Blunt Abdominal Trauma in Cases of Multiple Trauma Evaluated by Ultrasonography: A Prospective Analysis of 291 Patients

Hoffmann, Reinhard; Nerlich, Michael; Muggia-Sullam, Michael; Pohlemann, Tim; Wippermann, B.; Regel, G.; Tscherne, H.

doi:10.1097/00005373-199204000-00008

Cited by 235 publications

(98 citation statements)

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Technique varies widely among trauma centers. The examination may consist of a brief survey for fluid alone, or it may include assessment of organ parenchyma.…”

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confidence: 99%

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

Brown

Casola

Sirlin

et al. 2001

J of Ultrasound Medicine

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Objective. To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma. Methods. A total of 2693 patients with blunt trauma who were triaged to a level 1 trauma center underwent screening abdominal ultrasonography in the resuscitation suite. Examinations were performed by experienced sonographers and included a screen for free intraperitoneal fluid and evaluation of the abdominal organ parenchyma and heart for traumatic injury. Screening ultrasonographic findings were reviewed and compared with findings from autopsy, laparotomy, diagnostic peritoneal lavage, computed tomography, repeated ultrasonography, cystography, and clinical outcome. Imaging studies of all patients with confirmed or suspected injuries were reviewed to identify those in whom parenchymal findings aided diagnosis. Results. One hundred seventy-two patients were found to have evidence of abdominal injury due to blunt trauma on the basis of clinical data, imaging, laparotomy, or autopsy. Forty-four of these patients had no sonographic evidence of hemoperitoneum at the time of initial ultrasonography. Screening ultrasonographic findings were positive for injury in 19 of 44 patients on the basis of parenchymal findings or small retroperitoneal collections of fluid thought to be indicative of trauma. In the remaining 25 patients, screening ultrasonography showed no abnormalities, and injuries were detected by repeated ultrasonography, subsequent computed tomography, or diagnostic peritoneal lavage performed for suspected occult injury on the basis of clinical parameters. In addition, 47 of 126 injured patients with sonographically detected free fluid had parenchymal findings that helped localize injury. Sixteen of those patients were taken to the operating room on the basis of clinical and sonographic findings without undergoing computed tomography. Conclusions. The inability to show injuries with no hemoperitoneum or with delayed hemoperitoneum has been shown to be a limitation of ultrasonography in patients with blunt trauma. In our series, 26% of all patients with documented injuries had no free fluid visible on screening ultrasonography. Attention to findings other than free fluid allowed detection in 43% of injured patients without sonographic evidence of hemoperitoneum.

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confidence: 99%

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

Brown

Casola

Sirlin

et al. 2001

J of Ultrasound Medicine

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“…1 In analyzing studies, sensitivity of ultrasonography for detection of free fluid was found to correlate with organ injury in the range of 80 to 90%. [4][5][6][7] In Luks and coworkers' study, 35% of abdominal injuries in blunt pediatric trauma were renal injuries. 10 In most other series of ultrasonographic evaluation of blunt abdominal trauma, renal injuries are rare.…”

Section: Discussionmentioning

confidence: 99%

“…7 In Hoffmann and associates' series investigating the use of ultrasonography in blunt abdominal trauma, none of the 209 patients had documented renal injuries. 6 We may postulate that the reason for the low occurrence or detection rate of renal injuries with ultrasonography is perhaps twofold. The first reason may be due to the fact that many studies lacked a correlation with CT or laparotomy in all patients.…”

Section: Discussionmentioning

confidence: 99%

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Use of ultrasonography in the patient with acute renal trauma.

McGahan

Richards

Jones

et al. 1999

Journal of Ultrasound in Medicine

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The purpose of this study was to assess the use of emergent ultrasonographic examination in acute traumatic renal injuries. Over a 3 year period, prospective data of all patients who had an emergency ultrasonogram were recorded. Thirty‐two patients with 37 renal injuries were studied retrospectively to identify in how many patients the sonogram detected free fluid or a renal parenchymal abnormality. Free fluid in the abdomen was identified in 19 of 32 patients (59%). However, 12 of these 19 patients had concomitant injury, such as splenic rupture requiring splenectomy, severe liver lacerations, or bowel lacerations requiring repair, that were possible causes of the free fluid. Eliminating these patients, only seven of 20 patients with isolated renal injuries had free fluid in the abdomen (35%), whereas 13 of 20 patients (65%) had no evidence of free fluid. All seven patients with free fluid had moderate or severe renal injuries. Renal parenchymal abnormalities were identified on ultrasonograms in eight of 37 (22%) of injured kidneys. The abnormalities were detected more commonly in cases of severe injury (60%). In conclusion, acute injuries of the kidney from blunt abdominal trauma often are associated with significant splenic, hepatic, or bowel trauma. Isolated renal injuries frequently occur without the presence of free fluid in the abdomen. Furthermore, the ultrasonogram of the kidney often is normal with acute renal injuries, but it is more likely to be abnormal with severe (grade II or greater) renal injuries. Sonography may be used in the triage of patients with blunt abdominal trauma and possible renal injury. However, a negative ultrasonogram does not exclude renal injury, and, depending on clinical and laboratory findings, other imaging procedures such as computed tomography should be performed.

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“…Lung sounds and respiratory airway pressures were normal and the roentgenograms of the thorax in supine position were within normal limits; in particular, no hemothorax or pneumothorax was found. Ultrasound scanning of the abdomen (to examine the liver and spleen parenchyma and check for bleeding) [1] revealed no pathological findings in the abdominal cavity or retroperitoneal space. The neurologic examination showed regular intrinsic muscle reflexes, both motor and sensory, in the upper and lower extremities.…”

Section: Case Reportmentioning

confidence: 99%

Unrecognized laceration of main bronchus caused by fracture of the T6 vertebra

Korovessis

Stamatakis²,

Baikousis³

1998

European Spine Journal

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IntroductionSpinal trauma frequently results from high-energy vehicular accidents, which may produce multisystem trauma [2][3][4][5]7]. Because of the priorities of resuscitation, other injuries may escape early diagnosis. This study reports on an extremely rare case of laceration of the bronchus by fragments of a bursting vertebral fracture that was not diagnosed on admission. Case reportA 58-year-old man riding a motorcycle was hit by a car. On admission, the patient was in an excellent general condition, without cardiovascular or respiratory complaints. Physical examination revealed displaced ankle fractures bilaterally and a displaced olecranon fracture on the left. Lateral roentgenograms of the spine revealed a fracture of the T6 vertebra, while the CT scan revealed a bursting of its vertebral body (Fig. 1). Lung sounds and respiratory airway pressures were normal and the roentgenograms of the thorax in supine position were within normal limits; in particular, no hemothorax or pneumothorax was found. Ultrasound scanning of the abdomen (to examine the liver and spleen parenchyma and check for bleeding) [1] revealed no pathological findings in the abdominal cavity or retroperitoneal space. The neurologic examination showed regular intrinsic muscle reflexes, both motor and sensory, in the upper and lower extremities. Two days after admission it was planned to stabilize the ankle and olecranon fractures under general anesthesia. The patient was placed in supine position for introduction of the general anesthesia. Immediately after introduction of the endotracheal tube and application of positive pressure by the anesthetist, a curious sound was observed inside the chest, which was followed by an increasing distention of the abdomen, without reverse filling of the ventilation balloon during the passive expiration. In other words, the volume of air passively inspirated through the tube was not followed by the passive expiration of an equal air volume. There appeared to be a significant concentration of the mechanically inspirated air somewhere inside the body. Initially it was supposed that the tube was not correctly positioned in the trachea. Thus, although the anesthetist performed repeated intubations in order to secure absolutely correct intubation (avoiding the esophagus, ensuring good contact of the tube on the inner surface of the trachea, etc.), the result was always the same. An increasing distention of the abdomen was observed during ventilation of the lungs with positive pressure, whereas when the tube was removed the distention decreased in a few seconds. Repeated blood gas analyses showed normal saturation and base levels, and the PO 2 , PCO 2 , and PH values were within normal limits for the age, height, and sex of the patient. Further anteroposterior and lateral chest roentgenograms in supine position on the operation table AbstractWe report on an extremely rare case of a 58-year-old male polytraumatized patient who sustained a bursting fracture of the T 6 vertebral body associated with laceration o...

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Blunt Abdominal Trauma in Cases of Multiple Trauma Evaluated by Ultrasonography: A Prospective Analysis of 291 Patients

Cited by 235 publications

References 0 publications

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

Use of ultrasonography in the patient with acute renal trauma.

Unrecognized laceration of main bronchus caused by fracture of the T6 vertebra

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