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Table 1 Diagnostic imaging in traumatic hemorrhage

From: Traumatic hemorrhage and chain of survival

Parameter assessed in trauma

Imaging modalities

Required views

Pertinent findings and key values

(1) Hemothorax

(Pleural cavity)

ATLS [16]

Chest radiograph

(Fig. 2a)

AP

(Upright preferred)

Blunting of costophrenic angle or partial or complete opacification of the affected half of the thorax

(2) Pelvic hemorrhage

(a) AP compression fracture (15–20%)

(b) Lateral compression fracture (60–70%)

(c) Vertical shear fracture (5–15%)

(d) Combined fracture mechanism

Cullinane et al. [127]

Pelvic radiograph

(Fig. 2b)

AP

(a) Pubic diastasis, disrupted pelvic ring

(b) Internal rotation with injury risk to bladder and urethra

(c) Vertical displacement of sacroiliac joint

(d) Combined

(3) Multisystem trauma

Fang et al. [40], Cinquantini et al. [41]

CT/ MDCT

2D images of a “slice” of the body. Can be used to construct

3D images

Comprehensively detect trauma to the chest, abdominal, pelvic, and active bleeding

(4) Hemopericardium

(Pericardial tamponade)

Klein et al. [46]

FAST (2D)

M-mode

Doppler

(Fig. 2c, Additional file 1: Video 1)

Subcostal/subxiphoid, parasternal long axis (PSLA), parasternal short axis (PSSA) and apical four chamber (A4C)

Tamponade criteria:

Large fluid quantification, > 1 cm

RA systolic collapse > 30% of the cardiac cycle

RV diastolic collapse

(5) Hemothorax

(Pleural cavity)

Brooks et al. [50]

FAST (2D)

(Fig. 2d, Additional file 2: Video 2)

RUQV: lower right thorax

LUQV: lower left thorax

(Angle the probe up above the diaphragm into chest cavity)

Anechoic area between the diaphragm and the parietal pleura within the costophrenic recess

(6) Intraperitoneal free fluid

(Abdomen)

Holmes et al. [51]

FAST (2D)

(Fig. 3a, Additional file 3: Video 3)

(Fig. 3b, Additional file 4: Video 4)

RUQV

(Hepatorenal view)

LUQV

(Perisplenic view)

Anechoic area (free fluid) between the liver and right kidney (Morisons’s pouch)

Anechoic area surrounding the spleen and obscuring the interface between the spleen and left kidney

(7) Intraperitoneal free fluid

(Pelvic)

Cullinane et al. [127]

FAST (2D)

(Fig. 3c, Additional file 5: Video 5)

(Fig. 3d, Additional file 6: Video 6)

Sagittal view

Transverse view

Aided by fluid-filled bladder

Anechoic area in the rectouterine space or pouch of Douglas (female) or rectovesical space (male)

(8) Intravascular volume status:

IVC size/collapsibility, for RAP

Rudski et al. [54], Brennan et al. [55]

2D

(Fig. 4a, b)

(Additional file 7: Video 7)

Visualization throughout the respiratory cycle

Size ≤ 2.1 cm; collapses > 50% during sniff = RAP 0–5 mm Hg

Size > 2.1 cm; collapses > 50% during sniff = RAP 5–10 mm Hg

Size > 2.1; collapses < 50% during sniff = 10- RAP 20 mm Hg

(9) Intravascular volume status and cardiac function:

LV and RV chamber size, areas, and volumes

Lang et al. [56]

2D

Volume

(Fig. 4c, d)

(Additional file 8: Video 8)

Function

(Additional file 9: Video 9)

Parasternal long axis (PSLA), parasternal short axis (PSSA) and apical four chamber (A4C

Normal ranges:

LVIDD 3.9–5.9 cm

LVEDV 46–150 mL

LVESV 14–61 mL

LVEF > 51%

RV FAC ≥ 35%

(10) Cardiac stroke volume & function (LV):

LVOT VTI

Ristow et al. [58]

2D; pulsed Doppler

Apical 5 chamber or 3 chamber views

Optimal Doppler alignment

Pulse wave Doppler at LVOT

Normal value:

VTI ≥ 18 cm

(11) RV function: TAPSE

RV Tissue Doppler S’

Rudski et al. [54]

M-mode (TAPSE)

Tissue Doppler (RV S ‘)

Optimal Apical four chamber view, alignment with TV annulus, M mode for TAPSE, Tissue Doppler for S’

Normal value:

TAPSE ≥ 16 mm

RV S ‘ ≥ 10 cm/sec

  1. Modality # 1 to 7 are diagnostic, modality # 8 to 11 are for volume status and cardiac functions
  2. AP anteroposterior, CT computed tomography, 2D two-dimensional, 3D three-dimensional, FAST Focused Assessment with Sonography for Trauma, IVC inferior vena cava, LUQV left upper quadrant view, LV left ventricular, LVEDV LV end diastolic volume, LVEF LV ejection fraction, LVESV LV end-systolic volume, LVIDD LV internal diameter at end-diastole, LVOT LV outflow tract, MDCT multidetector computed tomography, RAP right atrial pressure, RUQV right upper quadrant view, RV right ventricular, RV FAC right ventricular fractional area change, RV S' RV systolic excursion velocity, TAPSE tricuspid annular plane systolic excursion, TV tricuspid valve, VTI velocity time integral