E1092. Bad Blood: Plain Film and Imaging Appearances of Mediastinal Hematomas - The Importance of Early Detection
Authors
Brandon Ballane;
New York Medical College
Kanika Thapar;
Westchester Medical Center
Yehuda Herman;
New York Medical College
Ekramul Gofur;
Westchester Medical Center
Mayer Rubin;
Westchester Medical Center
Jared Meshekow;
Temple University, Lewis Katz School of Medicine
Perry Gerard;
Westchester Medical Center
Background
This project seeks to identify the varying radiographic imaging presentations of mediastinal hematomas as the result of various traumatic and nontraumatic etiologies, including blunt chest trauma, aortic injury, or musculoskeletal fractures in emergency medicine and various nontraumatic causes. Mediastinal hematomas can present with complex variations on radiologic imaging depending on the mechanism of injury. It is most important to identify the presence of a mediastinal hematoma on plain films as it requires further imaging studies to identify aortic injury and other injuries such as tearing of mediastinal vessels, sternal fractures, and thoracic spine injuries. We discuss the various imaging findings including plain film radiographs, CTA, and MRI. Recognition of findings of mediastinal hematoma in the emergency room setting is essential for appropriate patient care.
Educational Goals / Teaching Points
Mediastinal hematomas can occur via several different mechanisms of injury resulting in the presence of blood within the mediastinal fascial planes. These hematomas can present radiographically in different anatomical regions of the mediastinum. The purpose of this exhibit is to identify the varying appearances of mediastinal hematomas on radiographic imaging in the setting of emergency radiology.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Thoracic trauma can result in a life-threatening injury and clinical evaluation can be nonspecific and associated with other injuries. The mechanisms of injury and hemodynamic findings can help identify critical chest injuries. Thoracic trauma can result in aortic injuries such as laceration and dissection. Plain radiograph of the chest can demonstrate indirect signs in the mediastinum, including widening, abnormal aortic contour, widened stripes, and hemothorax. Recognition of these signs is important to direct follow-up imaging studies.
Conclusion
Mediastinal hematomas can occur from a variety of different mechanisms of injury and etiologies. Radiographic imaging can detect hematomas, and familiarity with the imaging findings including plain films is essential to recognize and order appropriate followup studies. This exhibit seeks to identify the differences in mediastinal hematoma presentations on radiographic imaging which arise from traumatic and nontraumatic mechanisms of injury.
