Diagnostic imaging of pelvic and chest wall trauma

Imaging of patients with pelvic trauma begins with a logical approach to plain radiographs. These films reveal the probable mechanism of injury and suggest a rationale for emergent reduction. Radiographs, along with the clinical impression, suggest the likelihood of associated soft tissue injury, possibly requiring further specific radiographic studies. Significant vascular injury most often accompanies disruption of the posterior pelvic ring. Bladder and urethral trauma may be suspected in any displaced type III pelvic fracture with suggestive clinical signs. Ideally, urethrography precedes bladder catheterization. Acetabular fractures must be recognized because of their implications for future hip joint function. CT is very helpful in definitive treatment planning of pelvic (especially acetabular) fractures but may be delayed until other life-threatening injuries have been addressed. Plain radiography is also well suited to evaluation of chest wall trauma. When multiple ribs are fractured in two places, the radiologist should suggest the possibility of flail chest. Sternal fractures and multiple rib fractures, including the first three ribs, may herald life-threatening vascular or cardiac damage. To summarize, the radiologist contributes most to the care of the trauma patient by recognizing roentgen patterns of injury, knowing which are commonly accompanied by damage to critical soft tissues, and performing the indicated radiographic studies efficiently.