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Arenaza Choperena G, Cuetos Fernández J, Gómez Usabiaga V, Ugarte Nuño A, Rodriguez Calvete P, Collado Jiménez J. Abdominal trauma. RADIOLOGIA 2023; 65 Suppl 1:S32-S41. [PMID: 37024229 DOI: 10.1016/j.rxeng.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/19/2022] [Indexed: 04/08/2023]
Abstract
Traumatic injuries are the leading cause of death in people aged<45 years, and abdominal trauma is a source of significant morbidity and mortality and high economic costs. Imaging has a fundamental role in abdominal trauma, where CT is a fundamental tool for rapid, accurate diagnosis that will be key for patients' clinical outcomes.
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Affiliation(s)
- G Arenaza Choperena
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain.
| | - J Cuetos Fernández
- Servicio de Radiología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - V Gómez Usabiaga
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - A Ugarte Nuño
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - P Rodriguez Calvete
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - J Collado Jiménez
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
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Kord A, Kuwahara JT, Rabiee B, Ray CE. Basic Principles of Trauma Embolization. Semin Intervent Radiol 2021; 38:144-152. [PMID: 33883812 DOI: 10.1055/s-0041-1726004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Jeffery T Kuwahara
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Behnam Rabiee
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Charles E Ray
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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Affiliation(s)
- John Pham
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX
| | - Justine Kemp
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX
| | - Jeffrey Pruitt
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX.
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Alexander LF, Hanna TN, LeGout JD, Roda MS, Cernigliaro JG, Mittal PK, Harri PA. Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries. Radiographics 2020; 39:1183-1202. [PMID: 31283454 DOI: 10.1148/rg.2019180153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by LeBedis .
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Affiliation(s)
- Lauren F Alexander
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Tarek N Hanna
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Jordan D LeGout
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Manohar S Roda
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Joseph G Cernigliaro
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Peter A Harri
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
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The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma. Emerg Radiol 2019; 26:647-654. [PMID: 31444680 DOI: 10.1007/s10140-019-01714-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE In the literature, no consensus exists about which CT protocol is to be adopted in patients who underwent high-energy blunt trauma. The aim of the study is to evaluate the additional value of the arterial phase in the CT assessment of vascular injuries of the liver. METHODS Admission CT examinations for patients with traumatic injury of the liver due to high-energy blunt trauma, performed between 2011 and 2017 in two major trauma centres, were retrospectively reviewed. Images were analysed for presence or absence of liver parenchymal injury, intrahepatic contained vascular injuries and active bleeding in the arterial and portal venous phase of the CT study. RESULTS Two hundred twelve patients have been identified. Parenchymal injuries were detected as isolated in 90.6% of cases, whereas they were associated with vascular injuries in 9.4% of cases: contained vascular injuries in 3.3% and active bleeding in 6.1%. Out of all parenchymal injuries detected on the CT portal venous phase, 90.5% were also detectable in the arterial phases (p < 0.0001). All of the contained vascular injuries were visible in the CT arterial phase, whereas they were detectable in 28.5% of cases also during the venous phase (p = 0.02). All 13 cases of active bleeding were detected on the CT venous phase, and 76.9% of these cases were also revealed in the arterial phase, thus confirming their arterial origin (p = 0.22). CONCLUSION The addiction of the arterial phase to the venous phase in the CT assessment of patients who underwent high-energy blunt trauma allows an accurate identification and characterization of traumatic vascular injuries, so distinguishing between patients suitable for conservative management and those requiring interventional or surgical treatment.
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Margari S, Garozzo Velloni F, Tonolini M, Colombo E, Artioli D, Allievi NE, Sammartano F, Chiara O, Vanzulli A. Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study. Emerg Radiol 2018; 25:489-497. [PMID: 29752651 DOI: 10.1007/s10140-018-1607-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/18/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. MATERIALS AND METHODS This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student's t, chi-squared, and Cohen's kappa tests. RESULTS Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p < 0.05) predictors of OM. Nonoperative management (NOM) failed in 23 patients out of 191 (12.04%). In 75% of them, NOM failure occurred within 30 h from the trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (p < 0.05). CONCLUSION Providing detection and characterization of parenchymal and vascular traumatic lesions, MDCT plays a crucial role for safe and appropriate guidance of ED management of splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.
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Affiliation(s)
- Sergio Margari
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Fernanda Garozzo Velloni
- Department of Diagnostic and Interventional Radiology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,DASA (Diagnósticos da America SA), Sao Paulo, Brazil
| | - Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Ettore Colombo
- Department of Diagnostic and Interventional Radiology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Diana Artioli
- Department of Diagnostic and Interventional Radiology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Niccolò Ettore Allievi
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Fabrizio Sammartano
- Department of Surgery, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Osvaldo Chiara
- Department of Surgery, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Angelo Vanzulli
- Department of Diagnostic and Interventional Radiology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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