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The role of computed tomography in abdominal and pelvic trauma
Journal of Computed Tomography 6:113-119,
1982
THE ROLE OF COMPUTED TOMOGRAPHY IN ABDOMINAL AND PELVIC TRAUMA* NEELA
LAMKI AND BHARAT
RAVAL
CT findings in 32 patients with abdominal and pelvic trauma are the subject of this report. Four patients had more than one organ involved. The most common abdominal organ to be injured in our series was the pancreas, unlike other series. Findings of pancreatic, splenic, hepatic, renal, and pelvic injuries are described. The role of CT in the investigation of a patient with abdominal and pelvic trauma is discussed and compared with other imaging modalities. CT was found to be superior especially as it is highly sensitive and not organ specific. KEY WORDS:
Trauma-Abdomen,
radiograph is done to evaluate the extent of injury and to decide the levels at which computed tomograms are required. Following intravenous injection of contrast medium, l-cm thick slices at l-cm intervals are taken through the upper abdomen from the diaphragm to the lower poles of the kidneys. When injury to the lower abdomen and pelvis is suspected, similar slices are taken at Z-cm intervals from the lower poles of the kidneys to the base of the bladder. If only pelvic trauma is suspected, no contrast is used. One-centimeter thick slices at l-cm intervals are done from the superior aspect of the acetabulum to the level of the greater trochanter.
pelvis
Computed tomography (CT) is invaluable in the rapid assessment of abdominal organs as well as the bony skeleton in the victim of trauma. Reports of usefulness and efficacy of CT in abdominal and pelvic trauma [l-8] are appearing increasingly in the literature. We would like to report our observations on 32 patients with history of abdominal trauma and positive CT findings. TECHNIQUE
All patients with abdominal trauma are given dilute contrast medium orally or via a nasogastric tube at least ‘/z-l hr prior to CT examination. A computed From the Department of Radiology, University Hospital, University of Western Ontario, London, Ontario, Canada *Presented in part at the 44th Annual Meeting of the Canadian Association of Radiologists, Toronto, April 1961. Address reprint requests to N. Lamki, M.D., Department of Radiology, University Hospital, P.O. Box 5339, Station ‘A’, London, Ontario, Canada N6A 5A5. Received 1981; accepted January 15, 1982. 0 1982 by Elsevier Science Publishing Co., Inc. 52 Vanderbilt Ave., New York, NY 10017 0149-936x/82/060113-07$2.75
RESULTS AND OBSERVATIONS We had a total of 32 patients with abdominal trauma who had positive CT findings. Four patients had involvement in more than one organ (see below]. Trauma Location Pancreatic
Number of Patientsa
injury
11
Liver
7
Kidneys
6 5
Spleen Retroperitoneal
hemorrhage
2 7
Pelvis “Four patients had multiple injuries.
Splenic
Injuries
Splenic injuries were not the commonest in our series; however, the spleen is the most frequently injured organ in patients with abdominal trauma. We classify the splenic injuries as follows: 1. Subcapsular hematoma 2. Intrasplenic hematoma 3. Single or multiple lacerations.
5
FIGURE 1. Subcapsular splenic hematoma. A low density collection of fluid indents the splenic parenchyma. FIGURE 2. Spenic lacerations. Linear bands of low density are seen in the splenic parenchyma (arrows). FIGURE 3. Subcapsular hepatic hematoma. A low density collection of fluid is limited by the liver capsule. FIGURE 4. Parenchymal hepatic hematoma. There is a low-density collection of fluid within the hepatic parenchyma. FIGURE 5. A linear area of low density liver laceration.
represents
the
SEPTEMBER 1982
CT IN ABDOMINAL
AND PELVIC TRAUMA
115
FIGURE 6. (A) A sagittally reformatted image shows the hepatic laceration with collection of fluid that has a low CT number. (B) A composite right lateral image from 99mTc HIDA (grey areas) and 99mTc sulfur colloid (white area) radionuclide scans confirms that the fluid collection in the hepatic laceration is bile.
The subcapsular hematoma is seen as a lenticular-shaped, low-density collection of blood limited by the splenic capsule and indenting the parenchyma of the spleen (Figure 1). The intrasplenic hematoma, on the other hand, is not limited by the FIGURE 7. (A) The right lateral view from 99mTc sulfur colloid liver scan depicts a photon-deficient area in the inferior aspect of the liver. (B) CT in the same patient shows an area of necrosis in the right lobe of the liver.
splenic capsule and is seen as a low-density lesion within the contrast-enhanced splenic parenchyma. Lacerations are seen as linear bands of low density in the contrast-enhanced splenic parenchyma (Figure 2). The presence of free blood in the peritoneal cavity can be easily seen on computed tomography if the bleeding is recent because of its high CT number. When the blood is old, the CT number is low; hence, this blood cannot be distinguished from ascitic fluid.
116
LAMKI AND RAVAL
THE JOURNAL OF COMPUTED TOMOGRAPHY VOL. 6 NO. 2
Liver Injuries Liver injuries were the second most common in our series, as in other series. We classify them thus: 1.
Immediate a. Subcapsular hematoma b. Parenchymal hematoma c. Laceration
2. Delayed a. Liver necrosis b. Bile leak c. Abscess. The subcapsular hematoma is seen as a crescentshaped collection of fluid just under the liver capsule indenting the liver parenchyma (Figure 3). The parenchymal hematoma appears as a low-density area within the liver and is not limited by the capsule [Figure 4). Liver lacerations may be complete or incomplete and are seen as linear areas of low density within the contrast-enhanced liver parenchyma (Figure 5). If the laceration involves a bile duct, there may be collection of bile which may be intrahepatic or extmhepatic (biloma) depending on the extent and position of the laceration. It is impossible to differentiate between bile and old blood on CT. Radionuclide study with QQmTc HIDA, which is excreted into the bile, may help in such cases. We had one such patient who had liver laceration with low-density fluid collection within the liver parenchyma [Figure 6A). The CT was done 2 weeks after trauma, and we could not determine on CT whether the fluid was old blood or bile. A QQmTc HIDA scan was then done and it showed the fluid collection to be bile (Figure 6B). We had another patient who had a liver laceration sutured prior to being transferred to our hospital because he was doing poorly postoperatively. A radionuclide study of liver with “*Tc sulfur colloid showed a photon-deficient area in the region of the previously sutured liver laceration (Figure 7A). CT scanning of the liver showed that the photondeficient area was an area of liver necrosis (Figure 7B). Liver abscess is yet another complication of abdominal trauma and it can easily be identified on CT, but cannot be differentiated from liver abscess owing to other causes. Renal Injuries Renal injuries were the third most common in our series. We classify them as follows: 1. Subcapsular hematoma 2. Intrarenal hematoma
FEURE 8. Intrarenal hematomain the right kidney is seen as a low density within the contrast-enhanced renal parenchyma. Splenic laceration is also present, seen at the same anatomical level.
3. Perirenal hemorrhage 4. Complete laceration 5. Partial laceration a. Communicating with calyces b. Not communicating with calyces. Subcapsular hematoma is often suspected from a QQmTc DMSA (dimethyl succinic acid) renal scan, but can be positively identified only by CT. It appears as a crecent-shaped collection of blood limited by the renal capsule and indenting the renal parenchyma. The CT density of the extravasated blood is
FIGURE 9. Perirenal hemorrhage of the right kidney. There is collection of blood within the perirenal space but clearly outside the renal capsule.
SEPTEMBER 1982
CT IN ABDOMINAL
FIGURE 10.
Laceration of the kidney with complete severance of blood supply appears as an absence of enhancement of the right kidney parenchyma. (Reprinted with permission from Raval et al. [9])
lower than that of renal parenchyma; which is enhanced with intravenous contrast. Intrarenal hematoma is seen as a low-density area within the contrast-enhanced renal parenchyma (Figure 8). Perirenal hemorrhage is seen as a collection of blood just outside the renal capsule but within the perirenal fat (Figure 9). Laceration of the kidney with complete severance of the blood supply shows no contrast enhancement of the kidney parenchyma (Figure 10). Partial laceration can also be easily diagnosed by CT. Extravasation of the contrast medium, whether from partial laceration of the kidney or of the ureter, is clearly seen with CT because of the inherent resolution and sensitivity of CT. Until the advent of CT scanners, Intravenous Urography was the standard. CT eliminates the necessity of intravenous urography because it permits better definition of the renal injuries, greater sensitivity in detecting extravasation, assessment of perirenal hematoma, and simultaneous assessment of injury to other organs. Pancreatic
Injuries
Pancreatic injuries are uncommon in other series but were the most common in our series. The major reason for this is that we are a tertiary referral center. We classify these injuries as follows: 1. 2. 3. 4.
Laceration Traumatic Pancreatic Pancreatic Lacerations
pancreatitis pseudocyst formation abscesses formation. are seen as linear defects in the pan-
AND PELVIC TRAUMA
117
FIGURE 11. Pancreatic laceration is manifested as a lin-
ear lucency through the pancreatic neck. (Reprinted with permission from RavoJ et al. [9])
creatic gland (Figure 11). Traumatic pancreatitis has the same CT features as pancreatitis due to other causes. The CT findings of pancreatitis have been extensively described in the literature. Traumatic pancreatitis may go on to the pseudocyst formation (Figure 12) or abscess formation, or both. Again, there are no specific features to distinguish pancreatic pseudocyst and pancreatic abscess due to other causes. CT is the most accurate and least invasive diagnostic procedure to investigate pancreatic injuries and sequelae. FIGURE 12. Pseudocyst
formation following traumatic pancreatitis is visualized by CT in this patient with blunt abdominal trauma.
118
LAMKI AND RAVAL
FIGURE 13. A cornminuted fracture of the posterior lip of the left acetabulum with a tiny intraarticular bony fragment are distinctly visualized by CT.
Pelvic Injuries Pelvic injuries may be classified into: 1. Acetabular fractures a. With intraarticular bony fragment b. Without intraarticular bony fragment 2. Femoral head fractures a. With intraarticular bony fragment b. Without intraarticular bony fragment 3. Other pelvic fractures.
THE JOURNAL
OF COMPUTED
TOMOGRAPHY
VOL. 6 NO. 2
puted radiograph not only eliminates the need for plain films but allows anteroposterior and lateral projections without movement of the patient. CT, when compared to other imaging modalities, such as radionuclide scanning and angiography, has the advantages of not being organ-specific and of being highly sensitive. Radionuclide scanning is useful when only splenic trauma is suspected and is extremely useful when bile leak is suspected, in which case ggmTc HIDA scanning is the procedure of choice. Radionuclide scanning thus has a limited role in a traumatized patient, especially in a center where CT is available. Ultrasound plays a less useful role than CT in a patient with trauma because it is hampered by obesity and by bowel gas, which is commonly present as a result of adynamic ileus. Bony injuries cannot be detected by ultrasound. With the advent of CT scanners, especially with the option of computed radiography, the radiological assessment of the trauma victim has been revolutionized. CT has high sensitivity and specificity when compared to other imaging modalities. CT assesses injury to the abdominal organs and bones simultaneously. It also has the potential of detecting vascular injuries now that dynamic CT scanning has been introduced. Every trauma center should have CT scanning available 24 hours a day to enable rapid and simultaneous detection of the constellation of multiple injuries that trauma patients often sustain. We wish to acknowledge the stenographic assistance of Peggy Marrier.
REFERENCES
The cross-sectional dimension is currently the easiest and best way to examine hip and pelvic fractures. The demonstration of involvement of anterior and/or posterior pillar and intraarticular fragment (Figure 13) is extremely valuable to the surgeon in deciding on operative versus conservative treatment. This assessment can be obtained rapidly with very little discomfort to the patient.
Federle MP, GoldbergHI, Kaiser JA, Moss AA, Jeffrey RB Jr, Mall JC: Evaluationof abdominaltraumaby computedtomography. Radiology138:637-644, 1981 2. Federle MP: Abdominal trauma: The role and impact of computed tomography.Invest Radio116:260-268, 1981 3. Druy EM, Rubin BE: Computedtomographyin the evaluation of abdominaltrauma. TComputAssist Tomogr 3:40-44, 1979 4. Schaner EG, Balow JE, DoppmanJL: Computedtomography in the diagnosis of subcapsular and perirenal hematoma.AJR
DISCUSSION
5. Mall JC, Kaiser JA: 134:265-269,198O
1.
129:83-88,1977
With the availability of the option of computed radiography on the present-day CT scanner, the patient with severe trauma can be transferred directly from the Emergency Room to the CT scanner, obviating the need for plain radiographs. The extent of bony injuries can be assessed from the computed radiograph and simultaneously the levels of computed tomograms may be decided on. The com-
Ct diagnosis of splenic laceration. AJR
Korobkin M, Moss AA, Callen PW, Demartini WJ, Kaiser JA: Computedtomographyof subcapsular splenic hematoma.Radiology 129:441-445, 1978 7. Sauser DD, Billimoria PE, Rouse GA, Mudge K: CT evaluation 6.
of hip trauma. AJR 135:269-274,
1980
8. Shirkhoda A, Brashear HR, Staab EV: Computed of acetabular fractures. Radiology 134:683, 1980
tomography
9. Raval B, Wan R, Carey L: The spectrum of liver disease on CT. J Can Assoc Radio1 30:211-215, 1979
CT IN ABDOMINAL
SEPTEMBER 1982
CONTINUING
MEDICAL
Choose one correct 1.
EDUCATION
QUESTIONS
answer.
Computed tomography eliminates the necessity of intravenous urography in renal injuries as CT permits a. Better definition of renal injuries b. Greater sensitivity in detecting extravasation c. Assessment of perirenal hematoma d. Simultaneous assessment of injury to other organs e. All of the above
2. Computed radiography is useful in the patient with trauma because a. Extent of bony injuries can be assessed b. Levels of computed tomograms can be decided on c. Anteroposterior and lateral projections can be done without movement of the patient d. All of the above
AND PELVIC TRAUMA
119
3. In liver laceration where CT shows collection of fluid, which of the following procedures is most appropriate in differentiating between old blood and bile? a. Ultrasonography b. Gallium scanning c. Immediate needle aspiration d. ggmTc HIDA scanning True or False 4. The CT appearance of acute traumatic pancreatitis is distinct enough to be distinguished from acute pancreatitis of other etiology.
1982
THE ROLE OF COMPUTED TOMOGRAPHY IN ABDOMINAL AND PELVIC TRAUMA* NEELA
LAMKI AND BHARAT
RAVAL
CT findings in 32 patients with abdominal and pelvic trauma are the subject of this report. Four patients had more than one organ involved. The most common abdominal organ to be injured in our series was the pancreas, unlike other series. Findings of pancreatic, splenic, hepatic, renal, and pelvic injuries are described. The role of CT in the investigation of a patient with abdominal and pelvic trauma is discussed and compared with other imaging modalities. CT was found to be superior especially as it is highly sensitive and not organ specific. KEY WORDS:
Trauma-Abdomen,
radiograph is done to evaluate the extent of injury and to decide the levels at which computed tomograms are required. Following intravenous injection of contrast medium, l-cm thick slices at l-cm intervals are taken through the upper abdomen from the diaphragm to the lower poles of the kidneys. When injury to the lower abdomen and pelvis is suspected, similar slices are taken at Z-cm intervals from the lower poles of the kidneys to the base of the bladder. If only pelvic trauma is suspected, no contrast is used. One-centimeter thick slices at l-cm intervals are done from the superior aspect of the acetabulum to the level of the greater trochanter.
pelvis
Computed tomography (CT) is invaluable in the rapid assessment of abdominal organs as well as the bony skeleton in the victim of trauma. Reports of usefulness and efficacy of CT in abdominal and pelvic trauma [l-8] are appearing increasingly in the literature. We would like to report our observations on 32 patients with history of abdominal trauma and positive CT findings. TECHNIQUE
All patients with abdominal trauma are given dilute contrast medium orally or via a nasogastric tube at least ‘/z-l hr prior to CT examination. A computed From the Department of Radiology, University Hospital, University of Western Ontario, London, Ontario, Canada *Presented in part at the 44th Annual Meeting of the Canadian Association of Radiologists, Toronto, April 1961. Address reprint requests to N. Lamki, M.D., Department of Radiology, University Hospital, P.O. Box 5339, Station ‘A’, London, Ontario, Canada N6A 5A5. Received 1981; accepted January 15, 1982. 0 1982 by Elsevier Science Publishing Co., Inc. 52 Vanderbilt Ave., New York, NY 10017 0149-936x/82/060113-07$2.75
RESULTS AND OBSERVATIONS We had a total of 32 patients with abdominal trauma who had positive CT findings. Four patients had involvement in more than one organ (see below]. Trauma Location Pancreatic
Number of Patientsa
injury
11
Liver
7
Kidneys
6 5
Spleen Retroperitoneal
hemorrhage
2 7
Pelvis “Four patients had multiple injuries.
Splenic
Injuries
Splenic injuries were not the commonest in our series; however, the spleen is the most frequently injured organ in patients with abdominal trauma. We classify the splenic injuries as follows: 1. Subcapsular hematoma 2. Intrasplenic hematoma 3. Single or multiple lacerations.
5
FIGURE 1. Subcapsular splenic hematoma. A low density collection of fluid indents the splenic parenchyma. FIGURE 2. Spenic lacerations. Linear bands of low density are seen in the splenic parenchyma (arrows). FIGURE 3. Subcapsular hepatic hematoma. A low density collection of fluid is limited by the liver capsule. FIGURE 4. Parenchymal hepatic hematoma. There is a low-density collection of fluid within the hepatic parenchyma. FIGURE 5. A linear area of low density liver laceration.
represents
the
SEPTEMBER 1982
CT IN ABDOMINAL
AND PELVIC TRAUMA
115
FIGURE 6. (A) A sagittally reformatted image shows the hepatic laceration with collection of fluid that has a low CT number. (B) A composite right lateral image from 99mTc HIDA (grey areas) and 99mTc sulfur colloid (white area) radionuclide scans confirms that the fluid collection in the hepatic laceration is bile.
The subcapsular hematoma is seen as a lenticular-shaped, low-density collection of blood limited by the splenic capsule and indenting the parenchyma of the spleen (Figure 1). The intrasplenic hematoma, on the other hand, is not limited by the FIGURE 7. (A) The right lateral view from 99mTc sulfur colloid liver scan depicts a photon-deficient area in the inferior aspect of the liver. (B) CT in the same patient shows an area of necrosis in the right lobe of the liver.
splenic capsule and is seen as a low-density lesion within the contrast-enhanced splenic parenchyma. Lacerations are seen as linear bands of low density in the contrast-enhanced splenic parenchyma (Figure 2). The presence of free blood in the peritoneal cavity can be easily seen on computed tomography if the bleeding is recent because of its high CT number. When the blood is old, the CT number is low; hence, this blood cannot be distinguished from ascitic fluid.
116
LAMKI AND RAVAL
THE JOURNAL OF COMPUTED TOMOGRAPHY VOL. 6 NO. 2
Liver Injuries Liver injuries were the second most common in our series, as in other series. We classify them thus: 1.
Immediate a. Subcapsular hematoma b. Parenchymal hematoma c. Laceration
2. Delayed a. Liver necrosis b. Bile leak c. Abscess. The subcapsular hematoma is seen as a crescentshaped collection of fluid just under the liver capsule indenting the liver parenchyma (Figure 3). The parenchymal hematoma appears as a low-density area within the liver and is not limited by the capsule [Figure 4). Liver lacerations may be complete or incomplete and are seen as linear areas of low density within the contrast-enhanced liver parenchyma (Figure 5). If the laceration involves a bile duct, there may be collection of bile which may be intrahepatic or extmhepatic (biloma) depending on the extent and position of the laceration. It is impossible to differentiate between bile and old blood on CT. Radionuclide study with QQmTc HIDA, which is excreted into the bile, may help in such cases. We had one such patient who had liver laceration with low-density fluid collection within the liver parenchyma [Figure 6A). The CT was done 2 weeks after trauma, and we could not determine on CT whether the fluid was old blood or bile. A QQmTc HIDA scan was then done and it showed the fluid collection to be bile (Figure 6B). We had another patient who had a liver laceration sutured prior to being transferred to our hospital because he was doing poorly postoperatively. A radionuclide study of liver with “*Tc sulfur colloid showed a photon-deficient area in the region of the previously sutured liver laceration (Figure 7A). CT scanning of the liver showed that the photondeficient area was an area of liver necrosis (Figure 7B). Liver abscess is yet another complication of abdominal trauma and it can easily be identified on CT, but cannot be differentiated from liver abscess owing to other causes. Renal Injuries Renal injuries were the third most common in our series. We classify them as follows: 1. Subcapsular hematoma 2. Intrarenal hematoma
FEURE 8. Intrarenal hematomain the right kidney is seen as a low density within the contrast-enhanced renal parenchyma. Splenic laceration is also present, seen at the same anatomical level.
3. Perirenal hemorrhage 4. Complete laceration 5. Partial laceration a. Communicating with calyces b. Not communicating with calyces. Subcapsular hematoma is often suspected from a QQmTc DMSA (dimethyl succinic acid) renal scan, but can be positively identified only by CT. It appears as a crecent-shaped collection of blood limited by the renal capsule and indenting the renal parenchyma. The CT density of the extravasated blood is
FIGURE 9. Perirenal hemorrhage of the right kidney. There is collection of blood within the perirenal space but clearly outside the renal capsule.
SEPTEMBER 1982
CT IN ABDOMINAL
FIGURE 10.
Laceration of the kidney with complete severance of blood supply appears as an absence of enhancement of the right kidney parenchyma. (Reprinted with permission from Raval et al. [9])
lower than that of renal parenchyma; which is enhanced with intravenous contrast. Intrarenal hematoma is seen as a low-density area within the contrast-enhanced renal parenchyma (Figure 8). Perirenal hemorrhage is seen as a collection of blood just outside the renal capsule but within the perirenal fat (Figure 9). Laceration of the kidney with complete severance of the blood supply shows no contrast enhancement of the kidney parenchyma (Figure 10). Partial laceration can also be easily diagnosed by CT. Extravasation of the contrast medium, whether from partial laceration of the kidney or of the ureter, is clearly seen with CT because of the inherent resolution and sensitivity of CT. Until the advent of CT scanners, Intravenous Urography was the standard. CT eliminates the necessity of intravenous urography because it permits better definition of the renal injuries, greater sensitivity in detecting extravasation, assessment of perirenal hematoma, and simultaneous assessment of injury to other organs. Pancreatic
Injuries
Pancreatic injuries are uncommon in other series but were the most common in our series. The major reason for this is that we are a tertiary referral center. We classify these injuries as follows: 1. 2. 3. 4.
Laceration Traumatic Pancreatic Pancreatic Lacerations
pancreatitis pseudocyst formation abscesses formation. are seen as linear defects in the pan-
AND PELVIC TRAUMA
117
FIGURE 11. Pancreatic laceration is manifested as a lin-
ear lucency through the pancreatic neck. (Reprinted with permission from RavoJ et al. [9])
creatic gland (Figure 11). Traumatic pancreatitis has the same CT features as pancreatitis due to other causes. The CT findings of pancreatitis have been extensively described in the literature. Traumatic pancreatitis may go on to the pseudocyst formation (Figure 12) or abscess formation, or both. Again, there are no specific features to distinguish pancreatic pseudocyst and pancreatic abscess due to other causes. CT is the most accurate and least invasive diagnostic procedure to investigate pancreatic injuries and sequelae. FIGURE 12. Pseudocyst
formation following traumatic pancreatitis is visualized by CT in this patient with blunt abdominal trauma.
118
LAMKI AND RAVAL
FIGURE 13. A cornminuted fracture of the posterior lip of the left acetabulum with a tiny intraarticular bony fragment are distinctly visualized by CT.
Pelvic Injuries Pelvic injuries may be classified into: 1. Acetabular fractures a. With intraarticular bony fragment b. Without intraarticular bony fragment 2. Femoral head fractures a. With intraarticular bony fragment b. Without intraarticular bony fragment 3. Other pelvic fractures.
THE JOURNAL
OF COMPUTED
TOMOGRAPHY
VOL. 6 NO. 2
puted radiograph not only eliminates the need for plain films but allows anteroposterior and lateral projections without movement of the patient. CT, when compared to other imaging modalities, such as radionuclide scanning and angiography, has the advantages of not being organ-specific and of being highly sensitive. Radionuclide scanning is useful when only splenic trauma is suspected and is extremely useful when bile leak is suspected, in which case ggmTc HIDA scanning is the procedure of choice. Radionuclide scanning thus has a limited role in a traumatized patient, especially in a center where CT is available. Ultrasound plays a less useful role than CT in a patient with trauma because it is hampered by obesity and by bowel gas, which is commonly present as a result of adynamic ileus. Bony injuries cannot be detected by ultrasound. With the advent of CT scanners, especially with the option of computed radiography, the radiological assessment of the trauma victim has been revolutionized. CT has high sensitivity and specificity when compared to other imaging modalities. CT assesses injury to the abdominal organs and bones simultaneously. It also has the potential of detecting vascular injuries now that dynamic CT scanning has been introduced. Every trauma center should have CT scanning available 24 hours a day to enable rapid and simultaneous detection of the constellation of multiple injuries that trauma patients often sustain. We wish to acknowledge the stenographic assistance of Peggy Marrier.
REFERENCES
The cross-sectional dimension is currently the easiest and best way to examine hip and pelvic fractures. The demonstration of involvement of anterior and/or posterior pillar and intraarticular fragment (Figure 13) is extremely valuable to the surgeon in deciding on operative versus conservative treatment. This assessment can be obtained rapidly with very little discomfort to the patient.
Federle MP, GoldbergHI, Kaiser JA, Moss AA, Jeffrey RB Jr, Mall JC: Evaluationof abdominaltraumaby computedtomography. Radiology138:637-644, 1981 2. Federle MP: Abdominal trauma: The role and impact of computed tomography.Invest Radio116:260-268, 1981 3. Druy EM, Rubin BE: Computedtomographyin the evaluation of abdominaltrauma. TComputAssist Tomogr 3:40-44, 1979 4. Schaner EG, Balow JE, DoppmanJL: Computedtomography in the diagnosis of subcapsular and perirenal hematoma.AJR
DISCUSSION
5. Mall JC, Kaiser JA: 134:265-269,198O
1.
129:83-88,1977
With the availability of the option of computed radiography on the present-day CT scanner, the patient with severe trauma can be transferred directly from the Emergency Room to the CT scanner, obviating the need for plain radiographs. The extent of bony injuries can be assessed from the computed radiograph and simultaneously the levels of computed tomograms may be decided on. The com-
Ct diagnosis of splenic laceration. AJR
Korobkin M, Moss AA, Callen PW, Demartini WJ, Kaiser JA: Computedtomographyof subcapsular splenic hematoma.Radiology 129:441-445, 1978 7. Sauser DD, Billimoria PE, Rouse GA, Mudge K: CT evaluation 6.
of hip trauma. AJR 135:269-274,
1980
8. Shirkhoda A, Brashear HR, Staab EV: Computed of acetabular fractures. Radiology 134:683, 1980
tomography
9. Raval B, Wan R, Carey L: The spectrum of liver disease on CT. J Can Assoc Radio1 30:211-215, 1979
CT IN ABDOMINAL
SEPTEMBER 1982
CONTINUING
MEDICAL
Choose one correct 1.
EDUCATION
QUESTIONS
answer.
Computed tomography eliminates the necessity of intravenous urography in renal injuries as CT permits a. Better definition of renal injuries b. Greater sensitivity in detecting extravasation c. Assessment of perirenal hematoma d. Simultaneous assessment of injury to other organs e. All of the above
2. Computed radiography is useful in the patient with trauma because a. Extent of bony injuries can be assessed b. Levels of computed tomograms can be decided on c. Anteroposterior and lateral projections can be done without movement of the patient d. All of the above
AND PELVIC TRAUMA
119
3. In liver laceration where CT shows collection of fluid, which of the following procedures is most appropriate in differentiating between old blood and bile? a. Ultrasonography b. Gallium scanning c. Immediate needle aspiration d. ggmTc HIDA scanning True or False 4. The CT appearance of acute traumatic pancreatitis is distinct enough to be distinguished from acute pancreatitis of other etiology.