No abstract

Penetrating transmediastinal injuries (TMIs) are injuries that traverse the mediastinum. These injuries are most commonly caused by firearms and knives. The investigation and management algorithms for TMI have undergone changes in recent years due to increasing evidence that computed tomography (CT) in useful in the evaluation of hemodynamically stable TMI patients. Initial investigation of TMI patients depends on the question of hemodynamic stability. In unstable patients, imaging (if any) should be limited to bedside radiography and focused ultrasonography. In hemodynamically stable patients in whom a mediastinal trajectory of injury is suspected, the primary imaging modality after radiography should be multidetector CT. CT is invaluable in the assessment of TMI due to its capacity to depict the injury track as well as demonstrate both direct and indirect signs of organ injury. On the basis of the suspected trajectory and specific findings, radiologists can play an essential role in determining future patient management and investigations for each mediastinal organ, thereby expediting appropriate investigation and treatment and avoiding unnecessary and sometimes invasive tests or surgery. The authors provide an up-to-date and evidence-based approach for the management of hemodynamically unstable and stable patients with suspected TMI, discuss management algorithms and CT protocols, and highlight common and uncommon imaging findings and diagnostic pitfalls associated with vascular, cardiac, esophageal, tracheobronchial, pleural, and pulmonary injuries. Online supplemental material is available for this article.

No abstract

Radiologists play an important role in evaluation of geriatric trauma patients. Geriatric patients have injury patterns that differ markedly from those seen in younger adults and are susceptible to serious injury from minor trauma. The spectrum of trauma in geriatric patients includes head and spine injury, chest and rib trauma, blunt abdominal injury, pelvic fractures, and extremity fractures. Clinical evaluation of geriatric trauma patients is difficult because of overall frailty, comorbid illness, and medication effects. Specific attention should be focused on the effects of medications in this population, including anticoagulants, steroids, and bisphosphonates. Radiologists should use age-appropriate algorithms for radiography, computed tomography (CT), and magnetic resonance imaging of geriatric trauma patients and follow guidelines for intravenous contrast agent administration in elderly patients with impaired renal function. Because there is less concern about risk for cancer with use of ionizing radiation in this age group, CT is the primary imaging modality used in the setting of geriatric trauma. Clinical examples are provided from the authors' experience at a trauma center where geriatric patients who have sustained major and minor injuries are treated daily.

Many excellent studies on shoulder imaging from a radiologic perspective have been published over the years, demonstrating the anatomy and radiologic findings of shoulder trauma. However, it may not always be clear what the surgeon, who bears the responsibility for treating the injured patient, really needs to know about the injury to predict outcomes and plan management. The authors review the relevant osseous, soft-tissue, and vascular anatomy and describe the clinically relevant concepts that affect management. Familiarity with the Neer classification system for proximal humerus fractures can have a significant impact on treatment. The length and displacement of the medial humeral metaphyseal fragment helps predict the risk of ischemia in proximal humerus fractures. The Nofsinger approach for measuring the area of glenoid fossa bone loss can help the surgeon determine the need for surgical repair of a bony Bankart lesion. The size of Hill-Sachs and reverse Hill-Sachs lesions is also an important predictor of stability. The Ideberg classification system for intraarticular fractures of the glenoid fossa, combined with information on instability and joint incongruity, helps determine the need for surgical fixation of glenoid fossa fractures. Awareness of what matters to the surgeon can help radiologists better determine where to focus their attention and efforts when describing acute shoulder trauma.