Trauma

-
Adrenal hemorrhage Etiology: Underlying tumor; Coumadin; Trauma; Infection; Hypercoagability states; stress
CT findings: high attenuation on NECT; may be unilateral or bilateral; in time may calcify; more common in females (3:1)
If bilateral adrenal hemorrhage in trauma consider addison syndrome need hormonal replacement therapy as life treatening (Emergency Radiology 2012; Sacerdote)
Variable appearnace of lesion: Round;
Blunt abdominal trauma findings: Adrenal hematoma (oval or round); irregular hemorrhage obliterating the gland; uniform adrenal gland swelling with increased attenuation; preiadrenal hemorrhage or stranding; retroperitoneal hemorrhage; adrenal pseudocyst (chronic) (Emergency radiology 2012 To'o)
Bright Adrenals in Trauma  Patient is hypotensive; hypovolemic shock syndrome 
Hypovolemic shock CT findings Bright Adrenals; Diffuse fluid filled dilated small bowel; hyperenhancement of the small bowel; hyperenhancement of the gall bladder mucosa; reduced splenic perfusion; intense enhancement of the kidneys; peripancreatic edema (BMJ 2008). Also look for a flat IVC 
Pelvic fracture in a pregnant patient In major trauma, when there is concern for maternal injury, CT is the mainstay of imaging. The risks of radiation to the pregnancy are small compared with the risks of missed or delayed diagnosis of trauma. (Imaging of trauma, abdominal trauma in prenancy, Sadro AJR 2012)
Trauma is the leading caue of non-obstatric maternal mortality affecting up to 7% of pregnancies and is significant cause of fetal loss. Approximately 2% of level-1 trauma patients have a positive pregnancy test.

Soft tissue / muscle injury; pelvic hematoma; bladder injury; colon injury

Bladder trauma: Blunt 60%, Penetrating 35% IAtrogenic 5%
GU trauma occurs in 5-10% of all patients with trauma; bladder injury occurs in 1.6% of blunt trauma cases; bladder rupture occurs in 2-11% of patients with pelvic trauma; however, 60-90% of patients with bladder rupture have a pelvic fracture
80% of cases are extraperitoneal rupture; 15% of cases are intraperitoneal; 5% of cases are combined bladder rupture
Intraperitoneal rupture has a higher morbidity and mortality
5 Bladder trauma categories: contusion; intraperitoneal (15%), interstitial or bladder wall hematoma; extraperitoneal (80%), combined (5%) - lower urinary tract trauma (Sandler, World J Urology)
15% of rupture intraperitoneal- delayed diagnosis results in increased mortality due in part to risk of chemical peritonitis; patients require surgical management

MDCT cystography os rapidly becoming the most recommended study for evaluation of th bladder for suspected trauma (Emergency radiology 2011, IShak) MDCT cystography should be done when pelvic fluid is present, especially when there are fractures or gross hematuria, to define which of the patients has a bladder rupture and to define the type of bladder rupture.
Splenic bleed and subsequent rupture Active bleeding, multiple, areas 

Popular posts from this blog

AN UNEXPECTED CHEST XRAY

-
Image
AN UNEXPECTED CHEST XRAY Mrs MacLeod was a rather prudent 54 year old women, that presented with a shortness of breath, a chronic cough and recurrent pneumonia. She had an obstructive lung pattern on pulmonary function tests. She come in for an xray of the chest. The chest XRAY was rather different. There was unequal lung volumes, with the right lung volume being larger than the left. There was also decreased left lung vessels noted. There were no pleural effusions and no pneumothorax present either. The right lung was perfectly normal. Upon further investigation she reported to have had a significant childhood viral infection that resulted in distal airspace obstruction, probably secondary to an adenovirus or and RSV viral infection. A case of Sweyer-James syndrome was diagnosed. She was treated with influenza vaccinations, but in this case no lobectomy was performed as the no specific lung segment was identified.
Read more

The Cardiovascular system, Heart Muscle, The Heart as a pump

-
Image
The Cardiovascular System is a  closed system , with a  one way circuit. efficiency Transports Materials throughout the body: Exogenous Endogenous Waste and heat elimination Brain is Oxygen dependent Cannot meed oxygen needs by using the anaerobic pathway 2 ATP + 1 NADH Must use the aerobic pathway - Glycolysis, Citric Acid cycle + Electron Transport System 6H2O+ 30 ATP + 6CO2 Nutrient, Hormone, Immunity transport CO2 and metabolic waste and heat removal How Blood flows: Down a pressure Gradient (dP) from high pressure to a low pressure Pressure, Volume, Flow and Resistance Pressure of a fluid in motion decreases over distance Hydrostatic Pressure: = may also be referred to as the hydraulic pressure - as fluid is in motion In a system that flows, pressure falls over distance as energy is lost to resistance / friction Pressure in Liquid changes without changes in Volume Driving pressure - the pressure of the ventricles on the systemic circulation -   dis
Read more

Lumps in the groin

-
Lumps in the groin: Differential diagnosis Inguinal hernia, femoral hernia, enlarged lymph nodes, saphena varix, hydrocele of the cord (or of the canal of Neck in women), vaginal hydrocele, undescended testis, lipoma of the cord, femoral aneurysm, psoas abscess. Determining the diagnosis Hernia A hernia (usually) has a cough impulse (i.e. it expands on coughing) and (usually) reduces with direct pressure or on lying down unless, uncommonly, it is incarcerated (i.e. the contents of the hernia are fixed in the hernia sac by their size and by adhesions).  Movement of the lump is not the same as expansion . Many groin lumps have a transmitted impulse on coughing (i.e. they move) but do not expand on coughing.  Since inguinal and femoral hernias arise from within the abdomen and descend into the groin, it is not possible to get above them. For lumps that arise from within the scrotum, the superior edge can be palpated (i.e. it is possible to get above them). Once a
Read more