The imaging of stab injuries.
In the trauma unit of the Bloemfontein Academic Complex, the total number of stab wounds seen represents approximately 70.5% of penetrating injuries, which is 6.4% of 5004 trauma cases seen in a period of 1 year. The other cases are gunshot wounds and pedestrian or motor vehicle accidents. Specific guidelines and protocols are followed for penetrating trauma management. All imaging modalities are utilized, with chest radiography the mainstay of thoracic imaging in patients having sustained sharp penetrating chest injuries. Computed tomography (CT) is being used more frequently as the primary imaging modality in the evaluation of hemodynamically stable patients with penetrating injuries. The improved speed of data acquisition and superior image reconstruction of multidetector CT (MDCT) has further driven this change in imaging approach. Although digital subtraction angiography (DSA) has been the reference standard for the diagnosis of traumatic vascular injuries, it is giving way to faster, less invasive, and less personnel-intensive imaging techniques, e.g., MDCT angiography. Given the fact that we work in an academic environment and that we have a dedicated interventional unit, arteriography is still frequently performed and still has its place as the "gold standard" in the diagnosis of vascular injuries. Penetrating chest injuries suspected of traversing the mediastinum or extending near the posterior mediastinal structures dictate esophageal and tracheal evaluation. Although radiology has a role to play, direct visualization (esophagoscopy, bronchoscopy) remains the most reliable method of excluding injuries to these structures. Transthoracic ultrasound (echocardiography) has become indispensable in helping to evaluate injuries to the heart and the ascending and descending aortas. More recent work has demonstrated that ultrasonography can also be used to detect hemothoraces and pneumothoraces with accuracy.
de Vries
Coert S
CS
Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Free State and Academic Health Complex, Free State Province Department of Health, Bloemfontein, South Africa. devriesc.md@ufs.ac.za
Africa
Mogoeemang
M
Gebremariam
Fekade A
FA
van Rensburg
J Janse
JJ
Otto
Susan F
SF
Potgieter
Henrik F
HF
D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media; D004452:Echocardiography; D006801:Humans; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014951:Wounds, Stab / Q000000981:diagnostic imaging*
D003287:Contrast Media