Difference between revisions of "CT of the neck in trauma"
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==Evaluation== | ==Evaluation== | ||
[[File:Computed tomographs of normal cervical vertebrae (thumbnail).jpg|thumb|link=Commons:Scrollable computed tomography images of normal cervical vertebrae|Normal cervical vertebrae {{noprint|[[Commons:Scrollable computed tomography images of normal cervical vertebrae|(Click here to scroll through the image stacks)]]}}]] | [[File:Computed tomographs of normal cervical vertebrae (thumbnail).jpg|thumb|link=Commons:Scrollable computed tomography images of normal cervical vertebrae|Normal cervical vertebrae {{noprint|[[Commons:Scrollable computed tomography images of normal cervical vertebrae|(Click here to scroll through the image stacks)]]}}]] | ||
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*Incongruences? | *Incongruences? | ||
*Prevertebral thickening? | *Prevertebral thickening? | ||
+ | *Any fracture lines? | ||
===Incongruencies=== | ===Incongruencies=== | ||
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| 11-15 years || 6.8 mm || 14.5 mm | | 11-15 years || 6.8 mm || 14.5 mm | ||
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+ | ===Fracture lines=== | ||
+ | If not already found by the above signs, scroll through the stack to look for fracture lines, such as through axial and sagittal images. ''General information: [[CT of fractures]]'' | ||
+ | |||
+ | If found, there are multiple classification systems and names, but the most important is the location of the fractures: | ||
+ | [[File:Gray84.png|thumb|500px|center]] | ||
==Report== | ==Report== |
Revision as of 23:56, 7 May 2019
Author:
Mikael Häggström [notes 1]
Contents
Planning
Indication for imaging
In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, such as using the the Canadian C-spine rule.[1] In practice, there is rarely any reason for a radiologist to decline an imaging request from a clinician for a trauma patient.
Choice of modality
Recommendations differ somewhat between children and adults:
- In children, CT of the neck in trauma is indicated in more severe cases such as neurologic deficits, whereas X-ray of the cervical spine is preferable in milder cases, by both US[2] and UK[3] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[4] It is thus reasonable to indicate CT by a combination of higher severity and older age.
- In adults, UK guidelines are largely similar as in children.[3] US guidelines, on the other hand, recommend CT of the neck in trauma in all cases where medical imaging is indicated, and that X-ray of the cervical spine is only acceptable where CT is not readily available.[5]
Settings
Evaluation
- Incongruences?
- Prevertebral thickening?
- Any fracture lines?
Incongruencies
Lines drawn along the anterior and posterior surfaces of vertebrae as well as the spinous processes should be smooth.
Also, the distances between vertebrae and spinous processes should be compared.
Prevertebral thickening
Upper limits of values vary with body constitution of the patient, but in adults they are generally as follows:[8]
The following are upper limits for prevertebral spaces in children:[9]
Age | C2 | C6 |
---|---|---|
0-2 years | 7.6 mm | 9.0 mm |
3-6 years | 8.4 mm | 9.8 mm |
7-10 years | 6.8 mm | 12.1 mm |
11-15 years | 6.8 mm | 14.5 mm |
Fracture lines
If not already found by the above signs, scroll through the stack to look for fracture lines, such as through axial and sagittal images. General information: CT of fractures
If found, there are multiple classification systems and names, but the most important is the location of the fractures:
Report
Even absence of:
- Fracture
- Misalignment
- Prevertebral thickening
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Saragiotto, Bruno T; Maher, Christopher G; Lin, Chung-Wei Christine; Verhagen, Arianne P; Goergen, Stacy; Michaleff, Zoe A (2018). "Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma ". Cochrane Database of Systematic Reviews. doi: . ISSN 14651858.
- ↑ Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
- ↑ 3.0 3.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
- ↑ . Traumamanual. Region Skåne. Last updated: 2018-03-29
- ↑ Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
- ↑ Tins, Bernhard (2010). "Technical aspects of CT imaging of the spine ". Insights into Imaging 1 (5-6): 349–359. doi: . ISSN 1869-4101.
- ↑ Mark Karadsheh. Cervical Spine Trauma Evaluation. Orthobullets. Updated: 4/24/2019
- ↑ Rojas, C.A.; Vermess, D.; Bertozzi, J.C.; Whitlow, J.; Guidi, C.; Martinez, C.R. (2009). "Normal Thickness and Appearance of the Prevertebral Soft Tissues on Multidetector CT ". American Journal of Neuroradiology 30 (1): 136–141. doi: . ISSN 0195-6108.
- ↑ Error on call to Template:cite web: Parameters url and title must be specifiedJeremy Jones. . Radiopaedia.