Emergency radiology
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Emergency radiology · Feb 2007
Diaphragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients.
In the US and Western Europe, trauma is the fourth most common cause of death and the leading cause of death in the population less than 45 years of age [Mullinix and Foley, J Comput Assist Tomogr 28(Suppl 1):S20-S27, 2004]. Diaphragmatic injuries occur in 0.8 to 8% of patients after blunt trauma (Gray H, The muscles of the thorax. Anatomy of the human body. ⋯ The clinical diagnosis of diaphragmatic rupture (DR) is difficult and is missed in anywhere from 7 to 66% of patients [Cantwell, Radiology 238(2):752-753, 2006]. The accurate diagnosis and prognosis of this pathology depend on a complete knowledge of the clinical and radiological presentation. Computed tomography is the imaging modality of choice in the assessment of patients with clinical or radiographic findings suggestive of DR.
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A 36-year-old man fell from his bicycle and struck his lower abdomen on the end of the handlebar. Computed tomography (CT) showed a small bowel loop protruding into the subcutaneous fat layer of the abdominal wall. We present this case of handlebar hernia, a rare type of traumatic abdominal wall hernia, and the usefulness of CT in diagnosing such injuries.
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Emergency radiology · Jan 2007
Case ReportsBilateral orbital emphysema and pneumocephalus as a result of accidental compressed air exposure.
Orbital emphysema is a rare condition in the absence of trauma or sinus disease. A 22-year-old man suffering from left orbital trauma due to sudden exposure to compressed air tube was admitted with severe pain in the left eye, swelling, and mild periorbital ecchymosis. Physical examination revealed a large conjunctival laceration in the left orbit. ⋯ The conjunctiva was sutured under local anesthesia. After 3 weeks of follow-up, the patient completely recovered without visual loss. Bilateral orbital emphysema with pneumocephalus can occur from a high-pressure compressed air injury after unilateral conjunctival trauma without any evidence of fracture.
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Emergency radiology · Jan 2007
Case ReportsBlunt traumatic injury of the ascending aorta: multidetector CT findings in two cases.
Blunt ascending aortic injuries are rare in clinical practice. We have encountered two types of injuries to the ascending aorta with multidetector computed tomography: (1) a tear of the wall of the aortic root with a contained rupture and associated hemopericardium and (2) a tear at the level of the aortic valve cusp without associated hemopericardium. In reviewing our experience with aortic trauma at our institution under IRB waiver of consent, we encountered two cases of ascending aortic rupture that illustrate the two injury patterns. We present these two cases to alert radiologists to the multidetector computed tomographic findings of this life-threatening injury.