J Korean Soc Radiol.  2019 May;80(3):445-465. 10.3348/jksr.2019.80.3.445.

Multidetector CT in Blunt Abdominal Trauma: Imaging Findings and Pitfalls

• Lee J
• Ahn JH

• KMID: 2454025
• DOI: http://doi.org/10.3348/jksr.2019.80.3.445

Abstract

Owing to the developments in imaging modalities, imaging has become an essential element in the early evaluation of and decision-making algorithm for patients with trauma. In particular, CT technology has developed over the past decades, resulting in faster image acquisition and higher image quality. Currently, CT is the key imaging modality for triaging surgical and non-surgical treatment in patients with abdominal trauma and plays an important role in increasing the frequency and success rate of non-surgical treatment. Because rapid and accurate diagnosis of injury in patients with trauma can improve the patients' prognosis, radiologists should be familiar with the imaging findings, especially the CT findings, in patients with trauma. In this article, the authors reviewed the considerations when performing CT for evaluating abdominal trauma. In addition, they described the important imaging findings and pitfalls when diagnosing blunt trauma in various intra-abdominal organs.

MeSH Terms

Abdominal Injuries
Diagnosis
Humans
Multidetector Computed Tomography
Prognosis
Wounds, Nonpenetrating

Figure

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  Fig. 1. Active bleeding in a 49-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows contrast extravasation (arrows) at the mesentery.

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  Fig. 2. The sentinel clot sign in a 59-year-old man after a motor vehicle accident. A. The non-enhanced axial CT image demonstrates the difference in density between the hemoperitoneum (32 HU, black asterisk) around the liver and the clot (69 HU, white asterisk) around the spleen. B. The contrast-enhanced CT image shows the lacerations (arrows) in the spleen. HU = Hounsfield unit

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  Fig. 3. Liver laceration in an 18-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows irregular and linear low-attenuation areas (arrows) in the liver, consistent with a laceration.

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  Fig. 4. Intraparenchymal hematoma in a 22-year-old man after beating. The contrast-enhanced CT image demonstrates an ill-defined, round, low-attenuation area (arrows) in the right posterior section of the liver.

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  Fig. 5. Subcapsular hematoma versus perihepatic hematoma. A. Subcapsular hematoma in a 35-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows the elliptic collection of a low-attenuation area (arrows) between the liver capsule and the parenchyma, which caused indentation of the liver margin. B. However, such a finding is not seen in perihepatic hematoma (arrowheads) in a 24-year-old man after a motor vehicle accident.

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  Fig. 6. Hepatic infarction in a 17-year-old man after a motor vehicle accident. A. The contrast-enhanced CT image shows a lack of perfusion (arrows) to the left lateral section of the liver. B. The follow-up contrast-enhanced CT image acquired 7 days later shows total necrosis (asterisk) of the left lateral section of the liver.

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  Fig. 7. Periportal low attenuation in an 18-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows low-attenuation areas around the portal vein and its branch (arrows). Note the laceration that extends to the portal vein branch (arrowheads).

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  Fig. 8. Periportal low attenuation in a 31-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows low-attenuation areas around the portal vein and its branches (arrowheads). A finding of marked distention of the inferior vena cava (arrow) may indicate vigorous fluid replacement.

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  Fig. 9. Hepatic hemangioma initially diagnosed as hematoma in a 68-year-old man after a motor vehicle accident. A. The initial contrast-enhanced CT image demonstrates a low-attenuation lesion (arrow) in the left hemiliver, simulating a liver hematoma. B. The contrast-enhanced CT image acquired 3 days later shows peripheral-enhancing portions (arrowheads) within the low-attenuation lesion (arrow), which are most consistent with a hemangioma. Note the hepatic hematoma in the right hemiliver (black arrow).

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  Fig. 10. Post-traumatic pseudoaneurysm in a 56-year-old man after a 2-meter fall. A. The initial contrast-enhanced CT image shows a large hematoma (arrows) in the right hemiliver. B. The contrast-enhanced CT image acquired 18 days later shows a newly developed, well-defined pseudoaneurysm (arrow) within the hepatic hematoma.

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  Fig. 11. Bile duct injury in a 63-year-old man after a motor vehicle accident. A. The initial contrast-enhanced CT image shows multiple lacerations and hematoma (arrows) in the medial section of the left liver and anterior section of the right liver. B. The follow-up contrast-enhanced CT image acquired 83 days later shows the development of a biloma (arrows) and left intrahepatic duct dilatation (arrowheads).

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  Fig. 12. Splenic laceration in a 31-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows an irregular and linear low-attenuation area (arrows) in the spleen. Hematoma in the left adrenal gland is also seen (arrowheads).

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  Fig. 13. Congenital cleft in a 42-year-old man after a motor vehicle accident. The contrast-enhanced CT image demonstrates a smooth low-attenuation line (arrows) in the spleen without perisplenic fluid collection. Note the lacerations of the liver (arrowheads).

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  Fig. 14. Splenic pseudoaneurysm in a 54-year-old man after a motor vehicle accident. A. The contrast-enhanced CT image acquired in an early phase of enhancement during chest CT shows a high-attenuation area (arrowheads) in the spleen. B. The contrast-enhanced CT image acquired in the portal venous phase of enhancement shows that the

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  Fig. 15. Transection of the pancreas with active bleeding in a 47-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows a linear low-attenuation area (arrow) across the pancreatic tail. Note the high-attenuation contrast material extravasation (arrowheads) within the intrapancreatic hematoma.

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  Fig. 16. Pancreatic laceration with the disruption of the pancreatic duct in a 43-year-old man after a motor vehicle accident. A. The contrast-enhanced CT image shows a deep laceration with hematoma (arrows) in the pancreatic tail. B. The endoscopic retrograde pancreatogram shows extravasation (arrows) of contrast material from a pancreatic duct, indicating duct disruption.

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  Fig. 17. Sigmoid colon perforation in a 57-year-old man after a motor vehicle accident. A large mural defect is seen at the sigmoid colon (arrows) with feces (F) spilling from the lumen (L) and multifocal intraperitoneal extraluminal air (arrowheads).

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  Fig. 18. Large bowel transection in a 49-year-old man after a motor vehicle accident. The contrast-enhanced CT image shows abnormal dual bowel wall enhancement (both increased and decreased), as well as the Janus sign (arrowheads). The surrounding hematoma (arrows) makes it difficult to recognize the transected bowel end.

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  Fig. 20. Delayed bowel perforation in a 62-year-old man after a motor vehicle accident. A. The initial contrast-enhanced CT image shows minimal amount of mesenteric fluid (arrow) without abnormality of the bowel. B. The contrast-enhanced CT image acquired 5 days later shows a newly developed mural defect of the small bowel (arrows) with extraluminal air (asterisk).

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  Fig. 21. Hypoperfusion complex in a 61-year-old man after a motor vehicle accident. The contrast-enhanced CT image demonstrates hyperen-hancement of the small bowel mucosa, consistent with a shock bowel. Flattening of the inferior vena cava (arrow) is also seen.

Reference

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