CT Imaging of Blunt Abdominal Trauma

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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