Blunt Abdominal Trauma: Screening US in 2,693 Patients1
Michèle A. Brown, MD,
Giovanna Casola, MD,
Claude B. Sirlin, MD,
Nirev Y. Patel, MD and
David B. Hoyt, MD
1 From the Departments of Radiology (M.A.B., G.C., C.B.S.) and Surgery (N.Y.P., D.B.H.), University of California, San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756. From the 1998 RSNA scientific assembly. Received April 14, 2000; revision requested June 7; revision received June 27; accepted July 11. Address correspondence to G.C. (e-mail: gcasola@ucsd.edu).
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Figure 1a. Transverse images in a 36-year-old man involved in a motor vehicle accident. (a) Screening US image of the pelvis shows free fluid (arrows) posterior to the bladder (B). (b) US image of the left upper quadrant shows heterogeneity (*) of the spleen. Arrows indicate the splenic margin. (c) Contrast material-enhanced abdominal CT image confirms splenic injury (arrows) and reveals perisplenic fluid (*). This image was obtained 3 days after screening US was performed. An earlier CT image (not shown) revealed similar findings, with a smaller amount of perisplenic fluid.
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Figure 1b. Transverse images in a 36-year-old man involved in a motor vehicle accident. (a) Screening US image of the pelvis shows free fluid (arrows) posterior to the bladder (B). (b) US image of the left upper quadrant shows heterogeneity (*) of the spleen. Arrows indicate the splenic margin. (c) Contrast material-enhanced abdominal CT image confirms splenic injury (arrows) and reveals perisplenic fluid (*). This image was obtained 3 days after screening US was performed. An earlier CT image (not shown) revealed similar findings, with a smaller amount of perisplenic fluid.
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Figure 1c. Transverse images in a 36-year-old man involved in a motor vehicle accident. (a) Screening US image of the pelvis shows free fluid (arrows) posterior to the bladder (B). (b) US image of the left upper quadrant shows heterogeneity (*) of the spleen. Arrows indicate the splenic margin. (c) Contrast material-enhanced abdominal CT image confirms splenic injury (arrows) and reveals perisplenic fluid (*). This image was obtained 3 days after screening US was performed. An earlier CT image (not shown) revealed similar findings, with a smaller amount of perisplenic fluid.
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Figure 2a. Images in a 19-year-old woman involved in a motor vehicle accident. (a) Longitudinal screening US image shows a small amount of fluid (arrow) near the inferior liver (L) edge. Real-time images (not shown) also suggested abnormal bowel in the left midabdomen. (b) Contrast-enhanced transverse abdominal CT image confirms bowel injury with thickened jejunum (open arrow) and fluid in the mesentery (black solid arrows) and right paracolic gutter (white solid arrow).
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Figure 2b. Images in a 19-year-old woman involved in a motor vehicle accident. (a) Longitudinal screening US image shows a small amount of fluid (arrow) near the inferior liver (L) edge. Real-time images (not shown) also suggested abnormal bowel in the left midabdomen. (b) Contrast-enhanced transverse abdominal CT image confirms bowel injury with thickened jejunum (open arrow) and fluid in the mesentery (black solid arrows) and right paracolic gutter (white solid arrow).
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Figure 3. Transverse CT image obtained with intravenously administered contrast material in a 19-year-old man who was involved in a motorcycle accident and who had normal screening US findings. Image was obtained because of persistent abdominal pain and reveals free air (black arrow) and thickened loops of small bowel (white arrows), which indicate bowel injury with perforation.
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Figure 4a. Images in two patients with abnormal liver parenchyma. (a) Transverse US image in a 20-year-old man involved in a motor vehicle accident shows a hyperechoic lesion (arrows) in the right hepatic lobe. (b) The lesion was confirmed at transverse contrast-enhanced CT to be a laceration (arrows). (c) Transverse US image in a 37-year-old man who experienced an assault shows an echogenic lesion (arrows) near the liver dome. (d) Portal venous phase transverse CT image reveals a lesion (arrows) in the liver. (e) Delayed transverse CT image obtained with intravenously administered contrast material shows the corresponding liver lesion (arrows) with enhancement characteristics comparable with those of hemangioma.
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Figure 4b. Images in two patients with abnormal liver parenchyma. (a) Transverse US image in a 20-year-old man involved in a motor vehicle accident shows a hyperechoic lesion (arrows) in the right hepatic lobe. (b) The lesion was confirmed at transverse contrast-enhanced CT to be a laceration (arrows). (c) Transverse US image in a 37-year-old man who experienced an assault shows an echogenic lesion (arrows) near the liver dome. (d) Portal venous phase transverse CT image reveals a lesion (arrows) in the liver. (e) Delayed transverse CT image obtained with intravenously administered contrast material shows the corresponding liver lesion (arrows) with enhancement characteristics comparable with those of hemangioma.
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Figure 4c. Images in two patients with abnormal liver parenchyma. (a) Transverse US image in a 20-year-old man involved in a motor vehicle accident shows a hyperechoic lesion (arrows) in the right hepatic lobe. (b) The lesion was confirmed at transverse contrast-enhanced CT to be a laceration (arrows). (c) Transverse US image in a 37-year-old man who experienced an assault shows an echogenic lesion (arrows) near the liver dome. (d) Portal venous phase transverse CT image reveals a lesion (arrows) in the liver. (e) Delayed transverse CT image obtained with intravenously administered contrast material shows the corresponding liver lesion (arrows) with enhancement characteristics comparable with those of hemangioma.
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Figure 4d. Images in two patients with abnormal liver parenchyma. (a) Transverse US image in a 20-year-old man involved in a motor vehicle accident shows a hyperechoic lesion (arrows) in the right hepatic lobe. (b) The lesion was confirmed at transverse contrast-enhanced CT to be a laceration (arrows). (c) Transverse US image in a 37-year-old man who experienced an assault shows an echogenic lesion (arrows) near the liver dome. (d) Portal venous phase transverse CT image reveals a lesion (arrows) in the liver. (e) Delayed transverse CT image obtained with intravenously administered contrast material shows the corresponding liver lesion (arrows) with enhancement characteristics comparable with those of hemangioma.
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Figure 4e. Images in two patients with abnormal liver parenchyma. (a) Transverse US image in a 20-year-old man involved in a motor vehicle accident shows a hyperechoic lesion (arrows) in the right hepatic lobe. (b) The lesion was confirmed at transverse contrast-enhanced CT to be a laceration (arrows). (c) Transverse US image in a 37-year-old man who experienced an assault shows an echogenic lesion (arrows) near the liver dome. (d) Portal venous phase transverse CT image reveals a lesion (arrows) in the liver. (e) Delayed transverse CT image obtained with intravenously administered contrast material shows the corresponding liver lesion (arrows) with enhancement characteristics comparable with those of hemangioma.
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Copyright © 2001 by the Radiological Society of North America.
