FREQUENCY, IMAGINIG PATTERNS AND PITFALLS IN BLUNT ABDOMINAL TRAUMA, A SINGLE CENTER EXPERIENCE STUDY

Pranvera Ramadani; Maja Jakimovska Dimitrovska; Elizabeta Stojovska Jovanovska; Violeta Vasilevska Nikodinovski; Ace Dodevski

Pranvera Ramadani Clinical Hospital of Tetovo, Faculty of Medicine, University of Tetovo, Tetovo, North Macedonia
Maja Jakimovska Dimitrovska Institute of Radiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Elizabeta Stojovska Jovanovska Institute of Radiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Violeta Vasilevska Nikodinovski Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Ace Dodevski Institute of Anatomy, Faculty of Medicine, University of St. Cyril and Methodius in Skopje, Republic of North Macedonia

Abstract

Blunt abdominal trauma is a life-threatening condition and imaging is key in identifying the next step in patient management. The objective of this study is to determine the frequency and pitfalls of blunt abdominal trauma findings in multiphasic Multidetector Computed Tomographic (MDCT) examinations in patients with road traffic injuries and falls in the setting of polytrauma. After institutional review board approval with a waiver of informed consent was obtained, a retrospective study was performed focusing on a three-month period in 2023, from May to July in patients referred to our department with the diagnosis of superficial injuries involving multiple body regions â€“ T00. A review of the Picture Archiving and Communication System (PACS), the electronic medical records and dictated reports identified patients who met the criteria of abdominal blunt trauma. A total number of 321 patients were identified, who met the criteria of superficial injuries involving multiple body regions (average age, 37.5 years). 220 patients were male. 2,8% (9 patients) had imaging findings of blunt abdominal trauma. 55,5 % of patients had spleen traumatic injuries, the remaining percentage was liver, kidney, retroperitoneal hematoma and isolated free abdominal fluid. MDCT and administration of intra venous contrast is crucial in recognizing many of the spectral findings blunt abdominal trauma. A protocol of biphasic â€œCombiâ€ scan should be implemented in order to minimize radiation exposure and duration of the scan. Multiphasic Computed Tomography (CT) acquisition is key to avoid pitfalls.

Key words: Blunt abdominal trauma, Multiphasic MDCT, spleen injury, liver injury, kidney injury, retroperitoneal hematoma, isolated free abdominal fluid.

References

1. O'Rourke MC, Landis R, Burns B. Blunt Abdominal Trauma. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
2. Injuries and violence. (2014). Accessed: December 29, 2020: 10-14.
3. Hussain et al. Cureus 13(4): 2021; e14267.
4. Sampathkumar, H., Lopez, E. Blunt Abdominal Trauma. In: Kahn, S., Xu, R. (eds) Musculoskeletal Sports and Spine Disorders. Springer, Cham. (2017).
5. Arumugam S, Al-Hassani A, El-Menyar A, Abdelrahman H, Parchani A, Peralta R, Zarour A, Al-Thani H. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis. J Emerg Trauma Shock. 2015 Oct-Dec;8(4):193-8.
6. James T. Lee, Emily Slade, Jennifer Uyeda, Scott D. Steenburg, Suzanne T. Chong, Richard Tsai, Demetrios Raptis, Ken F. Linnau, Naga R. Chinapuvvula, Matthew P. Dattwyler, Adam Dugan, Arthur Baghdanian, Carl Flink, Armonde Baghdanian, and Christina A. LeBedis, American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings Radiology 2021 299:1, 122-130.
7. Scaling system for organ specific injuries, Ernest E. Moore, MD, Thomas H. Cogbill, MD, Mark, Malangoni, MD, Gregory J. Jurkovich, MD, and Howard R. Champion, MD.
8. Woong Yoon, Yong Yeon Jeong, Jae Kyu Kim, Jeong Jin Seo, Hyo Soon Lim, Sang Soo Shin, Jung Chul Kim, Seong Wook Jeong, Jin Gyoon Park, and Heoung Keun Kang, CT in Blunt liver Trauma, RadioGraphics 2005 25:1, 87-104.
9. Slotta, J.E., Justinger, C., Kollmar, O. et al. Liver injury following blunt abdominal trauma: a new mechanism-driven classification. Surg Today 44, 241â€“246 (2014).
10. Woong Yoon, Yong Yeon Jeong, Jae Kyu Kim, Jeong Jin Seo, Hyo Soon Lim, Sang Soo Shin, Jung Chul Kim, Seong Wook Jeong, Jin Gyoon Park, and Heoung Keun Kang, CT in Blunt Liver Trauma, RadioGraphics 2005 25:1, 87-104.
11. Asensio JA, Petrone P, GarcÃa-NÃºÃ±ez L, Kimbrell B, Kuncir E. Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study. Scand J Surg. 2007;96(3):214-20.
12. Lee YJ, Oh SN, Rha SE, Byun JY. Renal trauma. Radiol Clin North Am. 2007 May;45(3):581-92, ix.
13. Reza JALLI, Nazafarin KAMALZADEH, Mehrzad LOTFI, Siamak FARAHANGIZ, Mahdi SALEHIPOUR, Accuracy of sonography in detection of renal injuries caused by blunt abdominal trauma: a prospective study, Turkish Journal of Trauma & Emergency Surgery Ulus Travma Acil Cerrahi Derg 2009;15(1):23-27.
14. Kathirkamanathan Shanmuganathan, MD, Multi-Detector Row CT Imaging of Blunt Abdominal Trauma, Â© 2004 Elsevier Inc. All rights reserved.
15. T. Eric Drasin, Stephan W. Anderson, Amy Asandra, James T. Rhea, and Jorge A. Soto, MDCT Evaluation of Blunt Abdominal Trauma: Clinical Significance of Free Intraperitoneal Fluid in Males with Absence of Identifiable Injury, American Journal of Roentgenology 2008 191:6, 1821-1826.
16.B ekker W, Smith M, Kong VY, Bruce JL, Laing G, Manchev V, Clarke DL. Isolated free fluid on computed tomography for blunt abdominal trauma. Ann R Coll Surg Engl. 2019 Nov;101(8):552-557.
17. Kevin P. Daly, Christopher P. Ho, D. Laurie Persson, and Spencer B. Gay, Traumatic Retroperitoneal Injuries: Review of Multidetector CT Findings, RadioGraphics 2008 28:6, 1571-1590.
18. Asensio JA, Feliciano DV. Abdominal Vascular Injury. In: Moore EE, Feliciano DV, Mattox KL. eds. Trauma, 8e. McGraw Hill; 2017. Accessed September 26, 2023.
19. Wang F, Wang F. The diagnosis and treatment of traumatic retroperitoneal hematoma. Pak J Med Sci. 2013 Apr;29(2):573-6.
20. Hakim W, Kamanahalli R, Dick E, Bharwani N, Fetherston S, Kashef E. Trauma whole-body MDCT: an assessment of image quality in conventional dual-phase and modified biphasic injection. Br J Radiol. 2016 Jul;89(1063):20160160
21. The Royal College of Radiologists. Standards of practice and guidance for trauma radiology in severely injured patients, Second edition. London: The royal College of Radiologists, September 2015.