Computed tomographic diagnosis of a “midline package” of abdominal trauma: Two illustrative cases

A “midline package” of abdominal injuries may occur when the anterior mid-abdomen suffers direct blunt trauma. This package may include lacerations of the left lobe of the liver, pancreatic lacerations or fractures, and bowel injuries; if high in location, it may also be associated with sternal fractures and cardiac injuries. A common cause is motor vehicle accidents in which the driver suffers anterior abdominal compression from striking the steering wheel or steering column. Two cases are illustrated that were correctly diagnosed by abdominal computed tomography. The authors recommend an awareness of abdominal injury mechanisms and a knowledge of the expected combinations of abdominal injuries that may result.