Improved chest wall trauma taxonomy: an interdisciplinary CWIS and ASER collaboration.

Purpose: Chest wall injury taxonomy and nomenclature are important components of chest wall injury classification and can be helpful in communicating between providers for treatment planning. Despite the common nature of these injuries, there remains a lack of consensus regarding injury description. The Chest Wall Injury Society (CWIS) developed a taxonomy among surgeons in the field; however, it lacked consensus and clarity in critical areas and collaboration with multidisciplinary partners.

Blunt Cerebrovascular Injury-Like Injury Observed in Patients With Craniofacial Self-Inflicted Gunshot Wounds.

Background: Although blunt cerebrovascular injury (BCVI) is recognized as a risk factor for trauma morbidity and mortality, little is described regarding similar cerebrovascular injury (CVI) in patients with penetrating wounds. The authors aim to characterize these injuries in the craniofacial self-inflicted gunshot wound (SIGSW) population.

Methods: An institutional review board (IRB)-approved retrospective nstudy was conducted on patients presenting to the R Adams Cowley Shock Trauma Center with SIGSWs between 2007 and 2016.

Preoperative Imaging for Facial Transplant: A Guide for Radiologists.

Facial transplant (FT) is a viable option for patients with severe craniomaxillofacial deformities. Transplant imaging requires coordination between radiologists and surgeons and an understanding of the merits and limitations of imaging modalities. Digital subtraction angiography and CT angiography are critical to mapping vascular anatomy, while volume-rendered CT allows evaluation of osseous defects and landmarks used for surgical cutting guides.

Imaging of Neck Visceral Trauma.

The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries.

Long-term follow-up of blunt cerebrovascular injuries: Does time heal all wounds?

Background: The short-term natural history of blunt cerebrovascular injuries (BCVIs) has been previously described in the literature, but the purpose of this study was to analyze long-term serial follow-up and lesion progression of BCVI.

Methods: This is a single institution's retrospective review of a prospectively collected database over four years (2009-2013). All patients with a diagnosis of BCVI by computed tomographic (CT) scan were identified, and injuries were graded based on modified Denver scale.

Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study.

Purpose: Neither the performance of CT in diagnosing penetrating gastrointestinal injury nor its ability to discriminate patients requiring either observation or surgery has been determined.

Materials And Methods: This was a prospective, single-institutional observational study of patients with penetrating injury to the torso who underwent CT. Based on CT signs, reviewers determined the presence of a gastrointestinal injury and the need for surgery or observation.

After-Hours Radiology: Challenges and Strategies for the Radiologist.

Objective: Because of the increase in the use of 24-hour-a-day 7-day-a-week real-time radiologic interpretation, radiologists more frequently perform after-hours work. The purpose of this article was to examine the challenges arising from after-hours work and describe evidence-based strategies meant to limit the adverse physical and psychologic stresses of after-hours work.

Conclusion: Working nontraditional hours affects a radiologist's health, social life, professional productivity, and possibly interpretive accuracy.

Vascular Injuries to the Neck After Penetrating Trauma: Diagnostic Performance of 40- and 64-MDCT Angiography.

Objective: The purposes of this study were to assess the diagnostic performance of 40- and 64-MDCT angiography with digital subtraction angiography as the reference standard in the detection of arterial injuries in patients at high risk after penetrating neck trauma and to perform a separate analysis of injuries to the external carotid artery.

Materials And Methods: In a retrospective evaluation of 53 sets of angiograms from 51 patients with penetrating neck injury, three reviewers unaware of the digital subtraction angiographic findings reviewed the CT angiographic (CTA) images to discern the presence or absence of arterial injuries. Sensitivity and specificity of CTA were calculated per injury, and a separate analysis of external carotid artery injuries was performed.

Lethal now or lethal later: The natural history of Grade 4 blunt cerebrovascular injury.

Background: Grade 4 blunt cerebrovascular injury (BCVI4) has a known, significant rate of stroke. However, little is known about the natural history of BCVI4 and the pathophysiology of subsequent stroke formation.

Methods: A 4-year review of patients with BCVI4 at the R Adams Cowley Shock Trauma Center was performed.

Initial screening test for blunt cerebrovascular injury: Validity assessment of whole-body computed tomography.

Introduction: Our whole-body computed tomography protocol (WBCT), used to image patients with polytrauma, consists of a noncontrast head computed tomography (CT) followed by a multidetector computed tomography (40- or 64- slice) that includes an intravenous, contrast-enhanced scan from the face through the pelvis. WBCT is used to screen for blunt cerebrovascular injury (BCVI) during initial CT imaging of the patient with polytrauma and allows for early initiation of therapy with the goal of avoiding stroke. WBCT has not been directly compared with CT angiography (CTA) of the neck as a screening tool for BCVI.

Multidetector CT of blunt cervical spine trauma in adults.

A number of new developments in cervical spine imaging have transpired since the introduction of 64-section computed tomographic (CT) scanners in 2004. An increasing body of evidence favors the use of multidetector CT as a stand-alone screening test for excluding cervical injuries in polytrauma patients with obtundation. A new grading scale that is based on CT and magnetic resonance (MR) imaging findings, the cervical spine Subaxial Injury Classification and Scoring (SLIC) system, is gaining acceptance among spine surgeons.

Predicting arterial injuries after penetrating brain trauma based on scoring signs from emergency CT studies.

The objective of this study was to determine the accuracy of individual radiologists in detection of vascular injury in patients after penetrating brain injury (PBI) based on head CT findings at admission. We retrospectively evaluated 54 PBI patients who underwent admission head CT and digital subtraction angiography (DSA), used here as a reference standard. Two readers reviewed the CT images to determine the presence or absence of the 29 CT variables of injury profile and quantified selected variables.

Parameters for successful nonoperative management of traumatic aortic injury.

Objective: Blunt traumatic aortic injury is associated with significant mortality, and increased computed tomography use identifies injuries not previously detected. This study sought to define parameters identifying patients who can benefit from medical management.

Methods: We reviewed 4.

MR imaging and differentiation of cerebral fat embolism syndrome from diffuse axonal injury: application of diffusion tensor imaging.

Introduction: Cerebral fat embolism syndrome (CFES) mimics diffuse axonal injury (DAI) on MRI with vasogenic edema, cytotoxic edema, and micro-hemorrhages, making specific diagnosis a challenge. The objective of our study is to determine and compare the diagnostic utility of the conventional MRI and DTI in differentiating cerebral fat embolism syndrome from diffuse axonal injury.

Methods: This retrospective study was performed after recruiting 11 patients with severe CFES and ten patients with severe DAI.

Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans.

Purpose: To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury.

Materials And Methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.

Emergency radiology eponyms: part 1-Pott's puffy tumor to Kerley B lines.

An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute.

Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene.

An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute.

Craniofacial gunshot injuries: an unrecognised risk factor for blunt cervical vascular injuries?

Objectives: To review our institutional experience with cervical arterial injuries remote from the penetrating tract seen in the setting of craniofacial gunshot injuries.

Methods: Institutional Review Board approval was obtained. Our institutional trauma registry was queried over a 5-year period for patients with cervical arterial injuries due to penetrating craniofacial gunshot wounds who underwent CT angiography.

Implementation of 24/7 radiology services in an academic medical centre level 1 trauma centre: impact on trauma resuscitation unit length of stay and economic benefit analysis.

Study Objective: To evaluate the impact of 24/7 radiology services on trauma resuscitation unit (TRU) length of stay (LOS) for patients with minor trauma and to analyse the economic benefits of such an impact from trauma centre perspective.

Methods: The study was HIPAA compliant and had IRB approval. Data were extracted from hospital and radiology information systems.

Imaging evaluation of penetrating neck injuries.

Penetrating neck injuries are a significant source of morbidity and mortality. Diagnostic imaging plays an integral role in the diagnosis and management of these injuries. Although clinical management of penetrating injuries to the neck remains controversial, many institutions have shifted away from mandatory surgical exploration of most penetrating neck injuries toward use of endoscopy, various imaging modalities, and selective surgery to manage specific injuries diagnosed with these techniques.

MDCT diagnosis of penetrating diaphragm injury.

The purpose of the study was to determine the diagnostic sensitivity and specificity of multidetector CT (MDCT) in detection of diaphragmatic injury following penetrating trauma. Chest and abdominal CT examinations performed preoperatively in 136 patients after penetrating trauma to the torso with injury trajectory in close proximity to the diaphragm were reviewed by radiologists unaware of surgical findings. Signs associated with diaphragmatic injuries in penetrating trauma were noted.

Blunt cerebrovascular injuries: does treatment always matter?

Background: Blunt cerebrovascular injuries (BCVI) have become an increasingly recognized entity. Stroke as a result of these injuries can have devastating consequences. Optimal screening criteria, diagnostic imaging, and therapy for BCVIs have not been elucidated.

Blunt cerebrovascular injuries: imaging with multidetector CT angiography.

Blunt cerebrovascular injuries (BCVIs) can cause ischemic stroke and are associated with high mortality rates. However, treatment of BCVI can prevent or limit stroke. Although digital subtraction angiography is the diagnostic standard for detecting BCVI, recent studies indicate that multidetector computed tomographic (CT) angiography may be an accurate, rapid, noninvasive diagnostic alternative.

Diagnosis of blunt cerebrovascular injuries with 16-MDCT: accuracy of whole-body MDCT compared with neck MDCT angiography.

Objective: The objective of our study was to determine whether whole-body 16-MDCT and neck MDCT angiography (MDCTA) can be used to diagnose blunt cerebrovascular injuries with comparable accuracy using angiography as the reference standard.

Materials And Methods: Retrospective review of radiology reports and prospective clinical observation identified 108 blunt trauma patients examined with either whole-body MDCT or neck MDCTA followed by angiography over a 23-month period. From this group, results from the retrospective interpretations of 77 whole-body MDCT and 48 neck MDCTA examinations were compared with the results extracted from angiography reports to estimate the accuracy of each protocol for detecting blunt cerebrovascular injuries.