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Tamburrini S, Lassandro G, Tiralongo F, Iacobellis F, Ronza FM, Liguori C, Comune R, Pezzullo F, Galluzzo M, Masala S, Granata V, Basile A, Scaglione M. CTA Imaging of Peripheral Arterial Injuries. Diagnostics (Basel) 2024; 14:1356. [PMID: 39001246 PMCID: PMC11240895 DOI: 10.3390/diagnostics14131356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Traumatic vascular injuries consist of direct or indirect damage to arteries and/or veins and account for 3% of all traumatic injuries. Typical consequences are hemorrhage and ischemia. Vascular injuries of the extremities can occur isolated or in association with major trauma and other organ injuries. They account for 1-2% of patients admitted to emergency departments and for approximately 50% of all arterial injuries. Lower extremities are more frequently injured than upper ones in the adult population. The outcome of vascular injuries is strictly correlated to the environment and the time background. Treatment can be challenging, notably in polytrauma because of the dilemma of which injury should be prioritized, and treatment delay can cause disability or even death, especially for limb vascular injury. Our purposes are to discuss the role of computed tomography angiography (CTA) in the diagnosis of vascular trauma and its optimized protocol to achieve a definitive diagnosis and to assess the radiological signs of vascular injuries and the possible pitfalls.
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Affiliation(s)
- Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy
| | | | - Carlo Liguori
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Filomena Pezzullo
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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2
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Caruso M, Rinaldo C, Iacobellis F, Dell'Aversano Orabona G, Grimaldi D, Di Serafino M, Schillirò ML, Verde F, Sabatino V, Camillo C, Ponticiello G, Romano L. Abdominal compartment syndrome: what radiologist needs to know. LA RADIOLOGIA MEDICA 2023; 128:1447-1459. [PMID: 37747669 DOI: 10.1007/s11547-023-01724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12 mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20 mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.
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Affiliation(s)
- Martina Caruso
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | | | - Dario Grimaldi
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesco Verde
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Costanza Camillo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Gianluca Ponticiello
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
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3
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Giurazza F, Pane F, Roccatagliata P, Casciano E, Corvino F, Festa P, Ponticiello G, Cappabianca S, Romano L, Niola R. Pelvic ring fractures with concomitant large hematomas: diagnostic investigation with arteriography and eventual embolization in 157 trauma patients, with or without contrast extravasation at emergency CT. LA RADIOLOGIA MEDICA 2023; 128:1429-1439. [PMID: 37715849 DOI: 10.1007/s11547-023-01714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE This study aims to evaluate the diagnostic value of pelvic arteriography in patients with pelvic ring fractures and associated large hematomas, in both cases of positive or negative findings of contrast agent extravasation at emergency CT; in those patients with positive DSA subsequently treated with embolization, correlations with clinical-radiological parameters were investigated. MATERIALS AND METHODS In this single-center retrospective study, patients with acute blunt pelvic trauma showing at CT pelvic ring fractures with associated large (> 3 cm) hematoma, with or without signs of arterial bleeding, were investigated with DSA. Technical success was considered radiographic bleeding control with disappearance of angiographic bleeding; clinical success was defined as clinical bleeding control hemodynamically stable, before applying other surgical maneuvers. Pelvic ring fractures were evaluated according to Tile classification system. RESULTS One hundred and fifty-seven patients, mean age 54years, were analyzed. 70.7% had polytrauma; 14.6% patients assumed antiplatelets and/or anticoagulation therapy. False-negative and false-positive rates at CT were 29.6% and 27.1%, respectively. Polytrauma and B3/C1 Tile pattern fractures were significantly associated with bleeding signs at DSA. Seventy-two patients required embolization: 52.8% showed direct signs of DSA bleeding; among these, technical and clinical successes were 88.8% and 81.9%, respectively. CONCLUSIONS In this study, patients with pelvic ring fractures and concomitant hematomas > 3 cm, with or without contrast extravasation at CT, have been examined in depth with DSA focusing on both direct and indirect angiographic signs of bleeding, finding polytrauma and Tile fracture patterns B3/C1 predictive factors for arterial hemorrhage detection at DSA despite negative CT findings.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy.
| | - Francesco Pane
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Pietro Roccatagliata
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, 80138, Italy
| | - Eduardo Casciano
- Orthopedic and Trauma Unit, Department of Surgery, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Patrizio Festa
- Trauma Center Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Gianluca Ponticiello
- Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, 80138, Italy
| | - Luigia Romano
- Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
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4
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Scaglione M, Masala S, Iacobellis F, Tonerini M, Sica G, Liguori C, Saba L, Tamburrini S. Imaging in Non-Traumatic Emergencies. Tomography 2023; 9:1133-1136. [PMID: 37368545 DOI: 10.3390/tomography9030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
"Emergency" is a scenario that every medical professional must face since the first day of her/his career [...].
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Affiliation(s)
- Mariano Scaglione
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital & Teesside University, Marton Road Marton Rd., Middlesbrough TS4 3BW, UK
| | - Salvatore Masala
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via Cardarelli 9, 80100 Napoli, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, 56124 Pisa, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy
| | - Carlo Liguori
- Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo, 11, 80147 Napoli, Italy
| | - Luca Saba
- Department of Medical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Iacobellis F, Di Serafino M, Caruso M, Dell’Aversano Orabona G, Rinaldo C, Grimaldi D, Verde F, Sabatino V, Schillirò ML, Giacobbe G, Ponticiello G, Scaglione M, Romano L. Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT. Diagnostics (Basel) 2023; 13:diagnostics13071347. [PMID: 37046565 PMCID: PMC10093738 DOI: 10.3390/diagnostics13071347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/18/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023] Open
Abstract
In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Martina Caruso
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | | | - Chiara Rinaldo
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Dario Grimaldi
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Francesco Verde
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Giuliana Giacobbe
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Gianluca Ponticiello
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Mariano Scaglione
- Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy
- James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Napoli, Italy
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6
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Kawinwongkowit K, Kaewlai R, Kasemassawachanont A, Chatpuwaphat J, Kumthong N, Somcharit L. Value of contrast-enhanced arterial phase imaging in addition to portovenous phase in CT evaluation of blunt abdominopelvic trauma. Eur Radiol 2023; 33:1641-1652. [PMID: 36322194 DOI: 10.1007/s00330-022-09208-1] [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: 08/12/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Compare the diagnostic performance of the arterial phase plus portovenous phases (AP + PVP) of abdominopelvic CT (CT) with PVP alone in the detection and characterization of traumatic vascular injury and the effects on radiologists' confidence. METHODS CT of 103 consecutive inpatients (median 36 years, 83 males) with blunt abdominopelvic injuries were retrospectively included if performed within 24 h after trauma and before definitive management. Images were re-reviewed by two blinded radiologists with disagreements resolved by the third radiologist. RESULTS Sixty vascular injuries (liver 23, spleen 15, kidneys 9, pancreas 2, adrenals 3, mesentery, and pelvis 4 each) were found with 4 injuries (liver 2, spleen, and kidneys 1 each) not detected at initial CT. Nineteen (liver 6, spleen 10, kidneys 2, adrenal 1) were visualized only on AP. The sensitivity and accuracy of AP + PVP were 89.58-91.67% and 94.44-95.15%, compared to 61.67-62.50% and 77.67-80.00% of PVP alone. The agreements on the types of injury with final diagnoses were higher for AP + PVP than for PVP alone (78.69% vs. 44.26%). The mean diagnostic radiologist confidence ((1 = 25%, 2 = 50%, 3 = 75%, 4 > 90%) increased significantly in the detection (from 3.38 to 3.71) and characterization (from 2.46 to 3.67) of vascular injuries with AP + PVP compared to PVP alone. For 19 lesions detected only on AP, 11 (spleen 8, liver 2, adrenal 1) received nonoperative management; others had transarterial embolization or surgery. CONCLUSIONS The addition of AP improves the detection and characterization of vascular injuries in CT evaluation of blunt abdominopelvic trauma. KEY POINTS • AP+PVP was more sensitive and precise than PVP alone in the detection of traumatic vascular abdominopelvic injuries. • AP+PVP improved the characterization of traumatic abdominopelvic vascular injuries. • When all abdominopelvic vascular injuries were considered, AP increased radiologists' diagnostic confidence in the detection and characterization of vascular injuries.
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Affiliation(s)
- Kawin Kawinwongkowit
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Rathachai Kaewlai
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Adisak Kasemassawachanont
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jitti Chatpuwaphat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Nutnaree Kumthong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Lertpong Somcharit
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
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7
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Iacobellis F, Brillantino A, Di Serafino M, Dell'Aversano Orabona G, Grassi R, Cappabianca S, Scaglione M, Romano L. Economic and clinical benefits of immediate total-body CT in the diagnostic approach to polytraumatized patients: a descriptive analysis through a literature review. Radiol Med 2022; 127:637-644. [PMID: 35553349 DOI: 10.1007/s11547-022-01495-4] [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: 02/04/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
Major trauma is an event causing injuries that may determine an immediate or potential risk to the patient survival. A correct management of major trauma is decisive in reducing disability, which has relevance both from the point of view of the quality of life of the single individual and from the point of view of health expenditure. The primary clinical approach to the polytraumatized patients is managed, in most cases, as outlined in the guidelines of Advanced Trauma Life Support, proposing conventional radiological investigations, such as chest and pelvis x-ray, and of FAST (focused abdominal sonography in trauma)/E-FAST (extended FAST) examinations, followed by selective targeted computed tomography (CT). This approach is questionable and is increasingly common in clinical practice the adoption of the immediate total-body CT in the diagnostic approach to the hemodynamically stable polytraumatized patient. However, the potential advantages of such conduct both in terms of clinical benefits and in terms of cost-effectiveness still need to be discussed. The objective of this review article consists of a descriptive analysis of the economic and clinical benefits of the adoption of immediate total-body CT in polytrauma patients through a literature review.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Antonio Brillantino
- Department of Emergency Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | | | - Roberto Grassi
- Department of Radiology, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Salvatore Cappabianca
- Department of Radiology, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Mariano Scaglione
- Department of Clinical and Experimental Medicine, University of Sassari, Via Roma 151, 07100, Sassari, Italy.,Department of Radiology, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.,School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Luigia Romano
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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8
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The Technique and Advantages of Contrast-Enhanced Ultrasound in the Diagnosis and Follow-Up of Traumatic Abdomen Solid Organ Injuries. Diagnostics (Basel) 2022; 12:diagnostics12020435. [PMID: 35204525 PMCID: PMC8871338 DOI: 10.3390/diagnostics12020435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022] Open
Abstract
Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS (contrast enhanced ultrasound) has been shown to be more sensitive than US (ultrasound) for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT (multidetector tomography). CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review, we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during the investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management.
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9
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Iacobellis F, Abu-Omar A, Crivelli P, Galluzzo M, Danzi R, Trinci M, Dell’Aversano Orabona G, Conti M, Romano L, Scaglione M. Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010539. [PMID: 35010799 PMCID: PMC8744756 DOI: 10.3390/ijerph19010539] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022]
Abstract
In industrialized countries, high energy trauma represents the leading cause of death and disability among people under 35 years of age. The two leading causes of mortality are neurological injuries and bleeding. Clinical evaluation is often unreliable in determining if, when and where injuries should be treated. Traditionally, surgery was the mainstay for assessment of injuries but advances in imaging techniques, particularly in computed tomography (CT), have contributed in progressively changing the classic clinical paradigm for major traumas, better defining the indications for surgery. Actually, the vast majority of traumas are now treated nonoperatively with a significant reduction in morbidity and mortality compared to the past. In this sense, another crucial point is the advent of interventional radiology (IR) in the treatment of vascular injuries after blunt trauma. IR enables the most effective nonoperative treatment of all vascular injuries. Indications for IR depend on the CT evidence of vascular injuries and, therefore, a robust CT protocol and the radiologist's expertise are crucial. Emergency and IR radiologists form an integral part of the trauma team and are crucial for tailored management of traumatic injuries.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (G.D.O.); (L.R.)
- Correspondence: ; Tel.: +39-339-1026757; Fax: +39-081-0362368
| | - Ahmad Abu-Omar
- Department of Radiology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK; (A.A.-O.); (M.S.)
| | - Paola Crivelli
- Department of Clinical and Experimental Medicine, University of Sassari, Via Roma 151, 07100 Sassari, Italy; (P.C.); (M.C.)
| | - Michele Galluzzo
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152 Rome, Italy; (M.G.); (M.T.)
| | - Roberta Danzi
- Department of Radiology, Pineta Grande Hospital, Via Domitiana Km 30, 81030 Castel Volturno, Italy;
| | - Margherita Trinci
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152 Rome, Italy; (M.G.); (M.T.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (G.D.O.); (L.R.)
| | - Maurizio Conti
- Department of Clinical and Experimental Medicine, University of Sassari, Via Roma 151, 07100 Sassari, Italy; (P.C.); (M.C.)
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (G.D.O.); (L.R.)
| | - Mariano Scaglione
- Department of Radiology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK; (A.A.-O.); (M.S.)
- Department of Radiology, Pineta Grande Hospital, Via Domitiana Km 30, 81030 Castel Volturno, Italy;
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
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10
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Ahmed HM, Borg M, Saleem AEA, Ragab A. Multi-detector computed tomography in traumatic abdominal lesions: value and radiation control. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background, The context
A prospective study was conducted involving 81 patients (mean age, 20.79 years) with abdominal trauma who underwent ultrasonography and post-contrast CT on MDCT scanner. The total DLP for each patient was reviewed, and the effective dose was calculated. Purpose of the study to: explore the role of MDCT in assessing traumatic abdominal lesions, demonstrate radiation dose delivered by MDCT, and describe specific CT technical features to minimize radiation.
Results
The spleen was the most commonly injured organ (49.4%) followed by liver (39.5%) and kidney (24.7%). Pancreatic injury occurred in seven patients, whereas only two patients had intestinal injuries. One patient had adrenal injury. Minimal, mild and moderate free intra-peritoneal fluid collection was detected in 21 (25.9%), 47 (58%) and 10 (12.3%) patients, respectively. Only three (3.7%) patients had no collection. One patient had active uncontrolled bleeding and died. Radiation dose was below the detrimental level (calculated effective dose), with optimal image quality.
Conclusions
MDCT is sensitive to all types of traumatic abdominal lesions. Not only in determining the injury, but also in its grading. MDCT has affected the treatment directions, spotting a focus on conservative treatment by raising the diagnostic confidence.
FAST cannot be the sole imaging modality. The individual radiation risk is small but real. Advancements in medical imaging reduce radiation risk.
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11
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Iacobellis F, Di Serafino M, Brillantino A, Mottola A, Del Giudice S, Stavolo C, Festa P, Patlas MN, Scaglione M, Romano L. Role of MRI in early follow-up of patients with solid organ injuries: How and why we do it? Radiol Med 2021; 126:1328-1334. [PMID: 34283337 DOI: 10.1007/s11547-021-01394-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
Trauma represents one of the most common causes of death or permanent disability in the population below 50 years. At present, non-operative treatment is the commonly adopted strategy in hemodynamically stable patients with solid organ injuries, when there are not concomitant bowel and mesenteric injuries requiring a prompt surgical approach, but it may require multiple imaging follow-up examinations, especially in the case of major injuries. No data are available about magnetic resonance imaging utilization in the early follow-up of trauma patients with solid organ injuries, particularly in liver and spleen trauma. We report our preliminary experience in this field.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Antonio Brillantino
- Department of Emergency Surgery, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Arianna Mottola
- Trauma Center, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Santolo Del Giudice
- Trauma Center, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Ciro Stavolo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Patrizio Festa
- Trauma Center, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK.,Teesside University School of Health and Life Sciences, Tees Valley, Middlesbrough, TS1 3BX, UK.,Department of Radiology, "Pineta Grande" Hospital, Via Domitiana Km. 30, 00 81030, Castel Volturno, CE, Italy.,Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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12
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Giurazza F, Contegiacomo A, Corvino F, Rebonato A, Castiglione D, Palmucci S, Niola R, Basile A. Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures. Diagnostics (Basel) 2021; 11:diagnostics11071256. [PMID: 34359339 PMCID: PMC8305924 DOI: 10.3390/diagnostics11071256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aims to investigate the correlation between computed tomography (CT) and digital subtraction angiography (DSA) findings in patients affected by acute post-traumatic intraparenchymal renal hemorrhages and evaluate their conservative management with superselective embolization. METHODS This retrospective multicenter analysis focuses on patients affected by renal bleedings detected by contrast-enhanced CT and treated with superselective endovascular embolization. CT findings were compared to DSA. Embolization procedural data were analyzed and renal function was evaluated before and after the intervention. RESULTS Twenty-seven patients were retrospectively evaluated in one year. Compared to DSA, CT showed 96.3% diagnostic accuracy in terms of hemorrhage recognition; concerning the type of vascular lesion, there was discrepancy between CT and DSA in five cases. The technical success rate of embolization was 100%, while primary clinical success was 88.9%. The inferior parenchymal third was the most frequent site of renal injury. Microcoils were the most adopted embolics. Renal function did not change significantly before and after embolization. CONCLUSIONS CT has elevated diagnostic accuracy in detecting post-traumatic intraparenchymal renal hemorrhages; in a small percentage, the type of vascular lesion may differ from the findings observed at DSA. In this scenario, superselective embolization presents high clinical success with a low complication rate.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy; (F.C.); (R.N.)
- Correspondence: ; Tel.: +39-0817473828
| | - Andrea Contegiacomo
- Radiology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00136 Rome, Italy;
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy; (F.C.); (R.N.)
| | - Alberto Rebonato
- Radiology Department, Marche Nord Hospital, Piazzale Carlo Cinelli 1, 61121 Pesaro, Italy;
| | - Davide Castiglione
- Radiology 1 Unit, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate, Università degli Studi di Catania, Via S. Sofia 98, 95100 Catania, Italy; (D.C.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Radiology 1 Unit, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate, Università degli Studi di Catania, Via S. Sofia 98, 95100 Catania, Italy; (D.C.); (S.P.); (A.B.)
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy; (F.C.); (R.N.)
| | - Antonio Basile
- Radiology 1 Unit, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate, Università degli Studi di Catania, Via S. Sofia 98, 95100 Catania, Italy; (D.C.); (S.P.); (A.B.)
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13
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Murao S, Yamakawa K, Kabata D, Kinoshita T, Umemura Y, Shintani A, Fujimi S. Effect of Earlier Door-to-CT and Door-to-Bleeding Control in Severe Blunt Trauma: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10071522. [PMID: 33917338 PMCID: PMC8038745 DOI: 10.3390/jcm10071522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 01/03/2023] Open
Abstract
Blunt trauma is a potentially life-threatening injury that requires prompt diagnostic examination and therapeutic intervention. Nevertheless, how impactful a rapid response time is on mortality or functional outcomes has not been well-investigated. This study aimed to evaluate effects of earlier door-to-computed tomography time (D2CT) and door-to-bleeding control time (D2BC) on clinical outcomes in severe blunt trauma. This was a single-center, retrospective cohort study of patients with severe blunt trauma (Injury Severity Score > 16). To assess the effect of earlier D2CT and D2BC on clinical outcomes, we conducted multivariable regression analyses with a consideration for nonlinear associations. Among 671 patients with severe blunt trauma who underwent CT scanning, 163 patients received an emergency bleeding control procedure. The median D2CT and D2BC were 19 min and 57 min, respectively. In a Cox proportional hazard regression model, earlier D2CT was not associated with improved 28-day mortality (p = 0.30), but it was significantly associated with decreased mortality from exsanguination (p = 0.003). Earlier D2BC was significantly associated with improved 28-day mortality (p = 0.026). In conclusion, earlier time to a hemostatic procedure was independently associated with decreased mortality. Meanwhile, time benefits of earlier CT examination were not observed for overall survival but were observed for decreased mortality from exsanguination.
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Affiliation(s)
- Shuhei Murao
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka 558-8558, Japan; (S.M.); (Y.U.); (S.F.)
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka 558-8558, Japan; (S.M.); (Y.U.); (S.F.)
- Department of Emergency Medicine, Osaka Medical College, Takatsuki 569-8686, Japan
- Correspondence: ; Tel.: +81-6-6692-1201; Fax: +81-6-6692-1155
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka 545-8586, Japan; (D.K.); (A.S.)
| | - Takahiro Kinoshita
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan;
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka 558-8558, Japan; (S.M.); (Y.U.); (S.F.)
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka 545-8586, Japan; (D.K.); (A.S.)
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka 558-8558, Japan; (S.M.); (Y.U.); (S.F.)
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14
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Shrestha A, Neupane HC, Tamrakar KK, Bhattarai A, Katwal G. Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury. Int J Emerg Med 2021; 14:7. [PMID: 33468067 PMCID: PMC7814543 DOI: 10.1186/s12245-021-00332-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. METHOD The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT. RESULTS Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86-0.98) and of ALT was 0.92 (95% confidence interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively. CONCLUSION In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center.
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Affiliation(s)
- Anup Shrestha
- Department of General Surgery, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal.
| | - Harish Chandra Neupane
- Department of General Surgery, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal
| | - Kishor Kumar Tamrakar
- Department of General Surgery, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal
| | - Abhishek Bhattarai
- Department of General Surgery, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal
| | - Gaurav Katwal
- Department of General Surgery, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal
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15
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CT Protocol Optimization in Trauma Imaging: A Review of Current Evidence. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Gilyard S, Shinn K, Nezami N, Findeiss LK, Dariushnia S, Grant AA, Hawkins CM, Peters GL, Majdalany BS, Newsome J, Bercu ZL, Kokabi N. Contemporary Management of Hepatic Trauma: What IRs Need to Know. Semin Intervent Radiol 2020; 37:35-43. [PMID: 32139969 DOI: 10.1055/s-0039-3401838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.
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Affiliation(s)
- Shenise Gilyard
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlin Shinn
- Department of Medical Education, Emory University School of Medicine, Atlanta, Georgia
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laura K Findeiss
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - April A Grant
- Division of Trauma/Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Gail L Peters
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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