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Blunt Abdominal Trauma: Should US Be Used to Detect Both Free Fluid and Organ Injuries?¹

¹ From the Division of Radiodiagnostic and Interventional Radiology (P.A.P., K.K., F.T.), Division of Medico-Surgical Emergencies (B.V., P.F.U.), and Clinic/Polyclinic of Digestive Surgery (F.I.), Hôpital Cantonal, University of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva-14, Switzerland. Received February 20, 2002; revision requested April 23; revision received June 15; accepted July 25. Address correspondence to P.A.P. (e-mail: pierre-alexandre.poletti@hcuge.ch).

View larger version (158K): [in a new window]   Figure 1a. Images in an 18-year-old man who was admitted to the hospital after interpersonal violence and who complained of mild abdominal pain. The results of admission US (not shown) were normal except for the presence of a small amount of free fluid. (a) Subsequently obtained transverse CT scan of the abdomen demonstrates a grade III laceration (arrow) of the posterior aspect of the spleen. (b) Sagittal oblique long-axis image of the spleen obtained at a second US examination does not demonstrate any parenchymal abnormality. The admission and second US examinations were considered to have yielded a false-negative result for organ injury.

View larger version (141K): [in a new window]   Figure 1b. Images in an 18-year-old man who was admitted to the hospital after interpersonal violence and who complained of mild abdominal pain. The results of admission US (not shown) were normal except for the presence of a small amount of free fluid. (a) Subsequently obtained transverse CT scan of the abdomen demonstrates a grade III laceration (arrow) of the posterior aspect of the spleen. (b) Sagittal oblique long-axis image of the spleen obtained at a second US examination does not demonstrate any parenchymal abnormality. The admission and second US examinations were considered to have yielded a false-negative result for organ injury.

View larger version (147K): [in a new window]   Figure 2a. Images in a 54-year-old woman who was admitted to the hospital after a motor vehicle collision. (a) Oblique long-axis image obtained at admission US does not demonstrate any injury of the right kidney. (b) Subsequently obtained transverse CT scan demonstrates a large laceration (arrow) of the right kidney that is surrounded by an extensive hematoma (arrowheads). (c) Oblique long-axis image obtained at second US reveals a slightly heterogeneous area (between crosshairs) in the lower portion of the right kidney. The admission US examination was considered to have yielded a false-negative result for kidney injury (demonstrated at CT and second US) in this patient.

View larger version (171K): [in a new window]   Figure 2b. Images in a 54-year-old woman who was admitted to the hospital after a motor vehicle collision. (a) Oblique long-axis image obtained at admission US does not demonstrate any injury of the right kidney. (b) Subsequently obtained transverse CT scan demonstrates a large laceration (arrow) of the right kidney that is surrounded by an extensive hematoma (arrowheads). (c) Oblique long-axis image obtained at second US reveals a slightly heterogeneous area (between crosshairs) in the lower portion of the right kidney. The admission US examination was considered to have yielded a false-negative result for kidney injury (demonstrated at CT and second US) in this patient.

View larger version (151K): [in a new window]   Figure 2c. Images in a 54-year-old woman who was admitted to the hospital after a motor vehicle collision. (a) Oblique long-axis image obtained at admission US does not demonstrate any injury of the right kidney. (b) Subsequently obtained transverse CT scan demonstrates a large laceration (arrow) of the right kidney that is surrounded by an extensive hematoma (arrowheads). (c) Oblique long-axis image obtained at second US reveals a slightly heterogeneous area (between crosshairs) in the lower portion of the right kidney. The admission US examination was considered to have yielded a false-negative result for kidney injury (demonstrated at CT and second US) in this patient.

View larger version (161K): [in a new window]   Figure 3a. Images in a 51-year-old woman admitted after a motor vehicle accident. (a) Sagittal oblique image obtained at admission US reveals a diffusely thickened hypoechoic duodenal wall (between crosshairs) that contains hyperechoic material consistent with blood and is surrounded by free fluid (arrowhead). (b) Subsequently obtained transverse CT scan reveals an area of thickening of the duodenal wall (black arrowheads) that is surrounded by free fluid (white arrowhead). A pancreatic injury (arrow) is also seen. The admission US examination was considered to have yielded a true-positive result for bowel injury.

View larger version (128K): [in a new window]   Figure 3b. Images in a 51-year-old woman admitted after a motor vehicle accident. (a) Sagittal oblique image obtained at admission US reveals a diffusely thickened hypoechoic duodenal wall (between crosshairs) that contains hyperechoic material consistent with blood and is surrounded by free fluid (arrowhead). (b) Subsequently obtained transverse CT scan reveals an area of thickening of the duodenal wall (black arrowheads) that is surrounded by free fluid (white arrowhead). A pancreatic injury (arrow) is also seen. The admission US examination was considered to have yielded a true-positive result for bowel injury.

View larger version (164K): [in a new window]   Figure 4a. Images in a 21-year-old woman admitted to the hospital with diffuse abdominal pain after trauma. (a) Transverse image obtained at admission US shows a hyperechoic area (arrowheads) in the right lobe of the liver. (b) Subsequently obtained transverse CT scan of the abdomen reveals a grade III liver laceration (arrowhead). The admission US examination was considered to have yielded a true-positive result for liver laceration.

View larger version (154K): [in a new window]   Figure 4b. Images in a 21-year-old woman admitted to the hospital with diffuse abdominal pain after trauma. (a) Transverse image obtained at admission US shows a hyperechoic area (arrowheads) in the right lobe of the liver. (b) Subsequently obtained transverse CT scan of the abdomen reveals a grade III liver laceration (arrowhead). The admission US examination was considered to have yielded a true-positive result for liver laceration.

View larger version (141K): [in a new window]   Figure 5a. Images in a 22-year-old man admitted to the hospital after a motor vehicle accident. (a) Sagittal long-axis image obtained at admission US demonstrates a normal-appearing spleen. A large amount of free fluid was also revealed at this examination (image not shown). (b) Subsequently obtained transverse CT scan depicts an extensive splenic laceration (arrowhead). Hemoperitoneum is seen in the perisplenic (white arrow) and perihepatic (black arrow) areas. (c) Sagittal oblique long-axis image obtained at second US reveals only a small hypoechoic lesion (arrowheads) in the splenic parenchyma. The admission US examination was considered to have yielded a false-negative result for splenic laceration.

View larger version (125K): [in a new window]   Figure 5b. Images in a 22-year-old man admitted to the hospital after a motor vehicle accident. (a) Sagittal long-axis image obtained at admission US demonstrates a normal-appearing spleen. A large amount of free fluid was also revealed at this examination (image not shown). (b) Subsequently obtained transverse CT scan depicts an extensive splenic laceration (arrowhead). Hemoperitoneum is seen in the perisplenic (white arrow) and perihepatic (black arrow) areas. (c) Sagittal oblique long-axis image obtained at second US reveals only a small hypoechoic lesion (arrowheads) in the splenic parenchyma. The admission US examination was considered to have yielded a false-negative result for splenic laceration.

View larger version (148K): [in a new window]   Figure 5c. Images in a 22-year-old man admitted to the hospital after a motor vehicle accident. (a) Sagittal long-axis image obtained at admission US demonstrates a normal-appearing spleen. A large amount of free fluid was also revealed at this examination (image not shown). (b) Subsequently obtained transverse CT scan depicts an extensive splenic laceration (arrowhead). Hemoperitoneum is seen in the perisplenic (white arrow) and perihepatic (black arrow) areas. (c) Sagittal oblique long-axis image obtained at second US reveals only a small hypoechoic lesion (arrowheads) in the splenic parenchyma. The admission US examination was considered to have yielded a false-negative result for splenic laceration.