A snapshot of circulation failure following acute traumatic injury: The expansion of computed tomography beyond injury diagnosis

Anand, Tanya; vanSonnenberg, Eric; Gadani, Kiran; Skinner, Ruby

doi:10.1016/j.injury.2015.09.013

Cited by 7 publications

(22 citation statements)

References 11 publications

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“…A slit-like or flattened IVC may be defined as an IVC with an anteroposterior diameter less than 9 mm or a transverse-to-anteroposterior diameter ratio greater than 3:1 that is seen at multiple levels (Fig. 24) [127][128][129]. This is particularly important to recognise in the context of trauma, as it can indicate hypovolaemia or hypotension [17].…”

Section: Other Pathologiesmentioning

confidence: 99%

“…This is particularly important to recognise in the context of trauma, as it can indicate hypovolaemia or hypotension [17]. Moreover, when not involved in trauma, this sign can predict development of shock, need for aggressive resuscitation and increased mortality [127][128][129][130]. However, this should be taken with a grain of salt, as a slit-like IVC may be non-specific outside the context of trauma.…”

Section: Other Pathologiesmentioning

confidence: 99%

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The inferior vena cava: anatomical variants and acquired pathologies

Lee

Hall

et al. 2021

Insights Imaging

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The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.

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Section: Other Pathologiesmentioning

confidence: 99%

Section: Other Pathologiesmentioning

confidence: 99%

The inferior vena cava: anatomical variants and acquired pathologies

Lee

Hall

et al. 2021

Insights Imaging

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“…After the full-text review, 20 articles were excluded due to no inclusion ( n = 5) or insufficient information ( n = 15). Finally, 12 studies [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] comprising a total of 1706 patients were included in this review ( Figure 1 ). Detailed information about the eligible studies is shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…All 12 included studies were summarized in Table 1 . Nine studies reported the development of shock [ 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 ], and eight reported in-hospital morality [ 15 , 16 , 17 , 19 , 20 , 23 , 24 , 25 ]. All studies reported flat IVCs as an index test.…”

Section: Resultsmentioning

confidence: 99%

Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis

2022

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Hypovolemia may be underestimated due to compensatory mechanisms. In this systematic review and meta-analysis, we investigated the diagnostic accuracy of a flat inferior vena cava (IVC) on computed tomography (CT) for predicting the development of shock and mortality in trauma patients. Relevant studies were obtained by searching PubMed, EMBASE, and Cochrane databases (articles up to 16 September 2022). The number of 2-by-2 contingency tables for the index test were collected. We adopted the Bayesian bivariate random-effects meta-analysis model. Twelve studies comprising a total of 1706 patients were included. The flat IVC on CT showed 0.46 pooled sensitivity (95% credible interval [CrI] 0.32–0.63), 0.87 pooled specificity (95% CrI 0.78–0.94), and 0.78 pooled AUC (95% CrI 0.58–0.93) for the development of shock. The flat IVC for mortality showed 0.48 pooled sensitivity (95% CrI 0.21–0.94), 0.70 pooled specificity (95% CrI 0.47–0.88), and 0.60 pooled AUC (95% CrI 0.26–0.89). Regarding the development of shock, flat IVC provided acceptable accuracy with high specificity. Regarding in-hospital mortality, the flat IVC showed poor accuracy. However, these results should be interpreted with caution due to the high risk of bias and substantial heterogeneity in some included studies.

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“…Vascular findings of decreased volume and perfusion include flattening of the inferior vena cava of less than 9 mm, a halo of fluid surrounding the intrahepatic inferior vena cava, and a diminished aortic caliber (43). A flattened inferior vena cava measured just superior to the renal vein confluence has been associated with hypovolemia, increased likelihood of admission to the intensive care unit, and metabolic acidosis ( Fig 10) (43,45). The authors of a retrospective study (46) of 90 patients imaged within 1 hour of blunt or penetrating trauma found that the combination of a flattened inferior vena cava with free fluid and abnormal small-bowel enhancement was associated with a higher rate of admission to the intensive care unit.…”

Section: Ct Hypoperfusion Complexmentioning

confidence: 99%

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

et al. 2019

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After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients.

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A snapshot of circulation failure following acute traumatic injury: The expansion of computed tomography beyond injury diagnosis

Cited by 7 publications

References 11 publications

The inferior vena cava: anatomical variants and acquired pathologies

The inferior vena cava: anatomical variants and acquired pathologies

Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

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