Errors in imaging of traumatic injuries

Abstract

The advent of multi-detector computed tomography (MDCT) has drastically improved the outcomes of patients with multiple traumatic injuries. However, there are still diagnostic challenges to be considered. A missed or the delay of a diagnosis in trauma patients can sometimes be related to perception or other non-visual cues, while other errors are due to poor technique or poor image quality. In order to avoid any serious complications, it is important for the practicing radiologist to be cognizant of some of the most common types of errors. The objective of this article is to review the various types of errors in the evaluation of patients with multiple trauma injuries or polytrauma with MDCT.

CTA Imaging of Peripheral Arterial Injuries

“…Correct positioning with a wide field of view is essential but not always possible, causing nondiagnostic examination [76] (Figure 7). A second limb acquisition could be performed by decentralizing the patient on the CT table and focusing the exam on the limb of interest Distal poor opacification may occur if adequate flow if not obtained or for delays due to cardiac output, in the latter situation bolus tracking may be helpful [66].Non optimal opacification especially of distal arteries may be avoided with a second contrast bolus or with a second acquisition immediately after the first arterial phase.…”

“…A second limb acquisition could be performed by decentralizing the patient on the CT table and focusing the exam on the limb of interest Distal poor opacification may occur if adequate flow if not obtained or for delays due to cardiac output, in the latter situation bolus tracking may be helpful [66].Non optimal opacification especially of distal arteries may be avoided with a second contrast bolus or with a second acquisition immediately after the first arterial phase. In penetrating trauma or in case of severe compressing hematomas, a delayed phase may be acquired to determine late extravasation [76].…”

Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience

“…However, there are further injuries not considered in the AAST classification, deserving an accurate evaluation at admission MDCT after trauma due to their importance in patient's survival: vascular injuries. To properly identify and characterize vascular injuries it is recommended the acquisition of at least two phases (arterial and portal venous) after IV injection (Figure 8) (8,18,19). This allows the radiologist to depict the origin (arterial or venous) and to estimate the entity of the bleeding, assuming a crucial role in the patient's management, as slight venous bleeding may be conservatively treated in stable patients, whereas jet or pooling of active bleeding need to be managed by endovascular approach, if possible, in arterial bleeding, or by surgical approach (7,18) (Figure 9).…”

“…The first step in order to avoid missing pancreatic injuries, is to consider the mechanism of trauma and then, evaluate the anatomical structures which are involved (7,8). Severe abdominal trauma antero-posteriorly directed, compressing the pancreatic gland against the spine, such as seat-belt injuries, acceleration-deceleration trauma, and handlebar compression trauma, represent the most common mechanism of injury (4).…”

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications

“…4,10,14,24,25 Therefore, both phases should be routinely included in the whole-body CT evaluation of patients with deceleration injury. 1,5,14,18,19,[26][27][28]…”