CT diagnosis of internal mammary artery injury caused by blunt trauma

AIM: To describe the computed tomography (CT) findings associated with active bleeding from the internal mammary artery (IMA) in blunt trauma victims and to assess complications related to IMA haemorrhage. MATERIAL AND METHODS: All cases of active IMA haemorrhage identified in blunt trauma patients on admission CT were identified from a trauma radiology data base covering 1990-1999. Computed tomography examinations, operative and medical records were reviewed to ascertain CT findings, complications, and patient outcome. The determination of active bleeding required CT evidence of a central contrast blush of CT density within 10 HU of an adjacent artery surrounded by haematoma. RESULTS: Four patients with CT evidence of active IMA haemorrhage were identified. All cases had surgical confirmation of an IMA source of haemorrhage. There were three patients with unilateral and one patient with bilateral IMA disruption. Three patients exhibited clinical signs of cardiac tamponade related to compression of one or more cardiac chambers by the anterior mediastinal haematoma. Sudden clinical deterioration compatible with tamponade developed in all three patients. CONCLUSION: Early CT recognition of active bleeding within the chest can direct rapid surgical or angiographic intervention. On-going blood loss and, in particular, the threat of cardiac tamponade must be considered with IMA injury.     

CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma

Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination or plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows.     

闭合性腹部外伤致胰腺损伤的CT诊断(附15例报告)

目的:评价CT对闭合性腹部外伤所致胰腺损伤的临床诊断价值。方法:回顾性分析15例经手术证实的闭合性腹部外伤所致胰腺损伤的CT征象。结果:15例闭合性腹部外伤所致胰腺损伤中,胰腺挫伤5例,胰腺完全性断裂6例,胰腺不完全性断裂1例,胰腺出血3例。胰腺内出血、水肿,胰腺增粗是胰腺挫伤的直接征象;胰腺外形不连续、平扫或增强时垂直胰腺长轴的低密度、线条状影是胰腺断裂的直接征象。胰周积液、网膜囊积血积液,肾前筋膜增厚,腹腔积液是胰腺损伤的间接征象。结论:CT检查对胰腺损伤的诊断价值较大,CT增强比平扫更能明确胰腺的断裂;CT检查对于主胰管的断裂的诊断价值有待进一步研究。     

闭合性腹膜内型膀胱破裂的CT诊断

目的　确定闭合性腹膜内型膀胱破裂的CT诊断价值。方法　对 9例闭合性腹膜内型膀胱破裂的CT资料和临床处理进行回顾性分析。结果　所有 9例腹膜内型膀胱破裂 ,CT均明确诊断。CT显示腹膜腔内低密度液体积聚 9例 ,其CT值比血液低 ,主要分布在膀胱侧隐窝、盆腔陷凹、结肠旁沟、肝脾周围和肠袢内。膀胱壁局部缺损 3例 ,泪滴状变形 2例 ;其他支持膀胱破裂的CT征象包括 :膀胱充盈不良 8例 ,膀胱壁挫伤 4例 ,膀胱内血凝块 6例。结论　在创伤情况下 ,腹膜腔内出现CT值比血液小的低密度液体积聚 ,强烈提示尿外渗 ,根据尿外渗的分布范围 ,CT还可以区别腹膜内和腹膜外型膀胱破裂。CT有时还可以观察到膀胱破裂的准确位置 ,有利于手术修补     

腹部钝性创伤中肠道及肠系膜损伤的CT表现

肠道及肠系膜损伤在腹部钝性伤中的发生率较高且易出现诊断延迟或漏诊。多层X线计算机断层成像具有较高的空间、时间和对比度分辨率,提高了肠道及肠系膜损伤诊断率。可显示腹腔内脏器损伤的直接和间接影像,指导非手术治疗或手术治疗的选择和效果评估。本文就肠道及肠系膜损伤在CT中特异性和非特异性征象作一论述。     

增强CT对腹部实质脏器损伤的诊断价值

目的：探讨增强CT扫描检查对腹部实质脏器损伤的诊断价值。方法：回顾性分析63例经手术、血管造影及CT随访证为腹部钝性损伤病人的平扫及增强CT表现征象,并比较分析各种征象的作用。结果：本组63例中,11例（2例脾损伤,3例肝损伤,6例肾损伤）平扫换明显异常,增强CT扫描呈明显的低工改变;11例器官内或周围斑点状造影剂外渗,提示为活动性出血;29例增强 CT扫描后清楚显示裂伤部位,结论：增强CT检查对肝肾损伤的诊断明显优于平扫,还可以判断有无活动性出血等情况,对损伤程度的判断和治疗方案的制定较平扫更有价值。     

Helical CT of diaphragmatic rupture caused by blunt trauma

OBJECTIVE: The purpose of this study was to determine the diagnostic sensitivity and specificity of helical CT with sagittal and coronal reformatted images in detecting diaphragmatic rupture after blunt trauma. MATERIALS AND METHODS: Chest and abdominal helical CT scans obtained in 41 patients with suspected diaphragmatic injury after major blunt trauma were reviewed by three observers who were unaware of surgical findings. Coronal and sagittal reformatted images were reviewed for each patient as well. Findings consistent with diaphragmatic injury, such as waistlike constriction of abdominal viscera (i.e., the "collar sign"), intrathoracic herniation of abdominal contents, and diaphragmatic discontinuity were recorded. Sensitivity and specificity of helical CT were calculated on the basis of surgical findings and clinical follow-up. RESULTS: Helical CT was performed preoperatively in 23 patients with diaphragmatic rupture (left, n = 17; right, n = 5; bilateral, n = 1). An additional 18 patients underwent helical CT to further evaluate suspicious findings seen on chest radiography at admission and were found to have an intact diaphragm. Sensitivity for detecting left-sided diaphragmatic rupture was 78% and specificity was 100%. Sensitivity for the detection of right-sided diaphragmatic rupture was 50% and specificity was 100%. The most common CT finding of diaphragmatic rupture was the collar sign, identified in 15 patients (sensitivity, 63%; specificity, 100%). Diaphragmatic discontinuity was seen in four patients. CONCLUSION: Helical CT, especially with the aid of reformatted images, is useful in the diagnosis of acute diaphragmatic rupture after blunt trauma. Helical CT can be used to detect 78% of left-sided and 50% of right-sided injuries.     

多层螺旋CT诊断急性腹部闭合性外伤的临床价值

收集我院2009年9月～2011年8月经多层螺旋CT检查及手术证实急性腹部闭合性外伤58例患者临床资料,探讨多层螺旋CT诊断急性腹部闭合性外伤的临床价值。1材料与方法本组58例患者,其中男性47例,女性11例,年龄7～79岁,平均43岁。患者均有明确外伤史,其中车祸伤42例、     

闭合性阴囊损伤的CT诊断

目的确定闭合性阴囊损伤的ＣＴ诊断价值。方法 对２３例闭合性阴囊损伤的ＣＴ资料及临床处理进行回顾性分析。结果 根据睾丸失去正常的卵圆形结构，白膜中断，睾丸组织突出或睾丸断片分离等征象，ＣＴ正确诊断睾丸破裂８例；ＣＴ亦能显示阴囊壁血肿，鞘膜积血，白膜下血肿，睾丸实质血肿，睾丸附睾挫伤，精索及附睾血肿等其他病理改变。１７例手术探查证实ＣＴ显示的各种病理改变与手术病理完全相符。结论 ＣＴ能准确诊断各种类型     

胰腺钝性伤的CT诊断

目的：总结分析胰腺钝性伤的CT征象。方法：经手术证实的胰腺钝性伤5例,回顾分析其CT表现及特点。结果：2例分别为胰腺断裂和实质出血的胰腺钝性伤患者,未能及时诊断和有效治疗,并发了重症胰腺炎、胰周感染和脓肿等严重并发症,致使住院治疗时间明显延长。另3例及时诊断和治疗,患者很快恢复出院,结论：CT是诊断胰腺钝性伤的首选方法。正确认识CT征象能及时作出诊断,为适时手术提供依据,从而减少并发症及死亡率,特别是对胰腺损伤程度严重的患者。     

闭合性喉损伤的CT诊断

目的 搪塞闭合性喉损伤的ＣＴ表现及诊断价值。方法 对１６例闭合性喉损伤病人的ＣＴ和临床资料进行回顾性分析。结果 软组织损伤５例,杓会厌襞和真假声带肿胀、气道狭窄４例,左环杓关节脱位,声带麻痹１例;声门损伤２例;均有会咽软骨骨折伴榴府厌襞和下咽部撕裂;声门损伤４例;甲状软骨右翼部骨折１例,甲状软骨前联合部纵行或粉碎骨折３例,其中１例骨折片进入喉腔形成异物,两侧声带和前联合撕脱;声门下损伤（５例）：左     

Chest injury in children with blunt abdominal trauma: evaluation with CT

One or more significant chest injuries were identified in 62 of 512 children (12%) examined with computed tomography (CT) after blunt abdominal trauma. Thirty-eight percent of all abnormalities identified on CT scans were underestimated or missed on the initial chest radiograph. Pleural and parenchymal abnormalities were missed in 50% and 34% of initial chest radiographs, respectively. Chest injuries occurred more frequently in children less than 7 years of age than in older children (62% vs 38%, P less than .02). Children with chest injuries tended to be more physiologically unstable than children without, as determined with lower (worse) mean trauma scores (P less than .001). Both the presence and severity of chest injuries strongly affected outcome. Mortality was 1.3% in children with no chest injury, 10.8% in children with significant unilateral chest injury, and 40% in children with significant bilateral or mediastinal chest injury (P less than .0001). Significant unsuspected or underestimated thoracic injuries are relatively common in children, and CT scans of the chest obtained while examinations of the upper abdomen are being performed can be helpful in the early recognition of such 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.     

钝性脾损伤的CT诊断

目的探讨CT非增强扫描对钝性脾损伤的诊断价值。方法回顾性分析经CT非增强扫描并经手术及临床确诊的41例钝性脾损伤。结果脾脏包膜下血肿12例,脾内血肿16例,脾撕裂伤19例,脾粉碎8例,伴有腹腔积血30例。无假阳性,3例假阴性,CT非增强扫描诊断脾损伤敏感性92.7%,特异性100%,准确率92.7%。结论CT非增强扫描能够较好的显示钝性脾脏损伤的表现,为临床治疗提供可靠依据。     

Abdominal aortic injury in blunt abdominal trauma

Injury to the abdominal aorta secondary to blunt abdominal trauma is rare; less than 50 cases have been reported in the literature. This patient failed to demonstrate any of the classic acute signs or symptoms specific to the aortic injury, thus emphasizing the importance of a high index of suspicion in patients with the appropriate mechanism and location of injury and associated signs and symptoms.     

CT diagnosis of abdominal trauma

Computed tomography (CT) findings from 95 patients with blunt abdominal trauma were evaluated. Among them, there was no false negative case. It can thus be said that if CT is negative the patient can be treated conservatively. The efficacy of CT in diagnosing injuries of various organs was also evaluated.     

Rupture of the bowel after blunt abdominal trauma: diagnosis with CT.

OBJECTIVE. The accuracy of CT in the detection of injuries of the solid viscera after blunt trauma is well established, but the value of CT in diagnosing bowel rupture resulting from blunt trauma is controversial. This study was conducted to determine the sensitivity of CT in diagnosing posttraumatic bowel rupture. SUBJECTS AND METHODS. During a 51-month period, 17 preoperative CT scans were obtained in 16 patients who subsequently had bowel ruptures verified surgically. Both preoperative (prospective) and retrospective CT findings were analyzed in these patients. Retrospective interpretation was made by consensus of two radiologists. RESULTS. Surgically confirmed bowel ruptures occurred in the duodenum (five), ileum (four), jejunum (four), colon (four), and stomach (two). CT findings considered diagnostic of bowel perforation were detected prospectively on 10 (59%) of 17 scans; these included pneumoperitoneum without prior peritoneal lavage (six), mesenteric, intramural, or retroperitoneal free air (six), or direct visualization of discontinuity of the bowel wall or extravasation of luminal contents (four). Prospective CT findings considered suggestive of bowel rupture were present on five (29%) of the 17 scans; these included intraperitoneal fluid of unknown source (three), thickened (> 4-5 mm) bowel wall (two), gross anterior pararenal fluid without a recognized source (one), and a mesenteric-bowel wall hematoma (one). On two of 17 scans, findings were seen in retrospect only; these included free intraperitoneal blood without a source (findings on a second CT scan were diagnostic) and pneumoperitoneum. CT findings diagnostic or suggestive of bowel injury were detected prospectively on 15 (88%) of 17 scans and were noted in all retrospectively. CONCLUSION. CT is sensitive for the diagnosis of bowel rupture resulting from blunt trauma, but careful inspection and technique are required to detect often subtle findings.