Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

Abstract

<jats:p> This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery. </jats:p>

Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds

“…[65][66][67] At the same time, Grade IV describes an injury with active bleeding beyond the hepatic parenchyma alongside the lobar parenchymal disruption of 25-75%. Injury to major hepatic veins and inferior vena cava are classified under Grade V. [68] In patients with splenic injury, a radiologist must state the trajectory of injury, whether it is traversing the splenic hilum and signs of vascular injury or shattered spleen. [4] e 2018 AAST OIS classified any splenic vascular injury or active bleeding within the splenic capsule as Grade IV.…”

“…At the same time, the extended active bleeding beyond the splenic capsule or a shattered spleen is classified as Grade V splenic injuries. [ 66 , 68 ] The presence of active extravasation, discontinuation of mesenteric vessels, pooling of contrast material, and inter-mesenteric free fluid (forming triangles) should raise the suspicion of injury to the mesenteric vasculature. Furthermore, the diffuse bowel hematoma in the vascular distribution pattern indicates mesenteric vascular injury.…”

“…For instance, the patient with CT findings of active contrast extravasation and free fluid is at increased risk of NOM failure. [ 68 ]…”

The spectrum of blunt abdominal trauma in Pietermaritzburg

“…10 The mechanisms of injury in blunt abdominal trauma (BAT) often result in concurrent non-abdominal injury which may also need urgent intervention. Clinical examination is not diagnostically reliable 12 and the use of US scanning 13 and CT scanning 14 are important diagnostic tools. This study reviews the Pietermaritzburg Metropolitan Trauma Service (PMTS) experience of suspected BAT and describes the spectrum and investigation, management of BAT in our setting.…”

Imaging Features and Interventional Treatment for Liver Injuries and Their Complications

“…The treatment strategy of blunt injuries in solid organs including the liver is shifting from surgical to nonoperative management (NOM) in hemodynamically stable patients ( 13 15 16 17 18 ). In addition, interventional management has been widely used with high clinical success rates ( 15 16 19 20 ).…”