Evaluation of blunt abdominal trauma using PACS-based 2D and 3D MDCT reformations of the lumbar spine and pelvis

OBJECTIVE: The purpose of this study was to show the value of 2D and 3D reformations of CT data from abdominal and pelvic CT performed immediately at the workstation using a PACS-based software program to evaluate the lumbar spine and pelvis in patients with blunt abdominal trauma. MATERIALS AND METHODS: We reviewed the abdominopelvic CT scans and conventional radiographs of the lumbar spine or pelvis of 156 consecutive patients with blunt abdominal trauma. The CT data were compared with the radiographic findings and also with the findings of dedicated repeat CT of the spine or pelvis, when performed. RESULTS: CT depicted 80 fractures of the lumbar spine and 178 pelvic fractures. Radiography showed 40 fractures of the lumbar spine and 138 pelvic fractures. No additional fractures were identified on dedicated repeat CT. CONCLUSION: Conventional radiographs to clear the lumbar spine are no longer required when abdominopelvic CT data are available. CT and reformatted CT data show more fractures than radiography and miss no fractures compared with dedicated CT of the lumbar spine or pelvis. Having these images immediately available through the PACS workstation saves time for the trauma team in the management of critically ill patients.     

Lap-belt injuries of the lumbar spine in children: a pitfall in CT diagnosis

A retrospective review of 365 consecutive CT studies in children assessed for intraabdominal trauma yielded five children in whom lap-belt-associated injuries of the lumbar spine were missed on CT. Facet subluxation and anterior dislocation of the third lumbar vertebra were present in four patients and multiple compression fractures were present in one. Clinical presentations included acute abdominal symptoms; two had acute back pain, and three experienced delayed onset of back pain. Although the injuries to the spine were visible retrospectively on anteroposterior radiographs, the findings were subtle and their extent was best appreciated on lateral lumbar spine views. Five of 365 patients with blunt abdominal trauma were identified as having sustained midlumbar spinal injury that was clearly visible only on a lateral radiograph of the spine.     

Abdominal crush injury in the Sichuan earthquake evaluated by multidetector computed tomography

AIM:To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography(MDCT). METHODS:Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan earthquake underwent emergency non-enhanced scans with 16-row MDCT. Data were reviewed focusing on anatomic regions including lumbar vertebrae,abdominal wall soft tissue, retroperitoneum and intraperitoneal space;and types of traumatic lesions. RESULTS:Fractures of lumbar vertebrae and abdominal wall soft tissue injuries were more common than retro-and intraperitoneal injuries(P<0.05).With regard to the 49 lumbar vertebral fractures in 24 patients,these occurred predominantly in the transverse process(P<0.05),and 66.67%of patients(16/24) had fractures of multiple vertebrae,predominantly two vertebrae in 62.5%of patients(10/16),mainly in L1-3 vertebrae in 81.63%of the vertebrae(40/49). Retroperitoneal injuries occurred more frequently than intraperitoneal injuries(P<0.05),and renal and liver injuries were most often seen in the retroperitoneum and in the intraperitoneal space,respectively(all P< 0.05). CONCLUSION:Transverse process fractures in two vertebrae among L1-3 vertebrae,injury of abdominal wall soft tissue,and renal injury might be features of earthquake-related crush abdominal injury.     

Screening US for blunt abdominal trauma: objective predictors of false-negative findings and missed injuries

PURPOSE: To determine the risk for missed injury in patients with blunt abdominal trauma and negative findings at screening ultrasonography (US) and with coexistent hematuria or fracture of the sixth through 12th ribs, lumbar spine, or pelvis. MATERIALS AND METHODS: From a database of 4,000 patients screened with US for blunt abdominal trauma at a level 1 trauma center, the 3,679 patients with negative US findings were retrospectively classified by consensus of two authors into high-risk (n = 494) and low-risk (n = 3,185) groups based on the presence of hypothetical predictors of missed injury: hematuria (n = 96) or fracture of the sixth through 12th ribs (n = 216), lumbar spine (n = 105), or pelvis (n = 174). Outcome in each patient was determined by the same two authors consensually after retrospective review of the trauma registry and all radiologic, surgical, and autopsy reports. The risk for missed abdominal injury was determined for each patient risk group and for each hypothetical predictor. Risks were statistically compared by using the Pearson chi2, Fisher exact, or Fisher-Freeman-Halton exact test, depending on expected frequencies. RESULTS: High-risk patients were 24 times more likely to have abdominal injuries after negative US findings (30 [6.1%] of 494) than were low-risk patients (eight [0.25%] of 3,185) (P <.001). Among high-risk patients, the absolute risks for missed abdominal injury associated with specific predictors were 15.6% (15 of 96 patients) for hematuria, 6.0% (13 of 216) for lower rib fractures, 7.6% (eight of 105) for lumbar spine fractures, and 5.2% (nine of 174) for pelvic fractures. Each of these risks was significantly higher for patients in the high-risk group than for those in the low-risk group (P <.001). CONCLUSION: Hematuria and fracture of the lower ribs, lumbar spine, or pelvis are objective predictors of missed abdominal injury in patients with blunt abdominal trauma and negative US findings, and such patients may benefit from additional screening with computed tomography.     

Abdominal CT for trauma: an adequate screen for lower thoracic and lumbosacral fractures?

Purpose: To assess the utility of routine trauma abdomen and pelvic CT for the detection of lumbosacral spine fractures. Materials and methods: The radiology records of the University of Arizona Medical Center over a 12-month period were reviewed. Fifty-eight patients with suspected blunt abdominal trauma were studied who had both abdominal CT and radiographs of lumbosacral spine. Twenty-two had one or more fractures of the lumbosacral spine. Thirty-six patients who underwent both imaging studies and had no fracture identified by either modality were selected as controls. The images were reviewed independently by three radiologists who were blinded to the CT and plain radiograph findings. Following the blinded review, all discrepancies were reviewed by the interpreting radiologists who then arrived at a consensus interpretation. A fracture was determined to be present if, by consensus of the reviewers, it was seen on either the CT scan or plain radiograph. Results: Thirty-two fractures were identified; 28 (88 %) were identified on CT, 17(53 %) were seen on plain films. Overall routine abdominal CT is significantly more sensitive in the detection of fracture than plain radiographs. No unstable injuries were missed on plain film while one fracture dislocation was missed on CT. Conclusion: Bone images obtained from routine trauma abdomen and pelvic CT are significantly more sensitive than radiographs in the detection of fractures of the lumbosacral spine. However, CT alone may miss significant injuries.     

CT detection of serious internal and skeletal injuries in patients with pelvic fractures

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the percentage of patients with known pelvic fractures who have additional findings of intraabdominal injury, as diagnosed at abdominal computed tomography (CT), and to determine if patients with specific types or patterns of fractures are more likely to have additional injuries. MATERIALS AND METHODS: The authors reviewed the medical records of 200 consecutive patients (125 women, 75 men; age range, 4-86 years) who had been admitted to a level 1 trauma center with osseous pelvic injury secondary to blunt trauma and who had undergone abdominal CT examinations. Abdominal CT findings in these patients were classified as negative, positive, or minimal and correlated with mechanism of pelvic fracture. RESULTS: Sixty-five (32%) of the 200 patients had negative CT findings, 43 (22%) had findings attributable to the trauma but required no follow-up, and 92 (46%) had positive findings that required nonsurgical management or exploratory laparotomy. Additional pelvic fractures were identified in 63 (32%) patients. The highest prevalence of additional injuries was in patients with Malgaigne fractures (four of 15, 27%) or bilateral pubic rami fractures (six of 18, 33%). CONCLUSION: CT examinations revealed that 135 (68%) of 200 patients with pelvic fractures secondary to blunt trauma had concomitant internal or skeletal injuries and that 92 (46%) patients had injuries severe enough to require nonsurgical management or exploratory laparotomy. Patients with bilateral pubic rami fractures or Malgaigne fractures were particularly prone to additional injuries; therefore, abdominal CT examinations are recommended in these patients.     

Can chest and abdominal trauma CT eliminate the need for plain films of the spine? – Experience with 329 multiple trauma patients

Purpose: To compare the accuracy of spine plain films with chest and abdominal trauma CT in detection of spine fractures. Methods: The study prospectively enrolled 329 multiple trauma patients. Of these, 38 patients had both chest CT for trauma and thoracic spine plain films, and 87 patients had both abdominal CT for trauma and lumbar spine plain films. Results: Of the fractures visible at either chest trauma CT or thoracic spine plain film examination, all were diagnosed on CT and 62 % on plain films. Of fractures visible at either abdominal trauma CT or lumbar spine plain films, 94 % were diagnosed on CT and 67 % on plain films. The one false negative CT involved an articular process fracture, which was visible but not mentioned, in a patient with a sacral fracture. Conclusion: Evaluation of the digital scout images and bone windows when a patient has chest and abdominal trauma CT appears to be as accurate as thoracic and lumbar spine plain films in the evaluation of spinal trauma.     

Imaging of the thoracic and lumbar spine in a high volume level 1 trauma center: are reformatted images of the spine essential for screening in blunt trauma?

Reformatted CTs of the thoracic and lumbar spine (CT T/L) from CTs of the chest, abdomen, and pelvis (CT body) may be performed for screening the thoracolumbar spine in patients sustaining blunt trauma. The purpose of this study was to determine whether there was a difference in the rate of detection of spinal fractures on CTs of the body compared to the reformatted T/L spine. A secondary endpoint was to evaluate whether cases dictated by trainees improved fracture detection rate. We reviewed the records of 250 consecutive blunt trauma patients that received CTs of the chest, abdomen, and pelvis (CT body) with concurrent CT T/L reformats. Each report was reviewed to determine if there was a thoracolumbar fracture and whether a trainee had been involved in interpreting the CT body. If a fracture was identified on either report, then the number, type, and location of each fracture was documented. Sixty-nine fractures, from a total of 38 patients, were identified on either the CT of the body or the CT T/L. Sensitivity for CT body interpretations was 94 % (95 % CI: 86–98 %) compared to a 97 % (95 % CI: 89–100 %) sensitivity for the CT T/L (p > 0.5). Although the sensitivity was 97 % (95 % CI: 88–100 %) when a trainee was involved in interpreting the body CT, there was no statistically significant improvement. The results suggest that with careful scrutiny most spine fractures can be diagnosed on body CT images without the addition of spine reformats. The most commonly missed finding is an isolated non-displaced transverse process fracture, which does not require surgical intervention and does not alter clinical management. The results suggest that thin section reformats do not need to be routinely ordered in screening blunt trauma patients, unless a bony abnormality is identified on the thicker section body CT images.     

Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution.

OBJECTIVE: We evaluated the incidence and organ distribution of arterial extravasation identified using contrast-enhanced helical CT in patients who had sustained abdominal visceral injuries and pelvic fractures after blunt trauma. SUBJECTS AND METHODS: Five hundred sixty-five consecutive patients from four level I trauma centers who had CT scans showing abdominal visceral injuries or pelvic fractures were included in this series. The presence or absence of arterial extravasation, as well as the anatomic sites of arterial extravasation, was noted. We obtained clinical follow-up data, including surgical or angiographic findings. RESULTS: In our series, 104 (18.4%) of 565 patients had arterial extravasation. Of the 104 patients, 81 (77.9%) underwent surgery, embolization, or both. The combined rate of surgery or embolization in patients with arterial extravasation was statistically higher than expected at all four institutions (p <0.001). The spleen was the most common organ injured, occurring in 277 (49.0%) of 565 patients, and arterial extravasation occurred in 49 (17.7%) of 277 patients with splenic injury. Several other visceral injuries were associated with arterial extravasation, including hepatic, renal, adrenal, and mesenteric injuries. CONCLUSION: Based on the limited reports of arterial extravasation in the nonhelical CT literature, the percentage (18%) of clinically stable patients in our study with CT scans showing arterial extravasation was higher than anticipated. This finding likely reflects the improved diagnostic capability of helical CT. Although the spleen and liver were the organs most commonly associated with arterial extravasation, radiologists should be aware that arterial extravasation may be associated with several other visceral injuries.     

Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma.

PURPOSE: To determine, at screening ultrasonography, the prevalence, severity, and clinical outcome of clinically important abdominal visceral injuries, without associated hemoperitoneum, that result from blunt abdominal trauma. MATERIALS AND METHODS: Computed tomography (CT) was performed at admission in 466 patients with visceral injury. A retrospective review was performed of findings from surgery and contrast material-enhanced spiral and conventional CT performed to verify abdominal visceral injuries in 467 (4%) of 11,188 patients with blunt trauma. These patients were admitted to a level 1 trauma center over 33 months to determine the presence of hemoperitoneum and to identify the grade of injury. Medical records of patients with abdominal visceral injury without hemoperitoneum were reviewed for the management required and for results of focused abdominal sonography for trauma (FAST). RESULTS: A total of 575 abdominal visceral injuries were identified at CT and/or surgery. Findings of CT at admission (n = 156) and of surgery (n = 1) revealed no evidence of hemoperitoneum in 157 (34%) patients with abdominal visceral injury; 26 (17%) of whom also had negative FAST studies. Abdominal visceral injuries diagnosed in patients without hemoperitoneum included 57 (27%) of 210 splenic injuries, 71 (34%) of 206 hepatic injuries, 30 (48%) of 63 renal injuries, four (11%) of 35 mesenteric injuries, and two (29%) of seven pancreatic injuries. Surgical and/or angiographic intervention was required in 26 (17%) patients without hemoperitoneum. CONCLUSION: Reliance on the presence of hemoperitoneum as the sole indicator of abdominal visceral injury limits the value of FAST as a screening diagnostic modality for patients who sustain blunt abdominal trauma.     

Blunt abdominal trauma: utility of 5-minute delayed CT with a reduced radiation dose

PURPOSE: To retrospectively evaluate the utility of 5-minute delayed computed tomography (CT) of the abdomen and pelvis by using a reduced radiation dose in patients with blunt abdominal trauma. MATERIALS AND METHODS: Institutional review board consent was obtained, and written informed consent was waived. The study was HIPAA compliant. A total of 662 patients (497 men, 165 women; mean age, 40.5 years; range, 18-94 years) were identified who were evaluated with CT after blunt abdominal trauma during a 1-year period. Delayed CT scans were acquired 5 minutes after intravenous contrast material injection by using a decreased tube current of 100 mAs. Injury was identified in 106 patients. Two radiologists blinded to initial CT scan interpretation reviewed these cases to determine the quality and utility of delayed scans. Disagreement was settled by consensus. Delayed scans were considered useful when they aided in (a) characterizing initial CT findings, (b) identifying findings not present at initial CT, (c) excluding injury suggested at initial CT, and (d) increasing reader confidence with regard to initial CT findings. RESULTS: All delayed scans were diagnostic. Delayed scans were useful in 27% (12 of 44) of patients with solid organ injury, 5.9% (one of 17) of patients with bowel or mesenteric injury, 4.5% (one of 22) of patients with pelvic fractures, and in none of the patients with free fluid only. Overall, delayed CT was useful in 2.1% (14 of 662) of all patients (95% confidence interval: 1.0, 3.2) referred for evaluation following blunt abdominal trauma. Utility increased to 13.2% (14 of 106) (95% confidence interval: 6.8, 19.7) in the group of patients with injury or suspected of having injury after initial CT. CONCLUSION: If delayed CT scans are acquired when patients with blunt abdominal trauma are evaluated, selective, rather than routine, acquisition is recommended and a reduced radiation dose seems adequate.     

Traumatic lumbar spine fractures: Transverse process fractures dominate

PurposeWith motor vehicle collisions (MVC) predominating as a source of trauma now, we sought to 1) reassess the types of traumatic lumbar spine fractures, 2) highlight the coincidence of transverse process fractures (TPF) with visceral injuries and 3) emphasize the difference in management between compression fracture (CF) and TPF.MethodsWe retrospectively reviewed the reports of lumbar spine and abdominopelvic CT scans from 2017 and 2018 to classify the types of spine fractures, their mechanism of injury, treatment and coexistence of abdominopelvic injuries.Results2.2% of patients had posttraumatic lumbar spine fractures (113/5229), including 58 patients (51.3%) with isolated TPF and 42 (37.2%) with isolated CF; 13 patients had mixed types. TPF accounted for 70% of all fractures (195/277) as opposed to 24% for CF (67/277). MVC was responsible for 60.3% (35/58) of TPF but falls accounted for 73.8% (31/42) of CF. The odds ratio of having isolated TPF from MVC was 4.1[1.8–9.0] versus CF after a fall from standing was 4.5[2.0–10.5]. Of patients with both visceral injuries and lumbar spine fractures, 75% (27/36) had isolated TPF (odds ratio of visceral injury with TPF was 4.4[1.8–10.7]). No TPF were treated with an intervention, however 77% (40/52) of CF were addressed surgically or with braces.ConclusionTPF are the most common lumbar spine fractures and are often associated with MVC. There is a high association between TPF and abdominopelvic visceral injury requiring radiologists' attentiveness even though the TPF is not directly addressed.     

CT scanning of children with blunt abdominal trauma – is oral contrast useful?

Purpose: To determine the usefulness of oral contrast in CT scanning of children with blunt abdominal trauma by comparing scans performed with and without oral contrast. Methods: CT scans of 273 children with abdominal trauma and 40 without trauma were reviewed. Results: Of the trauma patients, 116 (43 %) were scanned with oral contrast, 157 (57 %) without. Among the children who underwent laparotomy, CT scanning identified 6 of 6 organ injuries in those scanned with oral contrast and 11 of 12 in those scanned without. CT scanning identified all bowel injuries. The pancreatic body and tail were significantly better visualized in scans with oral contrast. Detection of pancreatic or liver injury was not, however, significantly different in the two groups. Opacification of the bowel by contrast was significantly better in elective than in trauma patients. Conclusion: There was no difference in detection of injuries between children scanned with and without oral contrast.     

Multidetector computed tomography of cervical spine fractures in ankylosing spondylitis

PURPOSE: To analyze multidetector computed tomography (MDCT) cervical spine findings in trauma patients with advanced ankylosing spondylitis (AS). MATERIAL AND METHODS: Using PACS, 2282 cervical spine MDCT examinations requested by emergency room physicians were found during a period of 3 years. Of these patients, 18 (16 M, aged 41-87, mean 57 years) had advanced AS. Primary imaging included radiography in 12 and MRI in 11 patients. RESULTS: MDCT detected one facet joint subluxation and 31 fractures in 17 patients: 14 transverse fractures, 8 spinous process fractures, 2 Jefferson's fractures, 1 type I and 2 type II odontoid process fractures, and 1 each: atlanto-occipital joint fracture and C2 laminar fracture plus isolated transverse process and facet joint fractures. Radiographs detected 48% and MRI 60% of the fractures. MRI detected all transverse and odontoid fractures, demonstrating spinal cord abnormalities in 72%. CONCLUSION: MDCT is superior to plain radiographs or MRI, showing significantly more injuries and yielding more information on fracture morphology. MRI is valuable, however, in evaluating the spinal cord and soft-tissue injuries. Fractures in advanced AS often show an abnormal orientation and are frequently associated with spinal cord injuries. In these patients, for any suspected cervical spine injuries, MDCT is therefore the imaging modality of choice.     

Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy?

The objective is to evaluate different multidetector-row CT (MDCT) strategies for adequate classification of spinal and pelvic injuries. Seventy intubated patients after multiple trauma underwent conventional radiography (CR) and MDCT. Examinations included the pelvis (P), the lumbar spine (LS) and the thoracic spine (TS). Conventional radiographs, 3-mm (CT5) and 5-mm scans (CT3) and 3-mm and 5-mm scans combined with MPR (CT3R/CT5R) were compared to surgery, autopsy and clinical course. MDCT led to significantly better results than CR (P<0.01). Correlation coefficients were r=1.0 (CT3R), r=0.96 [TS] to r=1.0 [P/LS] (CT5R), r=0.8 [P] to r=1.0 [TS] (CT3), r=0.80 [P] to r=0.86 [TS] (CT5) and r=0.3 [TS] to r=0.69 [P] (CR). Fractures were identified by CT3R in 100% of cases, by CT5R in 95%, by CT3 in 90% [P]–100% [TS], by CT5 in 83.3% [LS]–90% [P] and by CR in 57.1% [TS]–87.2% [P]. Unstable fractures were identified in 100% by CT3R, CT5R and CT3, 85.7% [TS]–100% [P/LS] by CT5 and 57.1% [TS]–80% [P] by CR. Only overlapping thin-slice multiplanar reformation allows for an adequate classification of spinal and pelvic injuries and thus is highly emphasized in patients after severe blunt trauma.     

Changes in splenic size after abdominal trauma

After blunt abdominal trauma, the spleen often increases in volume on serial computed tomographic (CT) scans. To determine the frequency and significance of such enlargement, the authors performed a retrospective analysis of 44 hemodynamically stable patients who had experienced recent blunt abdominal trauma. The severity of splenic, hepatic, or other visceral injuries seen on each CT scan was numerically scored, and the amount of intraperitoneal fluid was assessed. Twenty-five patients (57%) had over 10% enlargement (average enlargement, 56%) on follow-up scans. Increasing volume did not correlate with clinical deterioration or the need for splenectomy. It did correlate modestly with the amount of blood in the peritoneum on CT scans, the number of units of blood transfused, and two clinical indexes of systemic trauma. Therefore, an enlarging spleen is not a CT indicator of a deteriorating clinical condition. This phenomenon is most likely due to marked adrenergic stimulation after injury and changing fluid volumes.     

Comparative Analysis of Body Radiologist to Neuroradiologist Evaluation of the Spine in Trauma Settings

IntroductionCT is routinely performed to evaluate trauma patients. When a radiologist misses an acute finding, there could be serious adverse consequences. In many subspecialty settings, body radiologists and neuroradiologists both interpret the thoracic and lumbar spine. RADPEER has estimated general disagreement rates between radiologists to be 2.9%, but the disagreement rate between neuroradiologists and body radiologists in trauma settings remains unknown.MethodsThis retrospective case review examined reports from the past 10 years of adult CT scans of the chest, abdomen, and pelvis interpreted by body radiologists, with concurrent thoracic and lumbar spine reconstructions interpreted by neuroradiologists. Reports were scrutinized for disagreement on the presence of acute fractures visible to both radiologists.Results1,497 report pairs were analyzed. Of them, 33 pairs (2.2%) disagreed on the presence of an unequivocal acute fracture. In scans where only one miss occurred, the body radiologist and neuroradiologist were attributed with 27 (82%) and 6 (18%) of 32 disagreements, respectively. One scan contained a miss by both the body radiologist and neuroradiologist. Transverse processes were most commonly missed, followed by vertebral body fractures.ConclusionMisses by body radiologists comprised the majority of disagreements. Neuroradiologists are more sensitive for detecting spinal fractures likely secondary to experience, education, small field of view reconstructed, and more detailed reporting protocols. Additional studies are needed to determine whether emulating neuroradiology practices may help body radiologists detect subtle fractures.     

Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

Abdominal sonography for the detection of hemoperitoneum has become increasingly popular as a screening test for visceral injury after blunt trauma. The purpose of this study was to determine the frequency, severity, and clinical significance (outcome) of abdominal organ injuries that occur without hemoperitoneum on the initial evaluation of blunt abdominal trauma patients.During a 12-month period, 3392 blunt trauma patients were admitted to our center. Sonographic studies were performed as an initial screening evaluation to determine the presence of hemoperitoneum in 772 (22.7%) of these patients. Abdominal visceral injuries were verified by computed tomography (CT) or surgery in 196 (5.8%) of all blunt trauma admissions. Sonography, CT, and operative findings were reviewed to determine the presence or absence of hemoperitoneum in patients with abdominal injury. Patients with abdominal visceral injury without hemoperitoneum were further analyzed to identify the type of injury and the management required.A total of 246 abdominal injuries were identified in 196 patients. Fifty (26%) patients with abdominal visceral injuries diagnosed by admission CT scan had no evidence of hemoperitoneum. Admission sonography performed in 15 (30%) of these 50 patients also showed no evidence of hemoperitoneum. Visceral injuries detected by CT in the patients without hemoperitoneum included 22 of 100 splenic injuries (22%), 18 of 91 hepatic injuries (20%), 12 of 26 renal injuries (46%), and 1 of 9 mesenteric injuries (11%). Surgery was required to manage injuries in 10 of these patients.Up to 26% of blunt trauma patients with abdominal visceral injuries do not have associated hemoperitoneum identified on admission abdominal CT or sonography. Dependence on hemoperitoneum as the sole criterion of abdominal visceral injury after blunt trauma will result in falsely negative examinations and will miss potentially significant injuries.     

Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT

Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.     

Added Value of Dedicated Spine CT to Detect Fracture in Patients with CT Chest,Abdomen, and Pelvis in the Trauma Setting

PurposeFractures of the thoracolumbar spine account for up to 90% of spinal fractures, and are associated with significant disability. The advantage of acquiring dedicated spine CT imaging in addition to visceral CT studies of the chest, abdomen and pelvis for detection of spinal fractures has not been definitively established. This retrospective study seeks to determine the contribution of dedicated spine CT in the acute clinical setting.MethodsPatients who were diagnosed with fractures of the thoracic or lumbar spine at our institution between January 1, 2010 and June 30, 2014 were identified. Additional inclusion criteria included having a CT of the chest and/or abdomen and pelvis followed by a dedicated thoracic or lumbar spine CT within 30 days. Reports were reviewed for accuracy of fracture detection, and missed fractures were retrospectively analyzed on images for detectability.ResultsA total of 102 patients met our inclusion criteria for a total of 312 fractures. Of the 312 fractures, 31 (10%) were missed on the initial visceral CT in 18 of the 102 patients. In all but two cases, at least one fracture was identified on the visceral spine CT. There were no cases in which the newly identified fractures changed patient management.ConclusionAll fractures requiring surgical intervention were identified on the visceral CT. A dedicated spine CT does detect additional spine fractures but does not clearly alter patient management.