RADIOLOGY OF

EMERGENCY &
TRAUMATOLOGI
Prof. Dr. dr. Bachtiar Murtala, Sp.Rad
(K)

Introductio
n:
Since Prof.W.C. Roentgen (1895) in Germany/

Europe discovered x-ray, medical science

developed rapidly both in diagnosis and
treatment.
The role of x-ray and other radiology modalities in
emergency cases, as well as traumatology, also
increased. It is very difficult to asses and make
precise diagnosis without radiology examinations.
Beside x-ray conventional, radiology has also
imaging machines such as CT-Scan, Ultrasound
(US), Magnetic Resonance Imaging (MRI) and
Nuclear medicine

Emergency and trauma cases may come

from the head and neck, chest, abdomen ,

and extremities regions.
In this topic, we focus to discuss about
conventional x-ray and the most common
cases in the daily practice.
US is the tool of choise in detecting free fluid
/ blood in the abdominal and chect cavities,
while,
CT scan for intracranial hemorrhages/injures
caused by trauma.

Emergency cases in the chest

region

Pneumothorax

Free air within pleural

cavity
Clinical signs : dyspnoe,
chest pain, etc
Chest x-ray :
- Avascular hyperluscent
- Shifting of mediastinal
organs and heart
toward contralateral.
- Additional exam. : CTScan

Pleural effusion
Pleural effusion:
- Light ( fluid volume
300 cc),
Detected in
erect/upright position
and Lateral Decubitus
(LD).
LD is more sensitive.

Radiological signs :
Opacification/fluid
accumulates in the lower
part of the chect cavity

Pleural effusion
- mild : Volume > 300 cc,
easily detected in
Posteroanterior (PA) or routine
position.
- Radiological signs :

Opacification
/Perselubungan in the
lower part of
hemithorax, blunting or
filled of sinus
costophrenicus,
obliterate of diaphragm

Notice: blunting of left

sinus ( Left Pl.eff.)

Pleural effusion :
- Severe/massive :
Radiological signs :
- Massive
opacification/Perselubungan
covers all region of the suffer
hemithorax.
- Mediastinal/heart shifting
toward contralateral side.
- intercostal space widening

Massive pl.eff.(R)

Hydropneumothorax

/ Hematothorax: free
air + fluid / blood in
the pleural cavity
Radiological signs:
-Free air
(hyperluscent) +
fluid level below (air
fluid level)
- Mediastinal shifting
toward contralateral

Air fluid level in L side

( Hydropneumothorax)

Atelectasis
Sinonim : Lung collapse
Clinical signs : dyspnoe, retraction of

thoracic cage
Mechanisms: Obstruction : by foreign bodies, tumor.
Compression : by free air/free fluid, mass.

Contraction : fibrosis, such as old Tb

Radiological signs : Opacification/perselubungan
hemithorax and mediastinal shifting toward
ipsilateral. Intercostal space narrowing

Pulmonary oedema :
Fluid accumulates inside

within alveoli/interalveoli.
May be found on heart
failure, cirrhosis hepatis,
intoxication,etc.
Radiological signs :
Opacification/haziness on
parahilar region
simmetrically.
(Batwing appearance,
butterfly apperance)

Lung oedema +

pl.effusion

Aspiration

pneumonia:
Commonly found on
baby, comatous and
postoperative pasients.

Radiological signs :
- Coarse
infiltrations mostly
in the lower part of
both lungs

Emergency in abdomen
Commonly known as acute abdomen
For examples:

-perforation,
-ileus obstructive and paralytic,
-free fluid or blood within abdominal cavity.
-peritonitis

It is recommended to perform cito foto

abdomen with positions :

1.Erect/half erect,
2.Supine,
3.Left Lateral Decubitus (LLD),
4. and Cross table position (optional).

Perforation
Could be come from:
Gastric ---ulcer,malignity
Small boweltyphoid fever,etc
Large bowelappendix, diverticulitis
From outside of abdominal wall---penetrans

trauma,etc

Perforation
Plain abdominal

radiography in 3
positions

Radiological signs :
Pneumoperitoneum,
free air just
below diaphragm
( subdiaphragm)
- The site of free air
depend on the
patients position.

Obstructive ileus
Sin : mechanical ileus, dynamic ileus
Caused by :
Invaginasi/intussusception
Tumor (intrinsic/extrinsic) of bowel
Volvulus, strangulation
Foreign bodies
Postoperative adhesion
etc

Obstructive ileus
Radiological signs
- Bowel dilatation
/distension in the
upper part of lesion.
- Lower part appears
opaque/lack of air.
- Air fluid levels (+),
- Step ladder
appeaarance
- Hearing bone
Appearance

Obstructive ileus :

Air fluid level

Air fluid levels

Paralytic ileus
Sin. : neurogenic ileus, adynamic ileus
Usually found in :
Peritonitis
Imbalance of electrolyte ;hypokalemia
Spasmolytic medicines
Postlaparotomi
Sequalae of longstanding dynamic ileus
Etc.

Radiological signs :

- Small and large

bowel distension. Air
appears in the entire
segmen of bowels, till
rectum.
- Long air fluid levels
(+)
- Disappear of
properitoneal fat line
in case of peritonitis

Distention of all parts of bowel, gas++

Air fluid level

Trauma
Can cause fracture,dislocation
Fracture : discontinuity of bone,

cartilage or both, associated with

soft tissue injury
Closed X open fracture
Complete X incomplete fracture

More important is the

impact of the fracture to

the soft tissue i.e. spinal
cord, brain tissue, etc

Types of shaft fractures

Bowing
Torus
Impaction/greenstick
Complete with two fragments
Comminuted fractures (>2

fragments)
etc

Types of skull fractures

Linear
Depressed
Brain or intracranial damage must be viewed

by CT-Scan or and MRI :

Epidural bleeding
Subdural bleeding
Intracerebral bleeding
Subarachnoid bleeding

Epidural hematoma

Subdural hematoma

Subarachnoid bleeding

Trauma of Spine
Cervical ( most important)
Thoracal
Lumbal
Sacrum

Fracture/dislocation of cervical
spine:
This fracture is very dangerous because of

the risk to the spinal cord injure /pressure

Routine position : AP and lateral view
Fracture of C1 or C7 T1, usually needed
special view :
- C 1 by Open mouth position
- C7 T 1 by swimmers position

Dislocation:
cervical dislocation

Anterior dislocation in
normal cervical, from

lateral view

C3 level ( lateral view )

C1 fracture

Fracture of C1 , as in
Jefferson fr. Can be
identified by open
mouth position

Fraktur
Jefferson:

Normal

Please look for more

information about :

Types of cervical fracture/dislocation

Types of thoraco-lumbal

fracture/dislocation
Traumatic intracranial hemorrhage

In : - Grainger and Allisons Diagnostic

Radiology
- Textbook of radiology (David Sutton)
- etc

Thank You