Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries

Abstract

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage.

Moderne CT-Diagnostik des akuten Thorax- und Abdominaltraumas

“…retroperitoneale Flüssigkeit kann in der CT-Untersuchung anhand der Dichtewerte und der Anzahl der beteiligten Kompartimente spezifiziert und mengenmäßig abgeschätzt werden. Die aktive Blutung lässt sich als Extravasation von intravenös verabreichtem Kontrastmittel nachweisen [1,2,25]. Mehrfachverletzungen werden in einem Untersuchungsgang erfasst (Abb.…”

“…Daher wird die Versorgung polytraumatisierter Patienten auf lange Sicht ein zentrales medizinisches und volkswirtschaftliches Problem bleiben. Verkehrsstatistiken in den meisten europäischen Län-dern weisen ein Verhältnis von polytraumatisierten Patienten zu Verkehrstoten von 40:1 auf [2,8,24,34,35,38].…”

Severe Unilateral Adrenal Hemorrhage in Blunt Abdominal Trauma with Pelvic Fracture

“…Rounded or ovoid-shaped hematomas arising in the center of the adrenal gland with imbibition of the periadrenal fat may be detected on CT imaging. In severe adrenal injuries the architecture of the gland can be completely lost with active contrast extravasation and a large hematoma in the adrenal area [10,11]. Active bleeding due to injury to the suprarenal vessels may be visualized using new CT techniques providing better spatial resolution such as MDCT.…”

Management of blunt liver injury: what is new?

“…Successful nonoperative management requires careful patient selection based on the hemodynamic status of the patient, absence of other signs of visceral injury that require surgery, good-quality CT imaging, and the availability of an effective multidisciplinary team with intensive care physicians, experienced surgeons, and interventional radiologists at the ready. While many factors help predict nonoperative management failure, it is now generally accepted that the most important factor determining successful nonoperative management is the hemodynamic stability of the patient, irrespective of the grade of injury or the volume of hemoperitoneum [3,8,37]. Approximately one quarter of patients with hepatic injury managed nonoperatively will require an intervention to manage a complication [29,38].…”