Abdominal computed tomography in blunt trauma

Shanmuganathan, Kathirkamanathan

doi:10.1016/0037-198x(92)90027-y

Cited by 16 publications

(5 citation statements)

References 73 publications

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“…In blunt trauma, the spleen and liver are much more common sites of injury than the GIT 37 . Lower grade injuries to these organs can be managed non‐operatively with minimal risk of missing a GITI, in most cardiovascularly stable trauma patients 13 , 14 , 33 , 38 –43 . Trivial mesenteric injuries are three times more frequent than serious intestinal injuries, 37 and will frequently be responsible for positive physical findings.…”

Section: Clinical Assessmentmentioning

confidence: 99%

“…The definition of injuries that have been said to require therapeutic intervention by means of a laparotomy has varied over time, between individual surgeons and between institutions. This and the popularization of the non‐operative management of most low‐ and medium‐grade solid viscus injuries in cardiovascularly stabilized patients in the last decade has made the majority of reports difficult to relate to current practice 12 –14 , 18 , 41 , 42 , 44 , 55 , 75 , 81 –83 . The false positive rate of DPL is greater when injuries not requiring intervention are included.…”

Section: Diagnostic Peritoneal Lavagementioning

confidence: 99%

“…In recent times computed tomography (CT) of the abdomen and pelvis has been widely used for the assessment of haemodynamically stabilized trauma patients. Computed tomography has the advantage of not only being able to detect intra‐abdominal injuries, but also being able to define the site and extent of injuries 10 –14 . Computed tomography scanning has been criticized for having a low sensitivity for the detection of GITI.…”

Section: Introductionmentioning

confidence: 99%

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The Diagnosis of Gastrointestinal Tract Injuries Resulting From Blunt Trauma

Hughes

1999

Aust. N.Z. J. Surg.

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The most accurate and safest methods of assessment of the abdomen in haemodynamically unstable patients with suspected abdominal injuries following blunt trauma are immediate laparotomy or diagnostic peritoneal lavage (DPL). The goal of assessment of the abdomen in stable patients is to accurately define the site and extent of intra-abdominal injury, in order that further management may be tailored to the specific injuries. The most recent evidence suggests that CT of the abdomen fulfils these criteria better than the other modalities of assessment available. The risk of overlooking a significant GITI on CT scan is minimal provided that unexplained free fluid, bowel wall thickening or enhancement, mesenteric fat streaking and bowel dilatation are taken as evidence of GITI. When scan quality is suboptimal or expert interpretation is unavailable, DPL is recommended. Fully cooperative patients with negligible abdominal signs can be safely observed clinically.

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Section: Clinical Assessmentmentioning

confidence: 99%

Section: Diagnostic Peritoneal Lavagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Diagnosis of Gastrointestinal Tract Injuries Resulting From Blunt Trauma

Hughes

1999

Aust. N.Z. J. Surg.

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“…Contrast-enhanced helical computed tomography (CT) is the imaging study of choice for evaluating the abdomen in hemodynamically stable patients following blunt abdominal trauma [1]. In general, victims of penetrating trauma to the abdomen usually undergo surgical exploration to identify all injuries directly, or they may have immediate celiotomy because of continuing hemodynamic instability.…”

Section: Introductionmentioning

confidence: 99%

Penetrating trauma to the abdominal aorta: CT demonstration of active bleeding

Bernstein

2001

Emergency Radiology

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Contrast-enhanced helical computed tomography (CT) is the imaging study of choice for evaluating the abdomen in hemodynamically stable patients following blunt trauma. Surviving victims of penetrating trauma, in contrast, are often hemodynamically unstable and may require urgent celiotomy with or without diagnostic peritoneal lavage (DPL) or ultrasonography. Abdominal CT is not routinely performed in this patient population, but may be done if the patient with penetrating abdominal trauma is stable on admission or becomes so with resuscitation. CT in this context can address questions regarding the location and extent of injury and help decide appropriate management. We present a case of a stabilized blunt and penetrating trauma patient with negative DPL and active retroperitoneal aortic extravasation demonstrated by CT. To our knowledge, penetrating injury to the aorta with active bleeding has not been previously seen on CT.

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“…Operator independence, robust image quality, and higher imaging speed have contributed to the increased use of CT in the assessment of trauma victims with suspected abdominal injuries. The high attenuation values achieved within vessels as well as the parenchyma with spiral CT permit identification of active hemorrhage, parenchymal hematomas, hemoperitoneum, as well as visceral injury [6,7,8].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional contrast-enhanced MRI using an intravascular contrast agent for detection of traumatic intra-abdominal hemorrhage and abdominal parenchymal injuries: an experimental study

et al. 2000

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The aim of this study was to compare the performance of 3D MRI in conjunction with an intravascular contrast agent to spiral contrast-enhanced CT, regarding the detection of abdominal parenchymal injuries as well as peritoneal hemorrhage in an animal model. Liver and kidney injuries were created surgically in six female pigs under general anesthesia. All pigs underwent contrast-enhanced spiral CT and 3D MR imaging following administration of an intravascular contrast agent (NC100150 Injection). Two readers rated their confidence independently on MR and CT data sets using a five-point scale for the presence of organ injury and hemoperitoneum. Autopsy findings served as standard of reference. Sensitivity and specificity for MR in detecting hepatic and renal injuries as well as hemoperitoneum was 100%. Computed tomography was less accurate with sensitivity and specificity values of 90 and 94%, respectively. Receiver operating characteristics (ROC) analysis revealed a higher confidence when interpretation was based on MR images. In an animal model 3D MR imaging in conjunction with an intravascular contrast agent proved highly accurate in detecting and localizing parenchymal injuries to the upper abdomen as well as in detecting intraperitoneal blood collections.

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Abdominal computed tomography in blunt trauma

Cited by 16 publications

References 73 publications

The Diagnosis of Gastrointestinal Tract Injuries Resulting From Blunt Trauma

The Diagnosis of Gastrointestinal Tract Injuries Resulting From Blunt Trauma

Penetrating trauma to the abdominal aorta: CT demonstration of active bleeding

Three-dimensional contrast-enhanced MRI using an intravascular contrast agent for detection of traumatic intra-abdominal hemorrhage and abdominal parenchymal injuries: an experimental study

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