CT Imaging of Blunt Abdominal Trauma
Gabriel Ledger, Harvard Medical School Year- IVGillian B. Lieberman, MD
September Gabriel LedgerGillian B. Lieberman,
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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 abdomenunstable pelvisright LE shortened & internally rotated
• Hematocrit 31.0
Gabriel LedgerGillian B. Lieberman,
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Imaging work-up
• Head CT: Negative: No bleed, no fracture
• C-spine CT: Negative: No fracture
• CXR: Negative: No pneumothorax, normal mediastinum
Gabriel LedgerGillian B. Lieberman,
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PELVIC PLAIN FILM
• Pelvic film:– bilateral SI joint
disruptions– R hip dislocation– pubic symphysis
diastasis
Image courtesy of BIDMC Radiology Deparment
Gabriel LedgerGillian B. Lieberman,
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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
Gabriel LedgerGillian B. Lieberman,
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Abdominal CT
Image courtesy of BIDMC Radiology Deparment
Gabriel LedgerGillian B. Lieberman,
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Splenic Laceration
Image courtesy of BIDMC Radiology Deparment
Gabriel LedgerGillian B. Lieberman,
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Pelvic CT
Image courtesy of BIDMC Radiology Deparment
Gabriel LedgerGillian B. Lieberman,
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Fluid Extravasation
Image courtesy of BIDMC Radiology Deparment
Gabriel LedgerGillian B. Lieberman,
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Our patient’s Radiologic Diagnosis
• Bowel and mesenteric vessel injury– (Indicated by extravasated contrast in low-mid
abdomen)• Spleen laceration
Gabriel LedgerGillian B. Lieberman,
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Our patient’s OR findings
• IMA avulsion
• Sigmoid colon ischemia– Serosa damage, hematoma– No perforation
• Large septated spleen
Gabriel LedgerGillian B. Lieberman, MD
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The patient underwent a Sigmoid Resection and ORIF of R Hip
Gabriel LedgerGillian B. Lieberman, MD
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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
Gabriel LedgerGillian B. Lieberman, MD
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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
Gabriel LedgerGillian B. Lieberman, MD
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Menu of tests
• Plain films
• Ultrasound– Focused Abdominal Sonogram for Trauma (FAST)
• CT– IV + oral contrast
Gabriel LedgerGillian B. Lieberman, MD
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Let’s look at some CT scans of different patients S/P trauma
Gabriel LedgerGillian B. Lieberman, MD
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Liver laceration
Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999
Gabriel LedgerGillian B. Lieberman, MD
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Gallbladder Avulsion
Fluid in empty fossa
Gallbladder
Axial View Coronal reconstruction
Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999 Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999
Gabriel LedgerGillian B. Lieberman, MD
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Gabriel LedgerGillian B. Lieberman, MD
Pneumoretroperitoneum due to Duodenum rupture
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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.
Gabriel LedgerGillian B. Lieberman, MD
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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.
Gabriel LedgerGillian B. Lieberman, MD
