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Raniga SB, Mittal AK, Bernstein M, Skalski MR, Al-Hadidi AM. Multidetector CT in Vascular Injuries Resulting from Pelvic Fractures: A Primer for Diagnostic Radiologists. Radiographics 2020; 39:2111-2129. [PMID: 31697619 DOI: 10.1148/rg.2019190062] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pelvic vascular injuries are typically caused by high-energy trauma. The majority of these injuries are caused by motor vehicle collisions, and the rest are caused by falls and industrial or crush injuries. Pelvic vascular injuries are frequently associated with pelvic ring disruption and have a high mortality rate due to shock as a result of pelvic bleeding. Morbidity and mortality resulting from pelvic vascular injury are due to pelvic hemorrhage and resultant exsanguination, which is potentially treatable and reversible if it is diagnosed early with multidetector CT and treated promptly. The pelvic bleeding source can be arterial, venous, or osseous, and differentiating an arterial (high-pressure) bleed from a venous-osseous (low-pressure) bleed is of paramount importance in stratification for treatment. Low-pressure venous and osseous bleeds are initially treated with a pelvic binder or external fixation, while high-pressure arterial bleeds require angioembolization or surgical pelvic packing. Definitive treatment of the pelvic ring disruption includes open or closed reduction and internal fixation. Multidetector CT is important in the trauma setting to assess and characterize pelvic vascular injuries with multiphasic acquisition in the arterial and venous phases, which allows differentiation of the common vascular injury patterns. This article reviews the anatomy of the pelvic vessels and the pelvic vascular territory; discusses the multidetector CT protocols used in diagnosis and characterization of pelvic vascular injury; and describes the spectrum of pelvic vascular injuries, the differentiation of common injury patterns, mimics, and imaging pitfalls. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Dreizin.
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Affiliation(s)
- Sameer B Raniga
- From the Departments of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, PO Box 38, PC 123, Al Khoud, Oman (S.B.R., A.K.M.); Department of Radiology, New York University Langone Health Medical Centers/Bellevue Hospital, New York, NY (M.B.); Department of Radiology, Palmer College of Chiropractic West, San Jose, Calif (M.R.S.); and Department of Radiology, Royal Hospital, Ministry of Health, Muscat, Oman (A.M.A.)
| | - Alok K Mittal
- From the Departments of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, PO Box 38, PC 123, Al Khoud, Oman (S.B.R., A.K.M.); Department of Radiology, New York University Langone Health Medical Centers/Bellevue Hospital, New York, NY (M.B.); Department of Radiology, Palmer College of Chiropractic West, San Jose, Calif (M.R.S.); and Department of Radiology, Royal Hospital, Ministry of Health, Muscat, Oman (A.M.A.)
| | - Mark Bernstein
- From the Departments of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, PO Box 38, PC 123, Al Khoud, Oman (S.B.R., A.K.M.); Department of Radiology, New York University Langone Health Medical Centers/Bellevue Hospital, New York, NY (M.B.); Department of Radiology, Palmer College of Chiropractic West, San Jose, Calif (M.R.S.); and Department of Radiology, Royal Hospital, Ministry of Health, Muscat, Oman (A.M.A.)
| | - Matthew R Skalski
- From the Departments of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, PO Box 38, PC 123, Al Khoud, Oman (S.B.R., A.K.M.); Department of Radiology, New York University Langone Health Medical Centers/Bellevue Hospital, New York, NY (M.B.); Department of Radiology, Palmer College of Chiropractic West, San Jose, Calif (M.R.S.); and Department of Radiology, Royal Hospital, Ministry of Health, Muscat, Oman (A.M.A.)
| | - Aymen M Al-Hadidi
- From the Departments of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, PO Box 38, PC 123, Al Khoud, Oman (S.B.R., A.K.M.); Department of Radiology, New York University Langone Health Medical Centers/Bellevue Hospital, New York, NY (M.B.); Department of Radiology, Palmer College of Chiropractic West, San Jose, Calif (M.R.S.); and Department of Radiology, Royal Hospital, Ministry of Health, Muscat, Oman (A.M.A.)
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Molinelli V, Iosca S, Duka E, De Marchi G, Lucchina N, Bracchi E, Carcano G, Novario R, Fugazzola C. Ability of specific and nonspecific signs of multidetector computed tomography (MDCT) in the diagnosis of blunt surgically important bowel and mesenteric injuries. Radiol Med 2018; 123:891-903. [PMID: 30039378 DOI: 10.1007/s11547-018-0923-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the accuracy of MDCT in the evaluation of blunt surgically relevant bowel and/or mesenteric injuries (BMIs) using single specific CT signs together with specific pairs of nonspecific signs. METHODS Fifty-four patients examined with MDCT were divided into two groups: a 'surgical' group of 20 patients-which underwent surgery for blunt BMIs-and a control group of 34 'nonsurgical' trauma patients. Two radiologists with different experience performed a double-blind retrospective evaluation of the images, classifying the patients in the two groups by using only single specific signs; then, the images were reviewed in consensus with a third radiologist and sensitivity and specificity were calculated. Subsequently, the frequency of every single sign and of every possible combination of nonspecific signs in the two groups was registered, to find combinations present only in the surgical group; sensitivity and specificity were calculated by using even those specific combinations. RESULTS At the first consensual evaluation, sensitivity and specificity were 75 and 100%, respectively. Two combinations of nonspecific signs (focal wall thickening + extraluminal air; focal wall thickening + seat belt sign) were found only in surgical patients that did not present any single specific sign: Sensitivity calculated adding those two combinations was 95%, without a decrease in specificity. CONCLUSIONS MDCT is an accurate technique in the evaluation of blunt surgically relevant BMIs. The single specific CT signs were sufficient for the diagnosis in only 75% of the cases; adding the two specific combinations allowed an increase in sensitivity of 20%.
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Affiliation(s)
- Valeria Molinelli
- Department of Radiology, University Hospital, Viale Borri 57, Varese, Italy.
| | - Simona Iosca
- Department of Radiology, University Hospital, Viale Borri 57, Varese, Italy
| | - Ejona Duka
- Department of Radiology, University Hospital, Viale Borri 57, Varese, Italy
| | - Giuseppe De Marchi
- Department of Radiology, University Hospital, Viale Borri 57, Varese, Italy
| | - Natalie Lucchina
- Department of Radiology, University Hospital Maggiore, Largo Nigrisoli 2, Bologna, Italy
| | - Elena Bracchi
- Department of Radiology, University Hospital, Luigi Sacco, Via Grassi 74, Milan, Italy
| | - Giulio Carcano
- Department of Surgery, University Hospital, Viale Borri 57, Varese, Italy
| | - Raffaele Novario
- Department of Medical Physics, University Hospital, Viale Borri 57, Varese, Italy
| | - Carlo Fugazzola
- Department of Radiology, University Hospital, Viale Borri 57, Varese, Italy
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Amerstorfer EE, Haberlik A, Riccabona M. Imaging assessment of renal injuries in children and adolescents: CT or ultrasound? J Pediatr Surg 2015; 50:448-55. [PMID: 25746706 DOI: 10.1016/j.jpedsurg.2014.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the introduction of the ALARA ("as low as reasonably achievable") concept, ultrasound (US) has been progressively advocated for paediatric diagnostic imaging. This study aimed to analyse the role and accuracy of US in paediatric renal trauma. METHODS From 1999 to 2009, the tertiary-care-hospital database was retrospectively evaluated for renal trauma with regards to aetiology, type of injury, diagnostics, management and outcome. RESULTS Forty-seven patients (29 males, 18 females; median age=14years, range 1-17 years) were identified. US was initially applied in 45 patients with correct results in 86.6%. Computed tomography (CT) was performed in 16 patients in the acute trauma setting - complementary to US in 14 cases, with a diagnostic accuracy of 93%. Most renal injuries were grade I° (n=30), followed by grade III° (n=8), IV° (n=5), and II°/V° (n=2 each). All patients were initially managed conservatively and followed by US. Clinical deterioration necessitated surgery in four patients (2 nephrectomies, 1 partial nephrectomy, 1 urinoma drainage). The outcome was generally favourable with a renal preservation rate of 95%. CONCLUSION With respect to the ALARA principle, US can be safely and reliably applied as the first-line diagnostic imaging technique and for follow-up for suspected traumatic paediatric renal injuries.
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Affiliation(s)
- Eva Elisa Amerstorfer
- Department for Paediatric and Adolescent Surgery, Medical University of Graz, Austria
| | - Axel Haberlik
- Department for Paediatric and Adolescent Surgery, Medical University of Graz, Austria.
| | - Michael Riccabona
- Department for Radiology, Division of Paediatric Radiology, Medical University of Graz, Austria
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Avarello JT, Cantor RM. Pediatric major trauma: an approach to evaluation and management. Emerg Med Clin North Am 2007; 25:803-36, x. [PMID: 17826219 DOI: 10.1016/j.emc.2007.06.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Trauma is the leading cause of death in children nationwide. Proper management of the pediatric trauma patient involves many of the components contained within standard trauma protocols. By paying strict attention to the anatomical and physiological differences in the pediatric population, clinicians will be assured the best possible outcomes. This article outlines the fundamentals of proper management of pediatric trauma patients.
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Affiliation(s)
- Jahn T Avarello
- Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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