Imaging Blunt Abdom nal l Trauma Imaging Blunt Abdominal Trauma CT of Blunt Abdominal ...

13 Pages·2014·0.81 MB·English

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CT of Blunt Abdominal Trauma
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Objectives

• Review several important CT

signs in abdominal trauma
• Review the spectrum of

abdominal injury which can be

diagnosed with CT

• Discuss strengths/weaknesses
of CT
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CT of Blunt Abdominal Trauma CT of Blunt Abdominal Trauma

Objectives Clinical Impact

• NOT going to review the AAST • Deciding operative vs non-
grading system for trauma of operative management
each organ in the abdomen!
• Guiding minimally invasive,
transcatheter embolization
• “One stop shopping” for global
assessment of head, MSK, visceral
and many vascular injuries

CT of Blunt Abdominal Trauma CT of Blunt Abdominal Trauma

Limitations Selected Signs

• Abdominal signs of thoracic injury
• GI tract and pancreatic injuries
• Signs of hemorrhage, shock and
• CT staging based entirely on
hypovolemia
morphologic criteria are of
limited value in management • Challenges for CT: signs of bowel,
pancreatic injury
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Ejected from Motor Vehicle
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Pneumothorax

“4 x 4 sign”

APoertric-aTorratincsBeclotioodn Blunt trauma, normal CXR

Peri-aortic blood
at the diaphragm

Arch and Innominate Injury Peri-aortic Blood at the
Diaphragm

• Only an abdominal CT may be ordered if
CXR is interpreted as normal
• Relatively insensitive (70%) but fairly
specific sign (94%) for aortic injury; re-
scan chest with MDCT angio
• Vertebral fractures and ruptured
diaphragm may also cause this finding

Wong, et al, Radiology, 2004, Vol.231: 185-189
Blood Along the Crus Blood Along the Crus

Spinal Trauma Traumatic Diaphragmatic Rupture

CT Signs of Diaphragmatic Diaphragmatic Rupture

Rupture
Collar Sign

• Collar sign: constriction of stomach or
colon traversing the hernia

• Dependent viscera sign: upper portion

of liver, spleen or bowel abuts ribs with no

intervening diaphrgam

• Discontinuity of visualized diaphragm
• Blood dissecting along crus

• Outside sign: abdominal viscera on
Dependent Viscera
wrong side of diaphragm on axial image
Sign

Diaphragmatic Rupture Diaphragmatic Rupture
Diaphragmatic Rupture
Diaphragmatic Rupture

Coronal Reconstruction

Where’s the blood coming from?

Sentinel Clot Sign

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s/p MVC
Sentinel Clot Sign
Sentinel Clot Sign

Blood closer to the site of

injury has higher

attenuation than blood 55 HU 27 HU
further away.
Fall from Horse Splenic Trauma

AAE into Paracolic Gutter
Active
Spurting
Arterial
Vessel
Extrav

Must have IV
contrast!

Splenic Trauma Splenic Injury

AAE + Pseudoaneurysm

Proper
bolus
and scan
delay are
critical!

delay

Intrasplenic CT of Active Arterial
Pseudoaneurysm Extravasation (AAE)
Teaching Points

• AAE = High attenuation focus (100-
150 HU) isodense with adjacent
major arteries; surrounded by lower
attenuation hematoma with adjacent
mass effect
• AAE may be displaced by clot
• AAE often requires intervention
• surgery vs embolization
Hepatic AAE
Hepatic Trauma, no AAE
Intervention required…
Successful non-operative management

Minimally Invasive Therapy
Lumbar Artery Lac, AAE
Transcatheter Embolization
Minimally Invasive Therapy

Renal Trauma
Renal Trauma: AAE
AAE and Traumatic Infarct
Renal Trauma: AAE?
Mesenteric AAE

Delayed images
can confirm AAE

Pelvic Arterial Extravasation
Mesenteric AAE

Renal Pedicle Injury Renal Pedicle Injury

Traumatic Renal Infarct Traumatic Renal Infarct
Duodenal Perforation
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Water Density Fluid

HU = 9

Jejunal Perforation Jejunal Perforation

Interloop Fluid, No Free Air Hyperdense bowel and FF

Small Bowel Injury Mesenteric Laceration

Interloop fluid, free air, dense bowel High Attenuation Interloop Fluid

HU 34
Small Bowel Laceration Colonic Perforation

Abdominal wall contusion: Seatbelt injury Seatbelt Injury

CT Findings in GI Tract Trauma: CT Findings in Bowel Injury
Stanford Experience (n = 62)
Location Findings

CT Finding Percent Stomach • free air and fluid
Free Fluid 85
• free air/fluid, often
Duodenum
Interloop Fluid 72 retroperitoneal
Mesenteric Blood 39 • free fluid, interloop
Small bowel
• little or no free air
Pneumoperitoneum 22
• large free air
No CT findings 3 Colon
• + free fluid or stool

Intra-abdominal water density
Intramural Hematoma
fluid S/P Trauma

High Attenuation in Bowel Wall
Teaching Points
• DDx
• Pre-existing ascites
• Luminal GI contents
• Bile
• Urine
• Lymph
• Succus pancreaticus
• Location of fluid hint to source
• Interloop fluid = bowel perforation
Gallbladder Rupture with
D5 s/p assault, abd distension
Hemorrhage

Intraperitoneal Bladder Rupture
Sentinel Clot Sign

Known Cirhosis

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Left ureteral transection

Shock/Hypovolemia Reperfusion Injury to Bowel

Caved-in Cava Sign Hyperdense bowel wall