Evaluation of non-contrast-enhanced CT in blunt abdominal trauma]

We compared the findings of noncontrast-enhanced CT with those of contrast-enhanced CT in 126 patients with blunt abdominal trauma to evaluate the usefulness of noncontrast-enhanced CT. In 112 of the patients, visceral injuries were confirmed by surgery or clinical follow-up including CT. Although noncontrast-enhanced CT diagnosed all patients with 12 intestinal injuries requiring immediate surgery, contrast-enhanced CT missed two of these patients because high density hematomas on noncontrast-enhanced CT became isodense after IV administration of contrast material. However, contrast-enhanced CT was superior to noncontrast-enhanced CT in the diagnosis of hepatic and renal injuries. A case of renal artery occlusion was only visualized on contrast-enhanced CT. We conclude that both noncontrast- and contrast-enhanced CT should be performed for the CT evaluation of blunt abdominal trauma.     

多层螺旋CT对腹部闭合性损伤的诊断价值

<正>腹部损伤约占所有损伤的0.4%～4.2%,常合并多脏器、多部位损伤而危及生命,其死亡率占所有损伤死亡率的10%。早期确诊腹部损伤的类别和准确定位有助于对伤者采取果断有效的处理措施、提高抢救成功率、降低死亡率、减少并发症。MSCT     

The value of CT in detecting bowel perforation in children after blunt abdominal trauma

In this era of conservative management for most infants and children with blunt abdominal trauma, there is a concern that the diagnosis of bowel perforation may be missed or delayed. To determine the sensitivity of CT in the detection of perforated viscus in this population, we reviewed the CT examinations of 547 consecutive children who had had blunt abdominal trauma. Of six patients (1%) with documented bowel perforation, four (67%) had free intraperitoneal air detected preoperatively by CT. The remaining two cases had secondary signs of bowel thickening and unexplained peritoneal fluid. Free intraperitoneal air was not a specific indicator for bowel perforation. Of nine patients in whom CT studies showed pneumoperitoneum, only four (44%) had a ruptured bowel. The remaining five patients had pneumoperitoneum from sources other than bowel perforation including pneumomediastinum, bladder perforation, and previous peritoneal lavage. This experience shows that the CT finding of pneumoperitoneum is useful, although not specific for the detection of bowel perforation in children with blunt abdominal trauma. When free air is not present, secondary signs of bowel wall thickening and unexplained peritoneal fluid suggest a bowel perforation.     

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、     

The clinical impact of CT for blunt abdominal trauma

The use of computed tomography (CT) has had a tremendous impact on the evaluation and management of blunt abdominal trauma. It is noninvasive, easy to perform, and has been shown to be highly sensitive (100%), specific (96.8%), and accurate (97.6%). The use of CT has helped decrease the total number of laparotomies performed for abdominal trauma at this institution (231 in 1975-1976, 74 in 1983) as well as the number of negative and nontherapeutic laparotomies. The use of other diagnostic tests such as radionuclide scans and angiography in blunt abdominal trauma has been virtually replaced by CT. Of the 41 peritoneal lavages performed in 1983, 39 were in patients who were in the operating room for treatment of other extraabdominal injuries (i.e., closed head injury, severe extremity trauma).     

钝性腹外伤并下腔静脉塌陷征的CT征象及其临床价值

目的:分析钝性腹外伤并下腔静脉塌陷征的CT征象,探讨这些征象的临床价值。方法:回顾性搜集我院诊治的23例有钝性腹外伤病史并出现下腔静脉塌陷征的患者,分析其临床表现和CT征象。结果:23例患者有2例死亡。腹部增强CT发现肝脾强化程度减弱16例,“休克肠”9例,肾延迟强化7例,肾上腺强化延迟6例,肾上腺强化增强3例,对比剂外渗2例。结论:下腔静脉塌陷征可能是早期预测血流动力学失稳和需要进一步手术干预的重要指标;同时,认识其伴发CT征象对判断失血性休克具有一定提示作用,对治疗和预后有重要意义。     

腹部闭合性创伤的急诊CT评价

目的：探讨急诊CT扫描在腹部闭合性创伤中的应用价值。方法：收集整理经手术或临床证实的腹部闭合性创伤65例急诊CT检查的影像资料,进行回顾性分析,所有病例均行CT平扫。结果：腹部闭合性创伤的急诊CT扫描主要表现为混杂高密度影像,多伴腹腔出血。本组65例腹部闭合性创伤中,肝脏损伤15例、脾26例、肾13例,肠系膜与肠管损伤2例,膀胱破裂2例,复合性实质性脏器损伤7例。其中51例伴腹腔出血,22例合并肋骨骨折。结论：急症CT扫描对诊断腹部闭合性创伤具有很大的价值,能明确腹部脏器损伤的部位、程度及复合性脏器损伤等信息,以指导临床医师制定有效的治疗方案。     

CT of false-negative peritoneal lavage following blunt abdominal trauma

The CT findings are presented in a patient with blunt trauma and a false-negative peritoneal lavage due to extraperitoneal insertion of the lavage catheter. Computed tomography correctly identified the presence of hemoperitoneum and the site of injury involving the small bowel mesentery. The diagnostic accuracy in peritoneal lavage and its relationship to abdominal CT is reviewed.     

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.     

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。     

CT signs of duodenal perforation secondary to blunt abdominal trauma

Two cases of duodenal perforation secondary to blunt abdominal trauma demonstrate CT findings of focal bowel wall thickening, interruption of progress of bowel contrast medium, and extraluminal gas and fluid.     

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。     

CT检查在腹部损伤治疗决策中的价值

腹部损伤是临床常见的外科急诊,其诊断、伤情评估及治疗决策极具挑战。在腹部损伤的诊治过程中,合理地应用腹部CT ,能够帮助我们更加准确地判断手术指征,决定手术时机和选择手术方式。     

Pediatric blunt abdominal trauma: periportal tracking at CT.

Periportal zones of decreased attenuation at computed tomography (CT) have been described in a variety of disorders. In the setting of blunt abdominal trauma, the zones have been attributed to dissection of blood along the portal tracts. Because of the observation of isolated periportal tracking (PPT) in children after blunt trauma, the authors retrospectively reviewed CT scans of the abdomen obtained in 114 children to determine the frequency of PPT, liver injury, and peritoneal fluid. PPT was present in 22% of patients (25 of 114); it was associated with liver injury in 10 and was the only liver abnormality in 15. Pathologic correlation was available in two patients: In one it revealed marked periportal lymphedema and in the other, PPT of blood. This study indicates that both hemorrhage and lymphatic edema may be represented as PPT in children after blunt abdominal injury.     

CT对腹部钝伤的诊断价值与限度

目的：探讨CT对腹部钝伤的诊断价值与限度。方法：应用CT扫描对42例胳部钝伤患者进行了检查。结果：CT扫描发现肾外伤19例,肝外伤5例,脾外伤19例,肠系膜血肿2例,肠穿孔2例,其中有5例为复合伤。CT扫描能清楚地显示脏器损伤及胳腔出血的程度和范围。结论：CT能迅速、准确地检出腹腔脏器损伤,为临床选择治疗方法提供重要依据。