This document discusses the imaging techniques used to evaluate abdominal trauma, including plain radiography, ultrasound, CT scan, and their findings. It focuses on injuries to solid organs like the spleen, liver, pancreas and kidneys. For each organ, it describes typical injuries seen like lacerations, hematomas, active bleeding and their grading systems. CT scan is highlighted as the most sensitive modality for evaluating abdominal trauma and detecting injuries to retroperitoneal structures and blood vessels.
5. Focused Assessment with
Sonography for Trauma (FAST)
To identify intra-abdominal free fluid – Hemoperitoneum
Sensitivity – 80-100% for FF and injuries is 40-80 %
12. Role of CT scan
More accurate for solid visceral assessment
Quantification of hemorrhage
Assessment of retroperitoneal injuries
Most sensitive and imaging modality o choice for evaluation
of abdominal trauma
13. Spleen
Most common injured organ in blunt trauma (40% of all solid organ injuries)
CECT is the investigation of choice
Integrity of organs
Extent of injury / Localization of parenchymal contusions, hematoma
16. Delayed splenic rupture
Bleeding due to splenic injury occurring more than 48 h after blunt trauma
Due to ruptures of subcapsular splenic hematomas.
40. Active contrast extravasation within liver parenchymal hematoma
DSA showed a large pseudoaneurysm
41. Pancreas
Least commonly injured solid organ (3-12 %).
Seatbelt injuries : Compression against the vertebral column.
Rarely an isolated injury
59. Imaging of Renal Trauma
Computed tomography (CT) is the modality of choice
Injury to the kidney is seen in approximately 8%– 10% of patients with
blunt or penetrating abdominal injuries
61. Laceration
Hypodense, irregularly linear areas, typically distributed along the vessels
and filled with blood.
They are best analyzed at arterial phase
Superficial (<1 cm from the renal cortex)
Deep (>1 cm from the renal cortex)
72. Urinoma/Urohematoma
Presence of a more or less significant breach of the collecting tube system,
with urine escape reflected by extravasation of contrast medium on
delayed imaging, in an extrarenal location
Pneumoperitoneum, bony injuries, subcutaneous emphysema, Insensitve to detect hemoperitoneum ///This difference in sensitivity occurs because the x-ray beam is centered at the iliac crest on abdominal films, so that it penetrates air beneath the diaphragm obliquely rather than tangentially.///Present as soft tissue haze near paracolic gutters displacing the colon….
Can be limited by bandages and dressing, subcutaneous emphysema and bowel shadows
Initial assessment of acutely injured patient. Negatve FAST should be viewed as the absence of hemoperitoneum not absence of abdominal injury Less sensitive than CT but better than diagnostic peritoneal lavage
Pericardial fluid and injury to the left lobe of liver….see the left lobe of liver and a 4 chambered heart view
Anechoic separation between the pericardium and myocardium
Right lobe of liver , kidney perihepatic ff, Fluid in morrisons pouch.
Spleen, left kidney and perisplenic free fluid
To view the urinary bladder and look for ff in pelvis and pouch of douglas
rich vascular supply, fractured ribs splenomegaly//viable parenchyma will enhance.//Identifies great vessels// Factors,.
Parenchymal hematomas appear as focal, poorly marginated hypodense areas.
Lenticular configuration and flattening of the adjacent splenic parenchyma….
following an apparently normal CT examination
Superficial, linear hypodensity, usually less than 3 cm in length
Fracture - involves two visceral surfaces, or if its length is more than 3 cm
Preserved fat planes…On delayed film laceration margins appear to fill in and become less visible, and in splenic
Clotted blood adjacent to the site of injury is of higher attenuation (45-70 HU) than unclotted blood (30- 45 HU) which flows Away.. location of highest attenuating
blood clot
Linear hypodense areas consistent with lacerations. Round and oval hypodense areas consistent with intrasplenic hematoma. Hemoperitoneum.
More triangular and more peripheral
Portal venous phase as heterogenous enhancement of spleen can simulate injury… Imaging early arterial for active extravastation/ traumatic pseudoaneurysm
Active contrast HU 85-350 HU ..High attenuating, poorly marginated, pseudoaneurysm has a well defined margin, enhancement close to 10 hu of artery even on delayed, angiography//hematoma that forms as the result of a leaking hole in an artery
Moderate volume of free intraperitoneal fluid, particularly around the spleen which has a small hypodense and superficial cleft posteriorly, suspicious for grade I laceration.
not involving trabecular vessels
hypodense laceration seen involving the posterior aspect of the spleen with intrasplenic hematoma.
expanding or involving trabecular vessels intraparenchymal haematoma/laceration measuring > 5 cm which extends to the splenic hilum
Extensive splenic lacerations extending to the hilum with areas of devascularisation. No evidence of active bleeding or pseudo-aneurysm. There is extensive haemoperitoneum throughout the abdominopelvic cavity. Cholecystectomy clips are noted along with extrahepatic and first order intrahepatic duct dilatation.
The spleen is shattered. When assessing the need for surgery hemodynamic status is more important than CT appearance
(devascularized).
As with spleen CT is the diagnostic modality of choice
Blood / obstructed lymphatics at hila. D/t Overtransfusion after traum
Liver (segment 7) subcapsular haematoma. Subcapsulatr hematomas indent the liver margin and are frequently identified in the right lobe of liver( anterolateral part of right lobe of liver) less chance for delayed rupture as spleen
Acute hematomas show higher attenuation than normal liver parenchyma on unenhanced CT
Superficial<3 cmDeep >3 cm
or expanding
Multiple deep linear branching hypodense lacerations are seen involving the posterior segment of right hepatic lobe with associated large hypodense subcapsular parenchymal hematoma. No evidence of contrast blush or active bleeding. Intact vascular pedicle.
Large laceration in the right lobe of the liver with a perihepatic haematoma.
Active contrast extravastation from the liver parenchyma into the perihepatic spac
vascular: juxtahepatic venous injuries
Role of surgery is more predictable by hemodynamic status of the patient
The patient underwent coil embolization
Elevated serum amylase is nonspecific and does not correlate with severity of injury…
Axial CECT scans show a contusion involving the head of pancreas
Axial CECT scan through pancreas ……… with a large collection seen anterior to pancreas
Ct is insensitive to detect duct injuries MRCP may be done
Specific sign is tracking of fluid between body of pancreas and splenic vein.
Deceleration injuries shearing forces
sagittal reformat (B) images of CECT shows a focal defect in wall of ileum (arrows) with air extending outside
bowel lumen. An axial section at a different level with changed window settings shows the presence of pneumoperitoneum
Presence of these signs mandate urgent laparotomy
(intramural hematoma) entire descending colon distended with hyperdense contents representing hematoma with thinned out abnormally enhancing walls and air within the wall suggesting colonic injury
Does not necessarily imply bowel rupture. Axial CECT scan through mid abdomen (A) shows diffuse thickening and hyperenhancement of jejunal loops. Flat ivc
Shows infiltration and hematoma (arrows) in mesentric root representing mesentric injury
Blunt injuries to IVC and aorta are rare..hepatic lacerations may extend to IVC , have a high mortality rate extreme hypovoluemia. Active extravastation in IVC lavceration
Infrarenal better prognosis than perihepatic due to tamponading effect of retroperitoneum.