Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.
Computed tomography (CT) is currently the diagnostic modality of choice in the evaluation of clinically stable patients with blunt abdominal trauma, including the assessment of blunt bowel and mesenteric injuries. CT signs of bowel and/or mesenteric injuries are bowel wall defect, free air, oral contrast material extravasation, extravasation of contrast material from mesenteric vessels, mesenteric vascular beading, abrupt termination of mesenteric vessels, focal bowel wall thickening, mesenteric fat stranding, mesenteric haematoma and intraperitoneal or retroperitoneal fluid. This pictorial essay illustrates CT features of bowel and/or mesenteric injuries in patients with blunt abdominal trauma. Pitfalls in interpretation of images are emphasized in proven cases.
Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).
40 cases of major renal trauma over a period of five years in a peripheral hospital in Singapore were reviewed. 90% were due to blunt trauma with motor-cycle accidents forming the majority. There were five cases of superficial cortical injury, three cases of shattered kidneys, six cases of parenchymal injuries, one case of pedicle injury and one case of combined pedicle and parenchymal injury. Nephrectomy rate was 22.5% in this series. This is felt to be unduly high. Half of all the cases operated upon ended up with an immediate total nephrectomy. There was no mortality in this series. We recommend a more conservative policy of watchful waiting to achieve better chances of organ preservation without increasing mortality.
Retroperitoneal duodenal rupture due to blunt abdominal trauma is relatively uncommon. Diagnosis is difficult because the physical signs are subtle or they are difficult to interpret. A case of retroperitoneal duodenal rupture due to blunt abdominal trauma in whom the diagnosis was delayed is reported. Radiographic features are discussed. The role of early roentgen diagnosis is stressed in order to reduce the very high mortality which is associated with delay in diagnosis and treatment.
A 20-year-old male sustained an inferior myocardial infarction following blunt chest trauma, after a motor vehicle accident. Though coronary arteriograms 9 months later were normal, LV angiography revealed severe hypokinesia of the inferobasal and diaphragmatic segments. The literature is reviewed with respect to mechanisms of injury, autopsy and angiographic findings and clinical outcome in this condition.
Renal injury is observed in 10 percent of cases of abdominal trauma, and the majority (80 percent to 90 percent) of these are attributable to blunt trauma. Intravenous urography and ultrasonography of the abdomen were previously the modalities of choice in the imaging of renal injuries. However, computed tomography (CT) is currently the imaging modality of choice in the evaluation of blunt renal injury, since it provides the exact staging of renal injuries. The purpose of this article is to describe the CT staging of renal injuries observed in blunt abdominal trauma based on the Federle Classification and the American Association for the Surgery of Trauma renal injury severity scale.