Trauma

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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 

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