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European Journal of Trauma and Emergency Surgery

Published in:

01-10-2011 | Original Article

Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment

Authors: M. E. Sims, L. K. Shin, J. Rosenberg, R. B. Jeffrey

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2011

Abstract

Purpose

The purpose of this study was to analyze the multidetector computed tomography (MDCT) morphologic characteristics of non-aortic acute vascular injuries (AVI) in patients with blunt abdominopelvic trauma that predict treatment.

Methods

CT scans of 65 trauma patients with non-aortic AVI were reviewed. AVI morphology was categorized as linear or round. The organ of involvement, location of hemorrhage, initial size of hematoma, and hemodynamic status were recorded. Expansion rates of the hematoma were calculated in 40 patients who had delayed imaging. Multivariate regression was used to analyze the morphologic features of AVI and treatment.

Results

Patients with linear AVI were four times more likely to require aggressive treatment (surgery or embolization) than those with a round morphology, independent of the hemodynamic status. There was no main effect of the organ involved, location of hemorrhage, initial bleed size, or expansion rate on the probability of aggressive treatment.

Conclusion

The location, initial size, and expansion rate of AVI are not significant predictors of aggressive treatment with surgery or embolization. Linear morphology of AVI, however, is more likely to require aggressive treatment than round AVI, independent of the hemodynamic status. Linear AVI likely reflects a spurting jet of active extravasation, whereas round AVI likely represents a pseudoaneurysm or slow bleed.

Kertesz JL, Anderson SW, Murakami AM, Pieroni S, Rhea JT, Soto JA. Detection of vascular injuries in patients with blunt pelvic trauma by using 64-channel multidetector CT. Radiographics. 2009;29:151–64.PubMedCrossRef

Anderson SW, Soto JA, Lucey BC, Burke PA, Hirsch EF, Rhea JT. Blunt trauma: feasibility and clinical utility of pelvic CT angiography performed with 64-detector row CT. Radiology. 2008;246:410–9.PubMedCrossRef

Sivit CJ, Peclet MH, Taylor GA. Life-threatening intraperitoneal bleeding: demonstration with CT. Radiology. 1989;171:430.PubMed

Jeffrey RB Jr, Cardoza JD, Olcott EW. Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT. AJR Am J Roentgenol. 1991;156:725–9.PubMed

Anderson SW, Varghese JC, Lucey BC, Burke PA, Hirsch EF, Soto JA. Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology. 2007;243:88–95.PubMedCrossRef

Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics. 2008;28:1603–16.PubMedCrossRef

Dondelinger RF, Trotteur G, Ghaye B, Szapiro D. Traumatic injuries: radiological hemostatic intervention at admission. Eur Radiol. 2002;12:979–93.PubMedCrossRef

Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol. 1993;161:65–9.PubMed

Federle MP, Courcoulas AP, Powell M, Ferris JV, Peitzman AB. Blunt splenic injury in adults: clinical and CT criteria for management, with emphasis on active extravasation. Radiology. 1998;206:137–42.PubMed

10.

Fang JF, Chen RJ, Wong YC, Lin BC, Hsu YB, Kao JL, Chen MF. Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma. J Trauma. 2000;49:1083–8.PubMedCrossRef

11.

Shanmuganathan K, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology. 2000;217:75–82.PubMed

12.

Thompson BE, Munera F, Cohn SM, MacLean AA, Cameron J, Rivas L, Bajayo D. Novel computed tomography scan scoring system predicts the need for intervention after splenic injury. J Trauma. 2006;60:1083–6.PubMedCrossRef

13.

Stuhlfaut JW, Lucey BC, Varghese JC, Soto JA. Blunt abdominal trauma: utility of 5-minute delayed CT with a reduced radiation dose. Radiology. 2006;238:473–9.PubMedCrossRef

14.

Miller LA, Shanmuganathan K. Multidetector CT evaluation of abdominal trauma. Radiol Clin North Am. 2005;43:1079–95, viii.PubMedCrossRef

15.

Yao DC, Jeffrey RB Jr, Mirvis SE, Weekes A, Federle MP, Kim C, Lane MJ, Prabhakar P, Radin R, Ralls PW. Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution. AJR Am J Roentgenol. 2002;178:17–20.PubMed

16.

Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, Meredith JW. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207:646–55.PubMedCrossRef

17.

Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE. Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol. 2007;189:1421–7.PubMedCrossRef

18.

Willmann JK, Roos JE, Platz A, Pfammatter T, Hilfiker PR, Marincek B, Weishaupt D. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol. 2002;179:437–44.PubMed

19.

Bessoud B, Denys A, Calmes JM, Madoff D, Qanadli S, Schnyder P, Doenz F. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol. 2006;186:779–85.PubMedCrossRef

20.

Mirvis SE, Whitley NO, Gens DR. Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology. 1989;171:33–9.PubMed

21.

Vasanawala SS, Desser T, Jeffrey RB. Value of delayed imaging in MDCT of the abdomen and pelvis. AJR Am J Roentgenol. 2006;187:154–63.PubMedCrossRef

22.

Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. The CT risk factors for the need of operative treatment in initially hemodynamically stable patients after blunt hepatic trauma. J Trauma. 2006;61:547–53; discussion 553–4.PubMedCrossRef

23.

Marmery H, Shanmuganathan K. Multidetector-row computed tomography imaging of splenic trauma. Semin Ultrasound CT MR. 2006;27:404–19.PubMedCrossRef

Title: Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment
Authors: M. E. Sims
L. K. Shin
J. Rosenberg
R. B. Jeffrey
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2011
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-011-0075-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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