Journal of the Canadian Association of Radiologists
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In recent years, pulmonary complications have become a major cause of death in burn victims. Familiarity with the spectrum of these complications leads to an earlier and more specific diagnosis based on chest radiographs. We reviewed the medical records and chest radiographs of 239 patients admitted to our burn unit over a one-year period. ⋯ Pneumonia, ARDS, pulmonary congestion, atelectasis and pulmonary emboli were the main complications secondary to the injury. Pulmonary complications developed in 76 patients (31.8%) and, of these, 57 died (75%). Patients involved in a closed space fire and those who had a burn involving 50% or more of their surface area seem to be at the greatest risk of developing pulmonary complications.
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Angiography plays a vital role in the investigation of the patient suffering from multiple trauma. The commonest injuries have been rupture of the thoracic aorta, renal lacerations, arterial bleeding associated with fractures and soft-tissue injuries to the pelvis, and occlusions of the arteries supplying the limbs. Transcatheter arterial embolization may be the definitive therapeutic procedure in pelvic bleeding.
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From a practical point of view, a woman who has blunt injury to the pelvic area with hematuria from the lower urinary tract, has a contused or ruptured bladder. In a man, such a situation calls for retrograde urethrography to determine if the injury is in the urethra or the bladder because the two organs are investigated differently. In both sexes, such injuries are usually associated with pelvic fractures. ⋯ Non-excretion on intravenous urography with tomography calls for selective renal arteriography to delineate the etiology. There can be serious renal trauma in the absence of hematuria, which may occur with renal pedicle injury or avulsion of the ureter. Minor forniceal ruptures may occasionally mask severe posterior renal lacerations.
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Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronchial rupture and diaphragmatic rupture.
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The study of severe facial trauma has been altered by the development of computed tomography (CT). As a regional trauma unit we have gained increasing experience with complex fractures of the face. ⋯ Conventional films still have a role, especially in the less severely traumatized patient. We describe our methods and observations, based upon experience at a trauma unit, in the radiologic investigation of facial injuries.