Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To identify the possibilities of computed tomography in detection of the nature and severity of the thoracic aorta trauma. Materials and method. Results of computed tomography (CT) of 15 patients from 2006 to 2017 with severe combined blunt injuries and thoracic aorta injury who had been treated in N. V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The majority of the patients were male 73% (n=11), the average age was 41,3+ 7,6 (22-79) years. The cause of injury in 12 cases were motor vehicle accidents, in 2 cases-falling from a height of more than three meters, in one case - A fall from patient's own height. Results. In evaluating the severity of the aortic injuries the classification proposed by the American Association of Thoracic Surgeons in 2013 was used. In our study there were no patients with Grade I; Grade II-small pseudoaneurysm (less than 50% of the circumference of the aorta) was identified in 8 patients; Grade III-big pseudoaneurysm (more than 50% of the circumference of the aorta) was identified in 3 patients; Grade IV-complete aortic rupture was identified in 4 patients. Simultaneously with the thoracic aortic injury pulmonary contusion was found in 9 patients, in 8-multiple fractured ribs, in 1-fracture of the sternum. In 8 patients mediastinal hematoma was identified, hemopericardium was found in 3 patients. Hemothorax was found in 12 patients. Signs of craniocerebral trauma were found in 6 patients, spinal cord injury-in 3 patients, injuries of the musculoskeletal system-in 4 patients, abdominal parenchymal organ injury was found in 4 patients (in 3 of these cases-of the liver, in 1-of the kidney), in one case sings of the duodenal rupture were found, in another-left-sided diaphragmatic rupture, in 1 patient with thoracic aortic rupture, a pseudoaneurysm of the hepatic artery was also found. Discussion. Using the classification of the severity of the aortic injuries by the CT results in patients with stable hemodynamics enables the ability to determine the degree of aortic stability, to predict the risk of rupture and to choose the type of optimal surgical intervention (early or delayed). There is a possibility to perform endoprosthetic repair of the aorta and surgical intervention of other areas against the background of controlled hypotension in patients with simultaneous traumatic aortic injury and other combined injuries. Conclusion. It is advisable to perform a CT examination at once of several anatomical regions when examining patients with severe combined injuries. Evaluation of the mediastinum structures in patients with severe combined injuries should be performed on the basis of a computed tomography of the chest with mandatory intravenous administration of contrast media. It is necessary to perform multiplanar and three-dimensional volume rendering to allow better visualization of the extent of thoracic aortic injuries. Choosing a method of treatment in victims with thoracic aorta injury is based on the use of endoprosthetics as an effective and low-traumatic intervention that can be used simultaneously with other surgical methods of treatment.

© 2018 Media Sphera Publishing Group. All rights reserved. The objective of the present study was the comprehensive investigation of morphogenesis of the surface relief of the major local ruptures of the liver in the case of a blunt injury and the obtaining of an additional information on the possibility to use these data for the purposes of forensic medical expertise. We explored the reliefs of the major local ruptures of the liver in the cases of a single fatal blunt injury inflicted in a traffic accident, by kicking or a powerful stroke with the fist. In addition, the threshold hepatic lesions depending on their severity were determined experimentally. The model allowing to describe the qualitative relief alterations of the rupture surface associated with a blunt injury has been developed. The main elements of the surface relief of the major ruptures include avulsion and shear ridges, folds as well as «extension zones». Three types of possible rupture surface reliefs have been identified, viz. relatively uniform, stratified and fragmented non-uniform ones. Such reliefs are formed in the case of a threshold injury, powerful stroke with the leg or the fist, and road traffic accident, respectively. The location of the shear ridges at the ruptured surface makes it possible to determine the direction of growth of the local major rupture and of the stroke vector. The presence of multiple «extension zones» at the surface of the local major rupture may serve as an indicator either of the influence of the unlimited traumatic surface or of the very strong stroke. The above features of the relief of the rupture surface provide the conditions for the application of the statistical approach to the elucidation of the mechanisms underlying the deformation and the destruction of the parenchymatous organs suffering a blunt injury.