CT Imaging of Blunt Abdominal Traumaeradiology.bidmc.harvard.edu/LearningLab/gastro/ledger.pdf ·...

CT Imaging of Blunt Abdominal Trauma

Gabriel Ledger, Harvard Medical School Year- IVGillian B. Lieberman, MD

September Gabriel LedgerGillian B. Lieberman,

2

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,

3

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,

4

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,

5

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,

6

Abdominal CT

Image courtesy of BIDMC Radiology Deparment

Gabriel LedgerGillian B. Lieberman,

7

Splenic Laceration

Image courtesy of BIDMC Radiology Deparment

Gabriel LedgerGillian B. Lieberman,

8

Pelvic CT

Image courtesy of BIDMC Radiology Deparment

Gabriel LedgerGillian B. Lieberman,

9

Fluid Extravasation

Image courtesy of BIDMC Radiology Deparment

Gabriel LedgerGillian B. Lieberman,

10

Our patient’s Radiologic Diagnosis

• Bowel and mesenteric vessel injury– (Indicated by extravasated contrast in low-mid

abdomen)• Spleen laceration

Gabriel LedgerGillian B. Lieberman,

11

Our patient’s OR findings

• IMA avulsion

• Sigmoid colon ischemia– Serosa damage, hematoma– No perforation

• Large septated spleen

Gabriel LedgerGillian B. Lieberman, MD

12

The patient underwent a Sigmoid Resection and ORIF of R Hip

Gabriel LedgerGillian B. Lieberman, MD

13

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

14

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

15

Menu of tests

• Plain films

• Ultrasound– Focused Abdominal Sonogram for Trauma (FAST)

• CT– IV + oral contrast

Gabriel LedgerGillian B. Lieberman, MD

16

Let’s look at some CT scans of different patients S/P trauma

Gabriel LedgerGillian B. Lieberman, MD

17

Liver laceration

Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999

Gabriel LedgerGillian B. Lieberman, MD

18

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

19Novelline, et al: Radiologic Clinics of NA 37(3):591, 1999

Gabriel LedgerGillian B. Lieberman, MD

Pneumoretroperitoneum due to Duodenum rupture

20

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

21

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