Purpose:
1. Review the classical physics of barotrauma and applied pathophysiology.
2. Discuss high-yield body MDCT findings in victims of soft tissue barotrauma.
3. Highlight the clinical prognostic importance of soft tissue barotrauma.
Physics/Pathophysiology of Barotrauma
Classical physics: pressure = force/area. Pascal’s Law states pressure applied to a closed body of fluid will be evenly distributed. While pressure is proportional to density it is independent of size and shape of the container. A force to the chest or abdomen acts as a shockwave. For example, if energy is transmitted throughout mesenteric fat a floating loop of bowel will experience an equal force on all sides.
Clinical and Prognostic Importance of Soft Tissue Barotrauma.
Clinical exam is surprisingly insensitive for pressure-related injuries. A “seatbelt sign” can be helpful on physical exam, however most attention is directed to fractures or solid organ injury. The radiologist plays a key role in completing the patient’s clinical picture. Barotrauma victims frequently suffer from multiple solid organ injuries and risk a “satisfaction of search” error. Tracheal injury may complicate oxygenation. Traumatic flank hernias include a risk of bowel entrapment. Bowel contusions may progress to ischemia.
Representative Cases and Mimics
Conclusion
Holstad, J,
MacAdam, B,
Zhou, D,
MDCT Findings of Soft Tissue Barotrauma: Striking, Subtle, and Mimics. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/14001575.html
