Lung parenchymal injuries:
1.
Pulmonary Laceration
Case 1: A 45-year male was brought to emergency department following a stab injury to the left chest.
A CT was performed and selected axial (Fig 1) and coronal images (Fig 2) show abnormal appearances of a collapsed left lower lobe with a circular laceration (arrows) containing gas and soft tissue.
There is also haemo-pneumothorax.
Case 2: This patient presented following a fall from a ladder,
having fallen approximately 15 feet landing on hard ground. Trauma CT showed a laceration (arrows) in the right middle lobe (Fig 3). Follow up CT performed 3 months later shows near complete resolution,
in keeping with a healing lung laceration (Fig 4).
2. Pulmonary Contusion/Haemorrhage
Case 3: A 35-year male imaged following a fall from a height (30 feet).
CT (Fig 5) confirmed clinically suspected right-sided anterior rib fractures and identified associated contusion within the underlying right lung (arrow).
Case 4: Selected axial CT image (Fig 6) from another patient involved in road traffic accident shows multifocal left sided contusions/haemorrhage (arrows) and a small left pneumothorax.
Pleural injuries:
1.Pneumothorax
Case 5: This 45-year old male was brought to emergency department following suicide attempt by jumping from a 5-storey building. Poly-trauma CT showed a large right sided tension pneumothorax (Fig 7) with mediastinal shift to the left (arrows).
This was drained immediately in the radiology department.
2.
Haemothorax
Case 6: This axial CT image (Fig 8) shows extravasation of contrast from a bleeding inter-costal vessel (black arrow). High-density fluid is present in the right pleural space in keeping with a right-sided haemothorax (red arrows).
There is extensive contusion as well as active bleeding in the right lung (blue arrow).
This patient was taken directly to theatre for a thoracotomy to gain control of haemorrhage in the chest.
3.
Haemopneumothorax
Case 7: Axial slice CT image (Fig 9) showing a large haemo-pneumothorax (arrow) on the right side.
Injuries to the diaphragm and the chest wall:
1.
Ruptured diaphragm
Case 8: This patient was involved in a road traffic accident (car v car) at 30 miles per hour.
Polytrauma CT (Fig 10) shows raised right hemi diaphragm with the liver positioned abnormally in the right hemi-thorax (arrows).
The CXR (Fig 11) from the previous admission showed a normal level diaphragm (arrows) suggesting the current new finding of raised right hemi-diaphragm in the polytrauma CT is likely secondary to rupture.
2.
Flail chest
Case 9: This is a reconstructed image (Fig 12) from a polytrauma CT showing a large flail segment involving the 2nd to 7th ribs (arrows).
3.
Unstable thoracic spine and sternal fracture
Case 10: A Motorcyclist T-boned a car at 60mph and was thrown 50 meters from the site of the collision. Acute polytrauma CT (Fig 13) showed fracture dislocation at the T4/T5 level (blue arrow) with extensive fragmentation of the vertebral bodies,
loss of normal alignment and associated sternal fracture (black arrow).
4.
Fracture of rib causing diaphragmatic puncture and liver laceration
Case 11: A 19-year female pedestrian was run over by a taxi. Axial CT image (Fig 14) shows fractured right 8th rib (black arrow),
which has lacerated the right lower lobe of the lung (blue arrow).
More inferiorly (Fig 15) the same rib has penetrated the diaphragm and punctured the right lobe of the liver (arrow).
Right sided pneumothorax is also seen (black arrow).
There was no active bleeding,
this patient subsequently went for surgical repair.
Cardiovascular injuries:
1.
Aortic Transection
Case 12: 50 year male,
unrestrained front seat passenger involved in a road traffic accident was brought to our centre with history of amnesia,
altered sensation in left leg and back pain. He was haemodynamically stable on admission.
The polytrauma CT images (Figs 16 and 17) shows transection of the proximal descending thoracic aorta (arrows).
This patient subsequently underwent aortic stenting by interventional radiologists and has since made a good recovery.
Case 13: A 37 year male involved in a motorbike accident (motorbike v wall) and was brought to emergency department and he was haemodynamically unstable.
Following a brief period of rapid resuscitation and stabilisation,
a polytrauma CT (Fig 18) was performed. Extensive multi organ injuries were confirmed,
including the focal dissection of the aorta at the level of the isthmus shown (arrow),
just distal to the left subclavian artery.
This patient was also shown to have both splenic and lung lacerations and was taken to theatre immediately but unfortunately died during the postoperative period.
2.
Haemo-pericardium and left ventricular laceration
Case 14: A 67 year female presented following a stab injury to the chest. CT (Fig 19) was performed,
showing air tracking through the inter-costal muscles and lying anterior to the pericardium with haemopericardium (arrows).
Given the mechanism of injury and presence of a haemopericardium,
the cardiac surgeons were contacted immediately as ventricular injury could not be completely excluded. The patient was taken straight to theatre,
where a left ventricular laceration (not seen on CT) secondary to stab wound was confirmed.
3.
Bleeding inter-costal vessel
Case 15: This is a selected CT image (Fig 20) from a patient who presented following a stab injury to the chest. Images show a large left-sided haemopneumothorax with collapse of the left lower lobe. There is active extravasation of contrast (arrows) into the chest arising from the left eighth inter-costal artery.
Injuries to the major airways and the oesophagus:
1.
Laryngeal injury
Case 16: This 22 year male,
presented following a stab injury to his neck with a screwdriver.
CT Neck & thorax (Fig 21) showed extensive subcutaneous surgical emphysema in the neck and a pneumo-mediastinum with air tracking along the trachea and the oesophagus (arrows).
The lower end of the thyroid cartilage (Fig 22) on the left side is irregular (arrow) with a defect in the cartilage at the glottic level. Appearances were highly suspicious for penetrating traumatic injury to the larynx with fracture of the thyroid cartilage just to the left of midline.
2.
Tracheobronchial laceration/rupture
Case 17: A 22-year male had poly-trauma CT (Fig 23),
which showed pneumo-mediastinum and extensive surgical emphysema.
The right main bronchus was noted to be abnormal (arrow) appearing disrupted just after the origin of the upper lobe bronchus.
There is an abnormal gas pattern within the mediastinum at this point (Fig 24,
arrows),
which was highly suggestive of rupture of the bronchial tree.
On call thoracic surgeons performed a flexible bronchoscope,
which confirmed a right bronchial tear. The patient was subsequently taken to theatre for thoraocotomy and repair of both the distal trachea and transected right main bronchus.
3.
Oesophageal injury
Case 18: 46-year female presented with self-inflicted stab injury to her neck.
CT was performed which showed a leak of oral contrast (Fig 25) from the proximal oesophagus on the right side (arrow). This was also demonstrated on Fluoroscopy (Fig 26) showing extra-luminal extravasation of oral contrast (arrows).