Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review

Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.

Blunt pancreatic trauma: A persistent diagnostic conundrum?

Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography(CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging(MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful nonoperative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.

Imaging in renal trauma

Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.

MRI in central nervous system infections: A simplified patterned approach

Recognition and characterization of central nervous system infections poses a formidable challenge to the neuro-radiologist.Imaging plays a vital role,the lesions typically being relatively inaccessible to tisue sampling.The results of an accurate diagnosis are endlessly re-warding,given the availability of excellent pharmaco-logical regimen.The availability of numerous magnetic resonance(MR)sequences which provide functional and molecular information is a powerful tool in the hands of the radiologist.However,the plethora of se-quences and the possibilities on each sequence is also intimidating,and often confusing as well as time con-suming.While a large number of reviews have already described in detail the possible imaging findings in each infection,we intend to classify infections based on their imaging characteristics.In this review we describe an algorithm for first classifying the imaging findings into patterns based on basic MR sequences(T1,T2 and enhancement pattern with Gadolinium),and then sub-classify them based on more advanced molecular and functional sequences(Diffusion,Perfusion,Susceptibili-ty imaging,MR Spectroscopy).This patterned approachis intended as a guide to radiologists in-training and in-practice for quickly narrowing their list of differentials when faced with a clinical challenge.The entire content of the article has also been summarised in the form of flow-charts for the purpose of quick reference.

Benign neck masses showing restricted diffusion: Is there a histological basis for discordant behavior?

Diffusion weighted imaging(DWI) evolved as a complementary tool to morphologic imaging by offering additional functional information about lesions. Although the technique utilizes movement of water molecules to characterize biological tissues in terms of their cellularity, there are other factors related to the histological constitution of lesions which can have a significant bearing on DWI. Benign lesions with atypical histology including presence of lymphoid stroma, inherently increased cellularity or abundant extracellular collagen can impede movement of water molecules similar to malignant tissues and thereby, show restricted diffusion. Knowledge of these atypical entities while interpreting DWI in clinical practice can avoid potential misdiagnosis. This review aims to present an imaging spectrum of such benign neck masses which, owing to their distinct histology, can show discordant behavior on DWI.

Acute femoral artery pseudoaneurysm due to lesser trochanter fragment： an unusual complication of an intertrochanteric fracture

大腿骨的动脉的假动脉瘤是 intertrochanteric 骨折的稀罕复杂并发症。大多数这些状况由于因医生之治疗而引的损伤或损伤本身并且被打乱的骨头碎片很少引起。这里，我们报导从更小的 trochanter 碎片的尖铁与表面的大腿骨的动脉的 pseudoaneurysm 尖锐地介绍了的一个 72 岁的人的一个案例。有盖住的 stent 的 pseudoaneurysm 的经皮的 endovascular 处理在一个迫切基础上被承担。五天以后，病人被操作在之上，更小的 trochanter 碎片通过一个前面的切口被切除， intertrochanteric 骨折用动态新潮的螺丝钉被修理。破裂在 10 个星期被统一。在 one-year’s 后续，没有接枝相关的复杂并发症。这个案例说明那有代替的更小的 trochanter 碎片的 intertrochanteric 破裂能与流血和大腿骨的动脉的 pseudoaneurysm 尖锐地介绍。

Clinical characteristics and management of patients with fat embolism syndrome in level I Apex Trauma Centre

Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion: FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.

Innocuous cardiac gunshot that proved fatal： A bitter lesson learned

有保留的 intra 心囊的外国身体的血液动力学地正常的病人的管理仍然是一件事推测。可得到的文学支持如此的无害的外国身体的非起作用的管理。我们从火器损害与一个保留的 intra 心囊的小团报导我们一个血液动力学地正常的病人的经验。他开始收到了成功的非起作用的管理，但是开发了致命的 hemopericardium 在损害以后的 21 天。在这份报纸，我们考虑到可得到的文学在如此的损害的管理讨论了陷井并且总结了临床的经验。