Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging

Melikian, Raymond; Goldberg, Solomon C.; Strife, Brian J.; Halvorsen, Robert A.

doi:10.5152/dir.2016.15232

Cited by 20 publications

(8 citation statements)

References 21 publications

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“…It should be noted that although we do not routinely perform an arterial phase CT scan of the abdomen and pelvis in patients with isolated blunt abdominal trauma, it has been shown that the combination of an arterial phase scan and a portal venous phase scan increases the sensitivity and accuracy for the detection of splenic vascular injury (24)(25)(26). However, in patients undergoing CT of the chest, abdomen, and pelvis because of high-velocity mechanisms of blunt trauma (namely, motor vehicle collisions), the arterial phase of the chest CT scan is extended inferiorly to include the splenic vasculature.…”

Section: Introductionmentioning

confidence: 99%

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

et al. 2017

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Blunt traumatic injury is one of the leading causes of morbidity and mortality in the United States. Unintentional injury represents the leading cause of death in the United States for all persons between the ages of 1 and 44 years. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Despite the relatively low rate of blunt bowel and mesenteric injury in patients with abdominal and pelvic trauma, delays in diagnosis are associated with increased rates of sepsis, a prolonged course in the intensive care unit, and increased mortality. During the past 2 decades, as multidetector computed tomography (CT) has emerged as an essential tool in emergency radiology, several direct and indirect imaging features have been identified that are associated with blunt bowel and mesenteric injury. The imaging findings in cases of blunt bowel and mesenteric injury can be subtle and may be seen in the setting of multiple complex injuries, such as multiple solid-organ injuries and spinal fractures. Familiarity with the various imaging features of blunt bowel and mesenteric injury, as well as an understanding of their clinical importance with regard to the care of the patient, is essential to making a timely diagnosis. Once radiologists are familiar with the spectrum of findings of blunt bowel and mesenteric injury, they will be able to make timely diagnoses that will lead to improved patient outcomes. RSNA, 2017.

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Section: Introductionmentioning

confidence: 99%

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

et al. 2017

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“…These two patients had a grade-4 splenic injury. Although the sensitivity and specificity of the computed tomography reach 80% in spleen injuries, it should be kept in mind that there may be injuries that imaging methods can miss in blunt abdominal trauma (25,26).…”

Section: Discussionmentioning

confidence: 99%

Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

Yıldırım

Şahiner

Kendirci

et al. 2021

Journal of Health Sciences and Medicine

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Backgrounds: Abdominal traumas have an important place in the emergency room. Historically, surgical intervention was adopted as a treatment method for liver and spleen traumas. However, with the development of imaging methods, the possibility of non-surgical follow-up was obtained. In this study, the advantages and disadvantages of conservative treatment for surgical intervention were investigated. Material and Method:The patients with complaints of blunt abdominal trauma, who were admitted to the third step research center emergency service during the 27-month period and were referred to general surgery, were retrospectively examined.Results: Of patients, 58.2% (n=53) was monitored conservatively, 34.1% (n=31) had splenectomy and 4.4% (n=4) underwent the primary repair due to isolated liver injury, and both splenectomy and liver primary repair were performed in 3.3% (n=3) because of multiple solid organ injury. We observed that the injuries of non-surgical spleen trauma patients changed between grade I and III. All patients with grade IV-V injuries underwent splenectomy. Patients with decreased hematocrit and whose hematocrit did not increase despite erythrocyte replacement were operated on. Conclusion:In this study, it was explained that patients who were followed up without surgery did not need surgery and that both liver trauma and spleen trauma should be given the chance to follow up without surgery.

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“…Despite the widespread use of CT to evaluate the posttrauma patient whose condition is stable, the optimal CT trauma protocol remains an area of continued evaluation (24)(25)(26)(27)(28)(29), and there are few data on the ideal imaging protocol for trauma patients after DCS. The imaging should cover the thoracic inlet to the femoral trochanters in at least the portal venous phase, which is best suited for the detection and characterization of solid organ injuries, particularly hepatic or splenic parenchymal disruption (17,24).…”

Section: Ct Protocolsmentioning

confidence: 99%

“…Imaging in the brain and neck can be added when it is warranted clinically. The addition of arterial phase imaging improves the diagnostic yield for the identification and characterization of vascular injuries, both in isolation and within solid organs, particularly in the spleen (24)(25)(26)(27).…”

Section: Ct Protocolsmentioning

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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Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging

Cited by 20 publications

References 21 publications

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

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

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