Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘trauma’ Category

Bankart and Bankart variant lesion

leave a comment »

Classification of Bankart and Bankart variant lesions. a Bankart lesion, b bony Bankart lesion, c Perthes lesion, d ALPSA (anterior labro-ligamentous periosteal sleeveavulsion) lesion, e GLAD (glenolabral articular disruption) lesion, f HAGL (humeralavulsion of glenohumeral ligaments) lesion. (LLC anteroinferior labro-ligamentous complex, P scapular periosteum, HH humeral head, AC articular cartilage of glenoid,IGHL inferior glenohumeral ligament)

Written by lmwong

December 12, 2010 at 10:33 am

Urethral Injury Types

leave a comment »

urethral injury typesPosterior urethra: from bladder neck, through prostate, to membranous urethra

Anterior urethra: bulbar and penile urethra

  • type 1: stretched, periurethral hematoma
  • type 2: rupture above urogenital diaphragm, extraperitoneal contrast
  • type 3: rupture below urogenital diaphragm, extraperitoneal and perinium contrast
  • type 4: bladder extending to urethra
  • Type 5: anterior urethral injury

Written by lmwong

March 31, 2010 at 2:53 pm

Posted in classification, GU, trauma

Bladder Rupture Classification

leave a comment »

  • Type 1: contusion
  • Type 2: intraperitoneal rupture
  • Type 3: interstitial bladder injury
  • Type 4: Extraperitoneal rupture; a = simple; b = complex
  • Type 5: Combined bladder injury

Written by lmwong

March 31, 2010 at 2:48 pm

Pellegrini Stieda Lesion

leave a comment »

  • curvilnear calcification or ossification adjacent to femoral attachment of MCL
  • old MCL injury

Written by lmwong

February 14, 2010 at 11:17 am

Posted in bone, msk, trauma

Hip Columns

leave a comment »

Written by lmwong

February 13, 2010 at 1:00 pm

Posted in bone, msk, trauma

Child Abuse Nonaccidental Trauma

leave a comment »

  • skull fractures: depressed, bilateral, healing
  • intracranial hemorrhage: subdural hematoms, other
  • cerebral infarction, anoxic brain injury
  • retinal hemorrhages
  • metaphyseal corner fractures
  • posterior rib fractures
  • scapular fractures
  • spiral fractures of long bones

Written by lmwong

January 25, 2010 at 11:07 am

Posted in bone, msk, neuro, pediatrics, trauma

Venous Epidural Hematoma

leave a comment »

  • laceration/tear of dural venous sinus
  • posterior MC
  • children
  • extends across tentorium (supratentorium –> infratentorium)

Written by lmwong

January 22, 2010 at 10:40 pm

Posted in bleeding, neuro, trauma

Ankle Fractures

leave a comment »

Pattern

Classification

Supination

LCL tear
avulsion fracture of lateral malleolus

Supination-external rotation

Stage 1 = disruption of anterior distal tibiofibular ligament
Stage 2 = +distal fibular fracture
Stage 3 = +tear of posterior distal tibiofibular ligament, fracture of posterior malleolus
Stage 4 = +fracture of medial malleolus

Pronation

Stage 1 = avulsion of medial malleolus
Stage 2 = +rupture of anterior and posterior distal tibiaofibular ligaments
Stage 3 = +fibular fractures

Pronation-external rotation

Stage 1 = avulsion of the medial malleolus, deltoid ligament tear
Stage 2 = +tear of anterior distal tibiofibular ligament and tibiofibular syndesmosis
Stage 3 = +fibular fracture
Stage 4 = + posterior distal tibiofibular ligament, posterior malleolar fracture
Tillaux fracture
triplane fracture
base of the 5th metatarsal fracture

Axial

Pilon Type 1 = nondisplaced
Pilon Type 2 = moderately displaced
Pilon Type 3 = severely displaced and impacted

Written by lmwong

January 20, 2010 at 2:35 am

Sinding-Larsen-Johansson disease

leave a comment »

  • Jumper’s knee = patellar tendonitis
  • fragmentation of lower pole of patella
  • repetitive stress injury

Written by lmwong

January 15, 2010 at 11:34 pm

Posted in bone, knee, msk, trauma

Tibial Plateau Fractures

leave a comment »

  • 80% localized to lateral tibial plateau
  • Schatzker classification
    • Type I = cleavage fracture of lateral tibial plateau
    • Type II = cleavage + depression of lateral
    • Type III = purely depressed
    • Type IV = lateral condylar tibial cleavage fracture that extends to medial tibial condyle
    • Type V = bicondylar fracture
    • Type VI = any fracture with a transmetaphyseal component

read

Written by lmwong

January 15, 2010 at 10:43 pm

Posted in bone, msk, trauma

Femoral fractures

leave a comment »

  • MRI has highest sensitivity, specificity
  • Bone scan highly sensitive after 72 hours
  • CT scan not as sensitive as MRI
  • femoral head fractures
    • associated with hip dislocation
  • femoral neck fractures
    • the most common
    • elderly, osteoporosis
    • types: subcapital (MC), midcervical, and basicervical
    • more displacement, higher chance of AVN and nonunion
    • Garden Classification of Subcapital fractures
      • Stage I = incomplete lateral impaction fractures
      • Stage II = complete subcapital fractures without displacement
      • Stage III = complete subcapital fractures with partial displacement
      • Stage IV = complete subcapital fracture with gross proximal displacement of the shaft relative to the head
  • intertrochanteric fractures
    • good prognosis
    • internal fixation with dynamic hip screw
  • avulsion fracture of less trochanter
    • pediatrics
    • superior avulsion of less trochanter, pulled by iliopsoas
  • femoral shaft fractures
    • often fragmented or butterfly
    • casting for pediatrics, intramedullary rod for adults
    • degree of rotation (version) is measured
  • femoral condyle fractures
  • stress fractures
    • detected on MRI
    • along medial femoral neck
    • become complete fractures, requiring pinning

Written by lmwong

January 15, 2010 at 9:23 pm

Posted in bone, hip, msk, pelvic, pelvis, trauma

Hip Dislocation

leave a comment »

  • ~ femoral head fractures
  • delayed relocation increases risk of AVN

Posterior

  • most common, 90%
  • superior displacement of femoral head on frontal view
  • femoral head may look smaller

Anterior

  • flexed = obturator anterior dislocation
    • femoral head is medial and inferior
    • overlying obturator foramen
  • extended = iliac dislocation
    • head is superior to acetabulum
    • femur is externally rotated; distinguish from posterior dislocation

Written by lmwong

January 15, 2010 at 9:04 pm

Posted in bone, hip, msk, pelvic, pelvis, trauma

Jones fracture

leave a comment »

  • transverse fracture through the proximal 5th metatarsal, distal to the tuberosity
  • impaction fracture
  • stress injury
  • delayed healing, requires fixation
  • distinguish from avulsion of proximal tip of 5th metatarsal; heals quicker

Written by lmwong

January 15, 2010 at 8:42 pm

Posted in bone, foot, fracture, msk, trauma

Renal Laceration Grading

leave a comment »

Grade 1

  • hematuria, normal imaging
  • contusion
  • nonexpanding subcapsular hematomas

Grade 2

  • nonexpanding perinephric hematoma confined to the retroperitoneum
  • laceration <1cm deep, collecting system not involved

Grade 3

  • laceration >1cm, collecting system not involved

Grade 4

  • laceration extending to collecting system
  • involve main renal artery or vein
  • segmental infarctions without associated lacerations
  • expanding subcapsular hematomas compressing kidney

Grade 5

  • shattered or devascularized kidney
  • ureteropelvic avulsions
  • complete laceration or thrombus or main RA or V

Written by lmwong

January 14, 2010 at 7:36 am

Posted in abdomen, GU, renal, trauma

Splenic Laceration Grading

leave a comment »

Grade 1

  • subcapsular hematoma <10% of surface area
  • capsular tear <1cm deep

Grade 2

  • Subcapsular hematoma 10-50% SA
  • intraparenchymal hematoma <5cm diameter
  • laceration 1-3 cm deep, not involving vessels

Grade 3

  • Subcapsular hematoma >50% SA or expanding and ruptured
  • subcapsular or parenchymal hematoma
  • Intraparenchymal hematoma >5cm or expanding
  • Laceration >3cm deep, or involving vessels

Grade 4

  • involves hilar vessels with devascularization >25% of spleen

Grade 5

  • shattered hilar vascular injury

spleen

Written by lmwong

January 14, 2010 at 7:32 am

Posted in abdomen, gi, spleen, trauma

Liver Laceration Grading

leave a comment »

Grade 1 (either or)

  • Subcapsular hematoma <1cm
  • Liver Laceration <1cm deep

Grade 2 SH or LL 1-3 cm

Grade 3 SH or LL >3cm

Grade 4 LL or SH >10cm Lobar destruction devascularization

Grade 5 Global destruction or devascularization

Grade 6 Hepatic avulsion

Written by lmwong

January 14, 2010 at 7:28 am

Posted in abdomen, gi, liver, trauma

AP Pelvis Trauma Checklist

leave a comment »

  1. Iliopubic line
  2. Ilioischial line
  3. Anterior acetabular rim
  4. Posterior acetabular rim
  5. Pubic Symphysis

Written by lmwong

January 14, 2010 at 7:14 am

Posted in bone, msk, pelvis, Phalen, trauma

Traumatic Aortic Transection

leave a comment »

  • 3 most common places
    • ligamentum arteriosum
    • aortic root
    • diaphragm
  • blunt chest trauma, high mortality; 50% who present will die within 24 hour
  • mediastinal hemorrhage
  • deformed aortic contour
  • intimal flap
  • intraluminal clot or debris
  • pseudoaneurysm
  • frank extravasation of contrast

Written by lmwong

January 13, 2010 at 1:38 am

Posted in aorta, chest, trauma

Uretheral Injury Classification

leave a comment »

The classification system of Goldman et al (6) is as follows:

Type I injury: The posterior urethra is stretched and elongated but intact. The prostate and bladder apex are displaced superiorly due to disruption of the puboprostatic ligaments and resulting hematoma.

Type II injury: Disruption of the urethra occurs above the urogenital diaphragm (UGD) in the prostatic segment. The membranous urethra is intact.

Type III injury: The membranous urethra is disrupted with extension of injury to the proximal bulbous urethra and/or disruption of the UGD.

Type IV injury: Bladder neck injury with extension into the proximal urethra.

Type IVA injury: Injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury.

Type V injury: Partial or complete pure anterior urethral injury.

Source: http://radiographics.rsnajnls.org/cgi/content/full/23/4/951

Written by lmwong

September 8, 2008 at 12:00 am

Posted in classification, GU, trauma

Bowing deformity

leave a comment »

  • traumatic injury to radius and ulna without fracture
  • if untreated, pronation and supination reduced
  • must be broken and reset

Written by lmwong

June 19, 2008 at 2:47 pm