubal Traumatic brain injury (TBI) occurs when an external mechanical force results in tissue and cellular damage within the brain that may lead to permanent or temporary impairment of cognitive, physical, or psychosocial functions and a diminished or altered state of consciousness. There are two types of TBI: closed and penetrating. Closed TBI is an injury to the brain caused…
Background Imaging of Patients at Outside Facilities Before Transfer Early and timely transfer of injured patients to a trauma center capable of definitive care has been shown to decrease mortality. Although long-standing national guidelines from the American College of Surgeons Committee on Trauma recommend simple clinical parameters and radiography to identify patients who benefit from transfer to a Level I or II trauma center, these are…
Acknowledgments All figures and much of the text in this chapter have been reprinted with permission from: Sodickson A. Strategies for reducing radiation exposure in multi-detector row CT. Radiol Clin North Am . 2012;50(1):1-14; and Sodickson A. Strategies for reducing radiation exposure from multidetector computed tomography in the acute care setting. Can Assoc Radiol J . 2013;64(2):119-129. Synopsis Many tools and strategies exist to enable reduction…
▪ Introduction Thoracic injury is a common sequela of acute trauma and is the third most common injury in trauma patients, after head and extremity injuries. The overall mortality rate approaches 25%, with acute aortic, tracheobronchial, and cardiac injuries often having an even worse prognosis. Given the high mortality rate and the impact on clinical management, rapid and accurate assessment of thoracic trauma imaging is imperative.…
▪ Introduction Thoracic interventions are performed for the diagnosis and treatment of focal lesions in the thorax. Image-guided percutaneous biopsy is used to obtain tissue for the diagnosis of benign and malignant conditions. Drainage of fluid or air from the pleural space or mediastinum can aid both diagnosis and therapy, and ablative therapies treat primary or secondary malignancy in lungs and chest wall. ▪ Lung and…
■ Lung Transplantation Since the first lung transplantation was performed in 1963, there have been major improvements in the surgical technique and posttransplantation management of organ recipients. Lung transplantation represents the only effective therapeutic option for many patients with advanced lung disease. Although there continue to be advancements in the understanding of the posttransplantation care of these patients, improvements in long-term survival have been limited by…
■ Introduction More than 8 million Americans each year present to the emergency department (ED) with acute chest pain. This poses a diagnostic challenge to physicians, who must distinguish patients with life-threatening conditions, including acute coronary syndrome (ACS), aortic dissection, and pulmonary embolism, from those who have chest pain related to more benign causes. Most patients with chest pain are discharged with a diagnosis of noncardiac…
■ Value of a Routine Daily Chest Radiograph in the Intensive Care Unit Determining Who Needs Imaging Imaging of an intensive care unit (ICU) patient can be a difficult task that relies on cooperation and teamwork among many members of the clinical care team and technologist. The complexity of these critically ill patients, many of whom have numerous support devices, has led to the practice of…