Penetrating Diaphragmatic Injury: Accuracy of 64-Section Multidetector CT with Trajectography

Abstract

Sixty-four-section multidetector CT trajectography facilitates the identification of transdiaphragmatic trajectory, which accurately rules in PDI when identified. Contiguous injury remains a highly sensitive sign, even when patients with multiple injuries are considered, and is useful for excluding PDI.

Penetrating Colorectal Injuries: Diagnostic Performance of Multidetector CT with Trajectography

“…Previous prospective single-institution studies on CT diagnosis in penetrating torso trauma typically included less than a handful of patients with colorectal or diaphragmatic injuries (6,8,9,11,12). A number of retrospective studies (13)(14)(15)(16) that evaluated the performance of multidetector CT for larger groups of penetrating diaphragmatic injury had documented improvements in diagnosis because of higher-number detector row scanners, multiplanar reformatting, and trajectory evaluation in nonstandard planes. However, little is known about the organ-specific diagnostic performance for penetrating colorectal injuries.…”

“…However, little is known about the organ-specific diagnostic performance for penetrating colorectal injuries. While the potential benefits of trajectory evaluation in nonstandard planes are recognized (16)(17)(18)(19), studies that evaluate trajectory for a variety of injuries in different body regions primarily relied on axial and conventional multiplanar reformatted images (9,14,20,21). Recently, multidetector CT with only intravenous contrast agent was advocated for penetrating torso trauma (4,22).…”

“…qualitatively graded the adequacy of a report in Radiology by Dreizin et al (16) on penetrating diaphragmatic injuries. By using the entry wound on the skin surface as the center point, crosshair lines (a ubiquitous feature of postprocessing software) are swiveled first in one orthogonal plane and then in another until the double-oblique orientation matches the wound path and shows the gunshot or knife track in profile.…”

Imaging of Thoracic Trauma

“…The construction of double oblique CT images along the trajectory of the knife or bullet can improve the accuracy of diagnosis. Demonstration of a tract extending on both sides of the diaphragm is specific for penetrating diaphragm injury and in many cases is adequate impetus for operative exploration [30]. …”

MDCT of complications and common postoperative findings following penetrating torso trauma

“…The majority of torso gunshot wound and some stab wound victims are hemodynamically unstable or have overt peritoneal signs and undergo exploration without pre-operative CT [1][2][3][4]. Multiple injuries are seen in most torso gunshot wounds, and patients in shock will often require initial damage control surgery, during which hematomas are explored, bleeding vessels are ligated, and splenectomies and single nephrectomies are performed in unsalvageable cases.…”