Imaging work-up. • Head CT: Negative: No bleed, no fracture. • C-spine CT: ....
Beverlee Turner for her support and PowerPoint expertise. • Larry Barbaras, our ...
Gabriel Ledger Gillian B. Lieberman,
September
CT Imaging of Blunt Abdominal Trauma
Gabriel Ledger, Harvard Medical School Year- IV Gillian B. Lieberman, MD
Gabriel Ledger Gillian B. Lieberman,
JG vs.Train • 55yo male crushed & pinned between 2 train cars • in the field: SBP 80, unconscious, intubated • in ER: HR 109 BP 131/70 suprapubic ecchymoses, soft abdomen unstable pelvis right LE shortened & internally rotated • Hematocrit 31.0 2
Gabriel Ledger Gillian B. Lieberman,
Imaging work-up • Head CT: Negative: No bleed, no fracture • C-spine CT: Negative: No fracture • CXR: Negative: No pneumothorax, normal mediastinum
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Gabriel Ledger Gillian B. Lieberman,
PELVIC PLAIN FILM • Pelvic film: – bilateral SI joint disruptions – R hip dislocation – pubic symphysis diastasis
Image courtesy of BIDMC Radiology Deparment
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Gabriel Ledger Gillian B. Lieberman,
Abdominal Ultrasound • Ultrasound: – small peri-splenic fluid collection in LUQ – No other solid organ lacerations noted
McKenney, KL:Radiology Clinics of NA37(5):888, 1999
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Gabriel Ledger Gillian B. Lieberman,
Abdominal CT
Image courtesy of BIDMC Radiology Deparment
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Gabriel Ledger Gillian B. Lieberman,
Splenic Laceration
Image courtesy of BIDMC Radiology Deparment
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Gabriel Ledger Gillian B. Lieberman,
Pelvic CT
Image courtesy of BIDMC Radiology Deparment
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Gabriel Ledger Gillian B. Lieberman,
Fluid Extravasation
Image courtesy of BIDMC Radiology Deparment
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Gabriel Ledger Gillian B. Lieberman,
Our patient’s Radiologic Diagnosis • Bowel and mesenteric vessel injury – (Indicated by extravasated contrast in low-mid abdomen)
• Spleen laceration
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Gabriel Ledger Gillian B. Lieberman, MD
Our patient’s OR findings • IMA avulsion • Sigmoid colon ischemia – Serosa damage, hematoma – No perforation
• Large septated spleen 11
Gabriel Ledger Gillian B. Lieberman, MD
The patient underwent a Sigmoid Resection and ORIF of R Hip
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Gabriel Ledger Gillian B. Lieberman, MD
Hospital Course • • • •
Extubated & sent to floor on POD #1 Transfused 2 units pRBC on POD #3 Post-op ileus on POD #6 Discharged to rehab on POD #14
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Gabriel Ledger Gillian B. Lieberman, MD
Discussion: Mechanism of injury • Compression – Solid organ impact on spine or body wall • Spleen, liver, pancreas, duodenum
– Hollow organ rupture due to increased pressure • Bowel
• Deceleration – Shearing of vessels • Major arteries, mesenteric vessels
– Bowel damage • Fixation points 14
Gabriel Ledger Gillian B. Lieberman, MD
Menu of tests • Plain films • Ultrasound – Focused Abdominal Sonogram for Trauma (FAST)
• CT – IV + oral contrast
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Gabriel Ledger Gillian B. Lieberman, MD
Let’s look at some CT scans of different patients S/P trauma
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Gabriel Ledger Gillian B. Lieberman, MD
Liver laceration
Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999
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Gabriel Ledger Gillian B. Lieberman, MD
Gallbladder Avulsion Fluid in empty fossa
Gallbladder
Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999
Axial View
Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999
Coronal reconstruction 18
Gabriel Ledger Gillian B. Lieberman, MD
Pneumoretroperitoneum due to Duodenum rupture
Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999
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Gabriel Ledger Gillian B. Lieberman, MD
References McKenney, KL: Radiology Clinics of NA 37(5):888, 1999. Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999. Novelline, et al: Radiology 213(2):321, 1999. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., Mosby-Year Book, Inc. 1998. Shackford, S.R.: Journal of Trauma-Injury, Infection & Critical Care 46(4):553, 1999. Taylor, C.R., et al: Journal of Trauma-Injury, Infection & Critical Care 44(5):893, 1998.
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Gabriel Ledger Gillian B. Lieberman, MD
Acknowledgements • • • • • •
Vassilios Raptopoulos, MD Gillian Lieberman, MD Joe Makris, MD Eric Chiang, MD Beverlee Turner for her support and PowerPoint expertise. Larry Barbaras, our WebMaster.
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