OBJECTIVETo examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain.

METHODSAll patients who presented to our emergency department following blunt trauma were enrolled in this study, except those with schiwora, neurological deficits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.

RESULTSA total of 200 cases were reviewed, of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.

CONCLUSIONSOur results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

Cervical Vertebrae ; injuries ; Humans ; Radiography ; Range of Motion, Articular ; Spinal Injuries ; Wounds, Nonpenetrating ; diagnostic imaging

OBJECTIVE: Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. MATERIALS AND METHODS: We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. RESULTS: The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. CONCLUSION: Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.
Abdominal Injuries/*radiography ; Adult ; Female ; Humans ; Intestines/*injuries/radiography ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; Reproducibility of Results ; Retrospective Studies ; Rupture ; Wounds, Nonpenetrating/*radiography

A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.
Accidents, Traffic ; Adult ; Aneurysm, False ; Aorta, Thoracic/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Cerebral Hemorrhage/radiography/surgery ; Endovascular Procedures/*methods ; Humans ; Male ; Subclavian Artery/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Wounds, Nonpenetrating/radiography/surgery

Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. An acute myocardial infarction (AMI) is a rare complication that can occur after chest trauma. We report a case of 66-year-old male who suffered a blunt chest trauma from a traffic accident resulting in an AMI. The coronary angiography revealed an eccentric 50% narrowing of the ostium of left anterior descending artery (LAD) by a dissection flap with calcification. Intravascular ultrasonography (IVUS) revealed eccentric calcified plaque (minimal luminal diameter [MLD]=3.5 mm) with a dissection flap. Intervention was not performed considering the MLD and calcified flap, and he has been conservatively managed with aspirin and losartan for 2 years. The follow-up coronary angiography showed an insignificant luminal narrowing of the proximal LAD from the ostium without evidence of a dissection. An early coronary evaluation including an IVUS study should be considered for managing patients who complain of ongoing, deep-seated chest pain with elevated cardiac enzyme levels and an abnormal electrocardiogram (ECG) after a blunt chest trauma. Based on this case, some limited cases of traumatic coronary artery dissections can be healed with conservative management and result in a good prognosis.
Aged ; Aneurysm, Dissecting/diagnosis/*etiology ; Coronary Aneurysm/diagnosis/*etiology ; Coronary Angiography ; Human ; Male ; Myocardial Infarction/diagnosis/*etiology ; Radiography, Thoracic ; Thoracic Injuries/*complications ; Ultrasonography, Interventional ; Wounds, Nonpenetrating/*complications

OBJECTIVE: To explore MSCT optimal examination time for patients with unconspicuous rib fracture. METHODS: Sixty-three patients with thoracic trauma from January 2009 to June 2011 were collected. They were examined by MSCT in the first week after trauma and re-examined during eighth weeks after trauma. The number of rib which had been found fractured in the first examination was compared to that in re-examinations. RESULTS: Patients with fine rib fracture often have different diagnostic results at different examination time after trauma. There was statistical difference between the number in the first week and the third week to the fifth week. CONCLUSION MSCT could show the pathophysiological changes of rib fracture objectively in the stage between the third week and the fifth week after trauma, which is optimal examination time for the fine rib fracture.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Pleura/pathology* ; Radiography, Thoracic/methods* ; Rib Fractures/physiopathology* ; Thoracic Injuries/physiopathology* ; Time Factors ; Wounds, Nonpenetrating/physiopathology* ; Young Adult

Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.
Abdominal Wall ; Angiography ; Ascites/surgery ; Embolization, Therapeutic ; Epigastric Arteries/*injuries ; Female ; Hematoma/*etiology/radiography/therapy ; Humans ; Liver Cirrhosis/*diagnosis ; Middle Aged ; Paracentesis/*adverse effects ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/complications

Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.
Accidental Falls ; Aneurysm, False/etiology/*radiography/ultrasonography ; Cardiac-Gated Imaging Techniques/methods ; Echocardiography/methods ; Female ; Follow-Up Studies ; Heart Aneurysm/etiology/*radiography/ultrasonography ; Heart Ventricles/injuries/radiography/ultrasonography ; Humans ; Middle Aged ; Multidetector Computed Tomography/*methods ; Remission, Spontaneous ; Thoracic Injuries/*complications ; Wounds, Nonpenetrating/*complications

OBJECTIVEWe evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.

METHODSPatients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization. Then, all the patients underwent plain radiography and computerized tomography of the cervical spine. The outcome measure was the presence of traumatic cervical spine injury. Sixty minutes after acetaminophen infusion, posterior midline cervical tenderness was reassessed.

RESULTSOf 1 309 patients, 41 had traumatic cervical spine injuries based on imaging. Sixty minutes after infusion, posterior midline cervical tenderness was eliminated in 1 041 patients, none of whom had abnormal imaging.

CONCLUSIONPatients with cervical spine trauma do not need imaging if posterior midline cervical tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention.

Acetaminophen ; administration & dosage ; Adolescent ; Adult ; Analgesics, Non-Narcotic ; administration & dosage ; Female ; Humans ; Iran ; Longitudinal Studies ; Male ; Middle Aged ; Neck Injuries ; diagnostic imaging ; drug therapy ; Prospective Studies ; Radiography ; Spinal Injuries ; diagnostic imaging ; drug therapy ; Unnecessary Procedures ; Wounds, Nonpenetrating ; diagnostic imaging ; drug therapy

OBJECTIVE: To evaluate the frequency and relevance of the "sentinel clot" sign on CT for patients with traumatic intraperitoneal bladder rupture in a retrospective study. MATERIALS AND METHODS: During a recent 42-month period, 74 consecutive trauma patients (45 men, 29 women; age range, 12-84 years; mean age, 50.8 years) with gross hematuria were examined by the use of intravenous contrast-enhanced CT of the abdomen and pelvis, followed by retrograde cystography. Contrast-enhanced CT scanning was performed by using a helical CT scanner. CT images were retrospectively reviewed in consensus by two radiologists. The CT findings including the sentinel clot sign, pelvic fracture, traumatic injury to other abdominal viscera, and the degree of intraperitoneal free fluid were assessed and statistically analyzed using the two-tailed x2 test. RESULTS: Twenty of the 74 patients had intraperitoneal bladder rupture. The sentinel clot sign was seen for 16 patients (80%) with intraperitoneal bladder rupture and for four patients (7%) without intraperitoneal bladder rupture (p < 0.001). Pelvic fracture was noted in five patients (25%) with intraperitoneal bladder rupture and in 39 patients (72%) without intraperitoneal bladder rupture (p < 0.001). Intraperitoneal free fluid was found in all patients (100%) with intraperitoneal bladder rupture, irrespective of an associated intraabdominal visceral injury, whereas 19 (35%) of the 54 patients without intraperitoneal bladder rupture had intraperitoneal free fluid (p < 0.001). CONCLUSION: Detection and localization of the sentinel clot sign abutting on the bladder dome may improve the accuracy of CT in the diagnosis of traumatic intraperitoneal bladder rupture, especially when the patients present with gross hematuria.
Abdominal Injuries/diagnosis/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Contrast Media/administration & dosage ; Extravasation of Diagnostic and Therapeutic Materials/diagnosis/etiology ; Female ; Fractures, Bone/diagnosis/etiology ; Hematuria/etiology ; Humans ; Image Processing, Computer-Assisted ; Iohexol/diagnostic use ; Male ; Middle Aged ; Observer Variation ; Pelvic Bones/injuries/radiography ; Predictive Value of Tests ; Radiographic Image Enhancement/methods ; Reproducibility of Results ; Retrospective Studies ; Rupture/diagnosis ; Tomography, Spiral Computed/*methods ; Urinary Bladder/*injuries/*radiography ; Wounds, Nonpenetrating/complications/*diagnosis