This presentation is a selection of images from 17th chapter of grainger and allison. Our aim is to provide standard and proved cases of the disease process. This all is for educational purpose

1. 17 Thoracic Trauma and
Related Topics
Dr. Muhammad Bin Zulfiqar
PGR IV FCPS Services Institute of Medical Sciences / Hospital
radiombz@gmail.com
GRAINGER & ALLISON’S DIAGNOSTIC RADIOLOGY

2. • FIGURE 17-1 ■ Haemopericardium and acute
traumatic aortic injury. CT image following
blunt trauma with a haemopericardium (A).
The patient also sustained an acute traumatic
injury with a dissection visible on axial images
(B, C) and on a coronal reformatted image (D).

3. • FIGURE 17-1 ■ Haemopericardium and acute
traumatic aortic injury. CT image following blunt
trauma with a haemopericardium (A). The
patient also sustained an acute traumatic injury
with a dissection visible on axial images (B, C) and
on a coronal reformatted image (D).

4. • FIGURE 17-2 ■ Cardiac herniation. Chest
radiograph following a fall from a height which
resulted in traumatic pericardial rupture with
herniation of the heart into the right hemithorax.
Other injuries including rib and spinal fractures
are present.

5. • FIGURE 17-3 ■ Aortic injury with mediastinal haematoma. Chest
radiograph in a patient with a post-traumatic aortic rupture and
mediastinal haematoma. Features present include a widened
mediastinum, filling in of the aortopulmonary bay and the
development of a left apical pleural cap. (Courtesy of Dr L. C.
Morus, Birmingham, UK.)

6. • FIGURE 17-4 ■ Pneumomediastinum. Chest
radiograph (A) with axial (B) and coronal reformatted
CT (C) images demonstrating pneumomediastinum
following blunt chest trauma.

7. • FIGURE 17-4 ■ Pneumomediastinum. Chest
radiograph (A) with axial (B) and coronal
reformatted CT (C) images demonstrating
pneumomediastinum following blunt chest
trauma.

8. • FIGURE 17-5 ■ ‘Fallen lung sign’. Chest
radiograph in a boy with complete rupture of the
right main bronchus following blunt chest
trauma. The right lung is seen sagging to the floor
of the right hemithorax.

9. • FIGURE 17-6 ■ Pneumothorax on supine chest radiograph. Left sided
pneumothorax seen on a supine chest radiograph demonstrating the deep
sulcus sign and an unusually sharp left heart border.

10. • FIGURE 17-7 ■ Lung contusion, haemothorax and rib
fractures. Axial (A) and coronal reformatted (B) CT
images demonstrating airspace opacity due to post-
traumatic contusion. Also seen is an associated
haemothorax and axial bone window images reveal
associated rib fractures (C).

11. • FIGURE 17-7 ■ Lung contusion, haemothorax and rib
fractures. Axial (A) and coronal reformatted (B) CT
images demonstrating airspace opacity due to post-
traumatic contusion. Also seen is an associated
haemothorax and axial bone window images reveal
associated rib fractures (C).

12. • FIGURE 17-8 ■ Pulmonary haematoma. Chest
radiograph demonstrating extensive
contusion in the right lung (A). A repeat
radiograph one week later (B) reveals clearing
of the contusion along with a right lower zone
pulmonary haematoma.

13. • FIGURE 17-9 ■ Traumatic pneumatocele. Axial CT
image in a patient who sustained a blunt injury to the
left side of the chest with bilateral contusion and a left-
sided haemothorax and pneumothorax. There are post-
traumatic pneumatoceles in the right lung which
occurred as a countercoup injury.

14. • FIGURE 17-10 ■ Lung
herniation. CT image
following blunt trauma to
the left side of the chest
demonstrating an anterior
lung herniation. This can
be seen on axial (A) and
coronal reformatted (B)
images.

15. • FIGURE 17-11 ■ Extra-pleural haematoma. CT
image demonstrating extra-pleural
haematoma in association with right-sided rib
fractures (arrowhead).

16. • FIGURE 17-12 ■ Diaphragmatic rupture. Chest radiograph
showing a left-sided diaphragmatic rupture. Bowel can be
seen herniating into the left hemithorax, the mediastinum
is displaced to the right and there is a nasogastric tube seen
coiled within an intrathoracic stomach. (Courtesy of Dr. L.C.
Morus, Birmingham, UK.)

17. • FIGURE 17-13 ■ Right hemidiaphragmatic rupture. Axial
(A) and coronal reformatted (B) CT images demonstrating
rupture of the right hemidiaphragm following blunt trauma.
The liver herniates into the right hemithorax. Rib fractures
and low-density regions in the liver indicating hepatic
contusion are also noted on the axial image.

18. • FIGURE 17-14 ■ Left hemidiaphragmatic rupture. Rupture
of the left hemidiaphragm following blunt trauma due to a
road accident. The chest radiograph reveals left mid-zone
contusion (A). CT images in the axial plane (B) and a sagittal
reformatted image (C) reveal a ruptured diaphragm on the
left side with the stomach herniating through into the
thorax. The stomach is constricted as it passes through the
diaphragmatic tear—the so-called ‘collar sign’.

19. • FIGURE 17-14 ■ Left hemidiaphragmatic rupture. Rupture
of the left hemidiaphragm following blunt trauma due to a
road accident. The chest radiograph reveals left mid-zone
contusion (A). CT images in the axial plane (B) and a sagittal
reformatted image (C) reveal a ruptured diaphragm on the
left side with the stomach herniating through into the
thorax. The stomach is constricted as it passes through the
diaphragmatic tear—the so-called ‘collar sign’.

20. • FIGURE 17-15 ■ Aspiration. CT image of
multifocal air-space opacity due to aspiration.

21. • FIGURE 17-16 ■ Acute respiratory distress
syndrome (ARDS). Chest radiograph showing
bilateral air-space opacity in a patient with ARDS
related to trauma.

22. FIGURE 17-17 ■ CT findings in ARDS.
CT images of two patients with acute
respiratory distress syndrome (ARDS).
In the first image (A) the patient’s
ARDS was due to an extra-pulmonary
cause and the CT shows increased
opacification in the posterior,
dependent portions of the lungs and
ground-glass opacity more anteriorly.
A right-sided intercostal tube is also
present and part of a Swan–Ganz
catheter can be seen in the left main
pulmonary artery. In the second
patient (B) whose ARDS was related
to pulmonary infection there is
patchy air-space opacity present with
no gradation from dependent to non-
dependent lung being seen.

23. • FIGURE 17-18 ■ Post-recovery ARDS. CT
image following recovery from ARDS.
Reticular opacities and traction bronchiectasis
can be seen anteriorly indicating fibrosis.

24. • FIGURE 17-19 ■
Bronchopleural fistula.
A chest radiograph
series (A–C) in
sequential order
showing an initial rise
in the air–fluid level in
the left hemithorax
following
pneumonectomy but
then a sudden fall due
to the development of
a postoperative
bronchopleural fistula.

25. • FIGURE 17-19 ■ Bronchopleural fistula. A chest
radiograph series (A–C) in sequential order
showing an initial rise in the air–fluid level in the
left hemithorax following pneumonectomy but
then a sudden fall due to the development of a
postoperative bronchopleural fistula.

26. • FIGURE 17-20 ■ Bronchopleural fistula. CT image
demonstrating a right-sided bronchopleural
fistula following a pneumonectomy. A track of air
close to the right main bronchus can be seen due
to the presence of the fistula (arrow).

27. • FIGURE 17-21 ■ Post-
lobectomy infection. A
postoperative CT
image demonstrates a
pleural fluid collection
with pleural thickening
and contrast
enhancement
indicating a
postoperative
empyema (A). The
infection progressed
and invaded the chest
wall (B).

28. • FIGURE 17-22 ■
Recurrence of original
disease. An early CT
image following a left
pneumonectomy for non-
small cell lung cancer
demonstrates a normal
post-pneumonectomy
space (A). On a later
follow-up examination
there is a soft-tissue mass
within the
pneumonectomy space,
which was shown by
biopsy to represent
recurrent tumour (B).

29. • FIGURE 17-23 ■ Appearances following lung
volume reduction surgery. Postoperative CT
image after lung volume reduction surgery.
The staple line with bovine pericardium
buttresses can be seen (arrowhead).

30. • FIGURE 17-24 ■ Post-lung transplant obliterative
bronchiolitis. The lungs are overinflated with mild
cylindrical bronchiectasis and attenuation of
pulmonary vessels. Areas of patchy ground glass
opacity in the periphery of the lung were thought to be
due to cytomegalovirus pneumonitis. The patient died
within a month of this examination.