Multi-slice computed tomography for diagnosis of combined thoracoabdominal injury

Liu, Jun; Wei-dong, Yue; Du, Debin

doi:10.1016/j.cjtee.2014.11.002

Cited by 10 publications

(7 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 37 studies were included. 1,4,6 -40 There were 34 published journal articles, 2 conference abstracts, and 1 published conference presentation. In 21 of the studies, imaging of PI was the primary objective.…”

Section: Resultsmentioning

confidence: 99%

Imaging of Blunt Pancreatic Trauma: A Systematic Review

2020

View full text Add to dashboard Cite

Purpose: Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. Methods: Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. Results: After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. Conclusion: There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.

show abstract

Section: Resultsmentioning

confidence: 99%

Imaging of Blunt Pancreatic Trauma: A Systematic Review

2020

View full text Add to dashboard Cite

show abstract

“…Therefore, thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury. In order to avoid overlooking such traumatic complication, both radiologists and surgeons should be familiar with the variety of changes potentially indicating diaphragm rupture, such as diaphragm discontinuity, collar sign, herniation, gas and fluid shadowing in the thoracic space, atelectasis in the lower lobes and dependent viscera sign like elevated abdominal organs [20,21]. Further signs indicative for advanced or complicated diaphragmatic ruptures on pulmonary radiographs are pleural effusion, pneumothorax, hydro-pneumothorax and mediastinal shift, as observed for our patient.…”

Section: Discussionmentioning

confidence: 99%

Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report

et al. 2021

View full text Add to dashboard Cite

Background Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. Case presentation A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7–10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3–9 on the left side. Conclusion This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.

show abstract

“…Therefore, thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury. In order to avoid overlooking such traumatic complication, both radiologists and surgeons should be familiar with the variety of changes potentially indicating diaphragm rupture, such as diaphragm discontinuity, collar sign, herniation, gas and uid shadowing in the thoracic space, atelectasia in the lower lobes and dependent viscera sign like elevated abdominal organs [20,21]. Further signs indicative for advanced or complicated diaphragmatic ruptures on pulmonary radiographs are pleural effusion, pneumothorax, hydro-pneumothorax and mediastinal shift, as observed for our patient.…”

Section: Discussionmentioning

confidence: 99%

Grave Thoraco-Intestinal Complication Secondary to an Undetected Traumatic Rupture of the Diaphragm - A Case Report

Beshay

Krüger

Singh

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundDiaphragmatic lesions as a result from blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare but as in our patient can be serious. Case presentationA 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT-scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall-trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. ConclusionThis is the first report on a primarily established empyema at the time of first surgical intervention for faeco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post traumatic complications.

show abstract

Multi-slice computed tomography for diagnosis of combined thoracoabdominal injury

Cited by 10 publications

References 7 publications

Imaging of Blunt Pancreatic Trauma: A Systematic Review

Imaging of Blunt Pancreatic Trauma: A Systematic Review

Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report

Grave Thoraco-Intestinal Complication Secondary to an Undetected Traumatic Rupture of the Diaphragm - A Case Report

Contact Info

Product

Resources

About