Introduction
A polytrauma patient has multiple injuries in at least two body regions or organ systems, and the combination threatens life. Imaging in these patients runs in parallel with resuscitation. Its goal is to find life-threatening injuries quickly, then identify the remaining injuries without delaying treatment.
Principles of imaging in the polytrauma patient
- Imaging follows the primary survey (airway, breathing, circulation, disability, exposure). Imaging never delays resuscitation or surgery.
- An unstable patient is examined with bedside tests first: FAST, portable chest X-ray and pelvic X-ray.
- A stable or stabilised patient receives a whole-body multidetector CT (the so-called pan-scan) of head, cervical spine, chest, abdomen and pelvis, with intravenous contrast in one sequence.
- Sagittal and coronal reformats are essential for the spine, pelvis and skull base.
Bedside and first-line examinations
- FAST (focused assessment with sonography for trauma) looks for free fluid in the pericardium, Morison pouch, the left upper quadrant and the pelvis. A positive FAST in an unstable patient usually means surgery or angioembolization. A negative FAST does not exclude solid organ injury or hollow viscus injury.
- The extended eFAST adds lung ultrasound. Absent lung sliding suggests pneumothorax.
- A portable supine AP chest X-ray shows mediastinal widening, pneumothorax, haemothorax, rib fractures and the position of tubes and lines. The supine position makes pneumothorax harder to see.
- The AP pelvic X-ray shows pelvic ring fractures and hip dislocation.