Whole Body Trauma CT Recognition Pattern

Systematic approach to interpreting pan-scan trauma CT (head-to-pelvis) with focus on life-threatening injuries

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1. Basic Principles

A. Standard Trauma Protocol

• Non-contrast head:
  - Initial evaluation for hemorrhage
  - WW 80/WL 40 (brain windows)
• Chest/Abdomen/Pelvis with contrast:
  - Portal venous phase (60-70 sec delay)
  - WW 350/WL 50 (soft tissue)
• Bone reconstructions:
  - WW 2000/WL 500
  - Sagittal/coronal cervical spine

B. Primary Survey Approach

• "Blood and Air" first:
  - Hemorrhage (active extravasation)
  - Pneumothorax, vascular injury
• ABCDE priority:
  - Airway compromise
  - Breathing (pneumothorax)
  - Circulation (active bleed)

2. ABCDEFGH Systematic Approach

Step	Assessment	Key Elements
A	Airway	Tracheal deviation, laryngeal fractures
B	Breathing	Pneumothorax, lung contusions
C	Circulation	Active bleeding, aortic injury
D	Disability	Brain hemorrhage, spine fractures
E	Exposure	All body regions covered
F	Fractures	Spine, pelvis, long bones
G	Gut	Bowel/mesenteric injury
H	Hidden	Subtle injuries (diaphragm, pancreas)

3. Immediately Life-Threatening Injuries

A. Thoracic Emergencies

Injury	Key Features	Window
Aortic injury	Irregular contour, pseudoaneurysm	Mediastinal
Tension PTX	Mediastinal shift, collapsed lung	Lung
Cardiac tamponade	Pericardial fluid, chamber collapse	Cardiac

B. Abdominal Emergencies

• Active hemorrhage:
  - Contrast blush (250+ HU)
  - Requires embolization
• Bowel/mesenteric injury:
  - Free air, wall thickening
  - Mesenteric stranding/hematoma
• Solid organ injury:
  - Liver/spleen laceration (AAST grade)
  - Active extravasation

4. High-Energy Injury Patterns

A. Deceleration Injuries

• Aortic isthmus:
  - Classic location for rupture
  - 90% mortality at scene
• Liver/spleen:
  - Capsular avulsion
  - Subcapsular hematoma

B. Pelvic Fracture Types

Classification	Mechanism	Stability
AP compression	Frontal impact	Unstable if open book
Lateral compression	Side impact	Stable/Unstable
Vertical shear	Fall from height	Always unstable

5. Secondary Survey Findings

A. Subtle Injuries

• Diaphragm rupture:
  - Left › right
  - "Collar sign", herniated organs
• Pancreatic injury:
  - Duct disruption
  - Peripancreatic fluid

B. Vascular Injuries

• Blunt cerebrovascular:
  - Carotid/vertebral dissection
  - Intimal flap, luminal narrowing
• Mesenteric vessels:
  - Thrombosis, pseudoaneurysm
  - Requires CTA for diagnosis

6. Trauma CT Reporting Template

1. Critical findings:
   - Active hemorrhage
   - Airway compromise
2. Head:
   - Hemorrhage (type/location)
   - Midline shift
3. Chest:
   - Aortic injury
   - Pneumothorax/hemothorax
4. Abdomen/Pelvis:
   - Solid organ injury (AAST grade)
   - Pelvic fracture stability
5. Spine:
   - Fractures (stable/unstable)
   - Cord compression

Prioritize identification of immediately life-threatening injuries requiring intervention. Communicate critical findings directly to trauma team. For polytrauma patients, correlate CT findings with FAST exam and clinical status. Document all injuries systematically and note any need for additional imaging (e.g., CTA for vascular injury). Follow institutional major trauma protocols.

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