CT of Nontraumatic Abdominal Fluid Collections After Initial Fluid Resuscitation of Patients with Major Burns

Blunt pancreatic trauma: evaluation with MDCT technology

The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. MDCT imaging findings suggestive of pancreatic injury included low attenuation peripancreatic fluid (n = 51), hyperattenuating peripancreatic fluid (n = 13), pancreatic contusion (n = 7), active hemorrhage (n = 2), and pancreatic laceration (n = 16). Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity, 100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance.

Clinical implications of immediate or later periportal edema in MS-CT trauma scans: surrogate parameter of intravenous fluid status and venous congestion

Periportal edema (PPE) of the liver in multislice computed tomography (MS-CT) scans that develops immediately (primary PPE [pPPE]) or later (secondary PPE [sPPE]) is not uncommon in severe trauma patients. Although PPE may serve as a marker for blunt abdominal trauma (22-31 % of cases), distinct causes and clinical implications of PPE are unclear. We analyzed the incidence of pPPE and sPPE in 68 MS-CT scans in severe trauma patients (2007-2009). Exclusion criteria were severely burned patients and patients with preexistent liver diseases predisposing to PPE. We divided PPE+ patients into two subpopulations-either initial/primary PPE (pPPE+) or later/secondary PPE (sPPE+). Further patient data were collected and statistically analyzed. PPE+ was found in 27.9 % (n = 19). Females predominated (p = 0.01), and PPE+ patients presented with a significantly better pH at admission (p = 0.008). The total amount of volume resuscitation (1,983 ± 1,155 ml; p = 0.02) and crystalloids (1,117 ± 796 ml; p = 0.006) administered before MS-CT scans was significantly higher in PPE+, whereas the amount of administered colloids (797 ± 640 ml) showed no significant difference in both groups. PPE+ was not associated with further patient data, i.e., trauma mechanism, injury severity, prognosis-relevant factors, adverse clinical events, or mortality. pPPE+ in MS-CT may serve as a surrogate parameter for intravenous volume load and/or venous congestion, and sPPE+ may also indicate venous congestion and right heart failure after severe trauma. In severe trauma patients with pPPE+/sPPE+ in MS-CT scans, causes of PPE relating to intravenous fluid overload and/or venous congestion should be excluded or treated.

Pseudopancreatitis in trauma patients

OBJECTIVE

The purpose of our study was to review the significance of intra- and peripancreatic fluid in trauma patients who have no other signs of pancreatic injury.

CONCLUSION

We propose that intra- and peripancreatic fluid may be the consequence of hypovolemic shock treated with hyperhydration when there is significant delay between injury and imaging.

Imaging of blunt pancreatic trauma

Blunt pancreatic trauma is an exceedingly rare but life-threatening injury with significant mortality. Computed tomography (CT) is commonly employed as the initial imaging modality in blunt trauma patients and affords a timely diagnosis of pancreatic trauma. The CT findings of pancreatic trauma can be broadly categorized as direct signs, such as a pancreatic laceration, which tend to be specific but lack sensitivity and indirect signs, such as peripancreatic fluid, which tend to be sensitive but lack specificity. In patients with equivocal CT findings or ongoing clinical suspicion of pancreatic trauma, magnetic resonance cholangiopancreatography (MRCP) may be employed for further evaluation. The integrity of the main pancreatic duct is of crucial importance, and though injury of the duct may be strongly suggested upon initial CT, MRCP provides clear delineation of the duct and any potential injuries. This article aims to review and illustrate the CT and magnetic resonance imaging findings of blunt pancreatic trauma and delineate the integration of these modalities into the appropriate imaging triage of severely injured blunt trauma patients.

Periportal oedema of the liver: correlation with clinical and paraclinical parameters in polytraumatic patients

PURPOSE

To clarify the occurrence of periportal edema in polytraumatic patients.

MATERIALS AND METHODS

Retrospective analysis of computed tomography (CT) scans from 74 polytraumatic patients (12 females, 62 males; 14-88 years old, median 32 years) performed shortly after the trauma. Periportal oedema was found in 22 patients. The existence and extent of the periportal oedema were studied with regard to the injury type, sex, weight and age, heart frequency, arterial blood pressure, as well as the lactate, pH value, and base excess (BE) directly after the admission of the patient to the intensive care unit.

RESULTS

There is a relevant statistical correlation between the existence of periportal oedema and the abdominal trauma (P<.0001), independent of the type of abdominal injury. No relevant correlation between periportal oedema and existence of liver rupture, liver haematoma, other abdominal organ injury, abdominal vessel injury, fracture in the skeletal system, or intracerebral bleeding was found. Periportal oedema occurs more commonly in females than in males, more in light weight patients than in the others, and more frequent in young patients than in older ones. There is no correlation with arterial blood pressure, heart rate, pH value, lactate, and BE.

CONCLUSION

The existence of periportal oedema is one sign of abdominal trauma and is independent of liver injury. Although it correlates with the sex, weight, and age of the patient, there is no correlation with arterial blood pressure, heart rate, pH value, lactate, and BE.

Traumatic Retroperitoneal Injuries: Review of Multidetector CT Findings

Multidetector computed tomography (CT) represents a significant advance in CT technology and can allow the accurate assessment of trauma patients, including the detection of traumatic retroperitoneal injuries, many of which are clinically occult. Retroperitoneal injuries include duodenal, pancreatic, vascular, renal, and adrenal injuries. Abnormal blood, fluid, or air within the retroperitoneal spaces may be isolated findings but can also occur in association with these injuries, and their recognition is the key to correctly identifying the injury. Accurate characterization of injury with CT can affect clinical management and can help minimize unnecessary laparotomies. Equivocal findings at initial abdominal CT should prompt close clinical follow-up with possible imaging follow-up, particularly for suspected occult duodenal and pancreatic injuries.