This document discusses various concepts and classifications related to abdominal trauma imaging. It begins with definitions of terms like window, Hounsfield units, and anatomy. It then covers classifications of injury to different solid organs like liver, spleen, kidney, and pancreas. Specific examples of injuries at different grades are shown, along with complications. Treatment options for some injuries are also mentioned.

1. CÁCH ĐỌCCÁCH ĐỌC
CHỤP CLVTCHỤP CLVT
BỤNGBỤNG
Bùi Văn GiangBùi Văn Giang
Saint Paul, 8-2008Saint Paul, 8-2008

2. Một số khái niệmMột số khái niệm
 Cửa sổCửa sổ
 Đơn vị tỷ trọngĐơn vị tỷ trọng
 Giải phẫuGiải phẫu
 Một số dấu hiệu cơ bảnMột số dấu hiệu cơ bản

3. Một số khái niệmMột số khái niệm
 Cửa sổCửa sổ

6. Một số khái niệmMột số khái niệm
 Cửa sổCửa sổ
 Nhu mô: tổn thương tạng: u, vỡ,Nhu mô: tổn thương tạng: u, vỡ,
nang, chảy máunang, chảy máu
 Mỡ: thâm nhiễm mỡ (viêm), khíMỡ: thâm nhiễm mỡ (viêm), khí
(thủng tạng rỗng).(thủng tạng rỗng).

7. Một số khái niệmMột số khái niệm
 Đơn vị tỷ trọngĐơn vị tỷ trọng
 Khí: -1000HUKhí: -1000HU
 HH22O: 0 HUO: 0 HU
 Mỡ: <0 HUMỡ: <0 HU
 Dịch 20HUDịch 20HU
 Nhu mô: 30-40Nhu mô: 30-40
 Máu 70-80HUMáu 70-80HU
 Xương >100 HUXương >100 HU

9. Một số khái niệmMột số khái niệm
 Cửa sổ
 Đơn vị tỷ trọng
 Giải phẫu lớp cắtGiải phẫu lớp cắt
 Một số dấu hiệu cơ bảnMột số dấu hiệu cơ bản

21. Một số khái niệmMột số khái niệm
 Cửa sổ
 Đơn vị tỷ trọng
 Giải phẫu
 Một số dấu hiệu cơ bảnMột số dấu hiệu cơ bản

23. Pancréatite aiguë +
thrombose splénique

24. Viêm t y c p + gi phìnhụ ấ ả

27. Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ

28. Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ
•• Đ 1: 75-85 % ch n th ng th n kínộ ấ ươ ậĐ 1: 75-85 % ch n th ng th n kínộ ấ ươ ậ
•• T n th ng nh :ổ ươ ỏT n th ng nh :ổ ươ ỏ
- Đ ng gi p nh nhu mô, không l n t i t y th nụ ậ ỏ ấ ớ ủ ậ- Đ ng gi p nh nhu mô, không l n t i t y th nụ ậ ỏ ấ ớ ủ ậ
- T máu d i baoụ ướ- T máu d i baoụ ướ
•• Đi u tr b o t nề ị ả ồĐi u tr b o t nề ị ả ồ
[5]:Kawashima RadioGraphics 2001

29. Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ

30. Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ

31. Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ

32. •• Đ 2: 10%ộĐ 2: 10%ộ
•• T n th ng nhu mô nhi u:ổ ươ ềT n th ng nhu mô nhi u:ổ ươ ề
- Rách nhu mô vào t i t y th n.ớ ủ ậ- Rách nhu mô vào t i t y th n.ớ ủ ậ
- Thi u máu thùy th n.ế ậ- Thi u máu thùy th n.ế ậ
[5]:Kawashima RadioGraphics 2001
Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ

33. Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ

35. Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ

36. •• Đ 3 : T n th ng nhu mô n ngộ ổ ươ ặĐ 3 : T n th ng nhu mô n ngộ ổ ươ ặ
- 5%- 5%
- Rách nhu mô th n ph c t p vào t i xoangậ ứ ạ ớ- Rách nhu mô th n ph c t p vào t i xoangậ ứ ạ ớ
th n kèm t n th ng m ch ngo i vi gây t máu,ậ ổ ươ ạ ạ ụth n kèm t n th ng m ch ngo i vi gây t máu,ậ ổ ươ ạ ạ ụ
đái máu, thi u máu nhu môếđái máu, thi u máu nhu môế
- Đ 4 : T n th ng sâu vào t i đ ngộ ổ ươ ớ ườ- Đ 4 : T n th ng sâu vào t i đ ngộ ổ ươ ớ ườ
bài xu t, m ch máuấ ạbài xu t, m ch máuấ ạ
[5]:Kawashima RadioGraphics 2001
Chấn thương thận kínChấn thương thận kín
Đ 3ộĐ 3ộ

37. Chấn thương thận kínChấn thương thận kín
Đ 3ộĐ 3ộ

38. Chấn thương thận kínChấn thương thận kín
Đ 3ộĐ 3ộ

39. Chấn thương thận kínChấn thương thận kín
Đ 4ộĐ 4ộ

44. DIVERTICULITEDIVERTICULITE
COECALECOECALE

46. Trauma to the Solid VisceraTrauma to the Solid Viscera
Trauma to the Solid VisceraTrauma to the Solid Viscera
• LiverLiver
• SpleenSpleen
• KidneyKidney
• PancreasPancreas
• AdrenalAdrenal
Other Traumatic InjuriesOther Traumatic Injuries
• DiaphragmDiaphragm
• MesenteryMesentery
• SpineSpine
• AortaAorta
• Abdominal WallAbdominal Wall

47. Hepatic Injury ClassificationHepatic Injury Classification
GradeGrade CriteriaCriteria
11 Capsular avulsionCapsular avulsion
Superficial laceration(s) < 1 cm. deepSuperficial laceration(s) < 1 cm. deep
Subcapsular hematoma < 1 cm. thickSubcapsular hematoma < 1 cm. thick
Periportal blood trackingPeriportal blood tracking
22 Lacerations(s) 1-3 cm. deepLacerations(s) 1-3 cm. deep
Central/subcapsular hematoma(s) 1-3 cm. thickCentral/subcapsular hematoma(s) 1-3 cm. thick
33 Laceration(s) > 3 cm. deepLaceration(s) > 3 cm. deep
Central/subcapsular hematoma(s) > 3 cm. thickCentral/subcapsular hematoma(s) > 3 cm. thick
44 Central/subcapsular hematoma(s) > 10 cm. thickCentral/subcapsular hematoma(s) > 10 cm. thick
55 Bilobar maceration or devascularizationBilobar maceration or devascularization

48. hemangiomahemangioma
 Globular peripheralGlobular peripheral
enhancementenhancement
 Lesion fills inLesion fills in
from peripheryfrom periphery

49.  Gunshot to liver with active bleedGunshot to liver with active bleed

50. Liver InjuryLiver Injury
 Grade 1 lacerationGrade 1 laceration  Liver laceration thought toLiver laceration thought to
be fissurebe fissure

51. Liver InjuryLiver Injury
 Grade 2 liver lacerationGrade 2 liver laceration

52. Liver InjuryLiver Injury
 Grade 3Grade 3
SubcapsularSubcapsular
hematomahematoma
 Grade 3Grade 3
IntraparenchymalIntraparenchymal
hematomahematoma

53. Liver LacerationLiver Laceration
 Grade 4 lacerationGrade 4 laceration  Delayed bilomaDelayed biloma
formationformation

54. Liver LacerationLiver Laceration
 Laceration extends to inferior vena cavaLaceration extends to inferior vena cava

55. Liver InjuryLiver Injury
 Devascularized leftDevascularized left
lobelobe
 Gallbladder hematomaGallbladder hematoma

56. Splenic Injury ClassificationSplenic Injury Classification
GradeGrade CriteriaCriteria
11 Localized capsular disruptionLocalized capsular disruption
Small subcapsular hematomaSmall subcapsular hematoma
22 Small peripheral lacerationsSmall peripheral lacerations
Parenchymal hematoma < 3 cm.Parenchymal hematoma < 3 cm.
33 Fracture extending to hilumFracture extending to hilum
Parenchymal hematoma > 3 cm.Parenchymal hematoma > 3 cm.
44 Shattered spleenShattered spleen
Vascular disruptionVascular disruption

57. Splenic InjurySplenic Injury
 Congenital cleftCongenital cleft

58. Splenic InjurySplenic Injury
 Grade 1 injuryGrade 1 injury  Grade 2 injuryGrade 2 injury

59. Splenic InjurySplenic Injury
 Grade 3 injuryGrade 3 injury  Grade 4 injuryGrade 4 injury

60. Splenic InjurySplenic Injury
 Infarcted spleenInfarcted spleen

61. Splenic InjurySplenic Injury
 Sentinel clot signSentinel clot sign

62. Splenic InjurySplenic Injury
 Active arterial bleedActive arterial bleed  Delayed hematomaDelayed hematoma

63. Splenic InjurySplenic Injury
 Active arterial extravasation from splenicActive arterial extravasation from splenic
lacerationlaceration
 Subcapsular and perisplenic hematomasSubcapsular and perisplenic hematomas

64. Splenic injurySplenic injury
 AngiographicAngiographic
embolizationembolizationActive bleedActive bleed

65. Pancreas injuryPancreas injury
 Pancreatic laceration with pseudocystPancreatic laceration with pseudocyst

66. Pancreas injuryPancreas injury
 Pancreas tail lacerationPancreas tail laceration
with blood in left anteriorwith blood in left anterior
pararenal spacepararenal space
 Pancreatic bodyPancreatic body
lacerationlaceration

67. Pancreas InjuryPancreas Injury
 Pancreatic neckPancreatic neck
laceration - bloodlaceration - blood
between pancreasbetween pancreas
and splenic veinand splenic vein
 Pancreatic headPancreatic head
contusioncontusion

68. Renal Injury ClassificationRenal Injury Classification
CategoryCategory CriteriaCriteria
MinorMinor Renal contusionRenal contusion
(85%)(85%) Small corticomedullarySmall corticomedullary
lacerationlaceration
Intrarenal hematomaIntrarenal hematoma
Segmental infarctionSegmental infarction
Small subcapsularSmall subcapsular
hematomahematoma

69. Renal Injury ClassificationRenal Injury Classification
CategoryCategory CriteriaCriteria
MajorMajor Parenchymal lacerations that communicateParenchymal lacerations that communicate
(10%)(10%) with the collecting systemwith the collecting system
Large subcapsular hematomaLarge subcapsular hematoma
Complete lacerationComplete laceration
Renal fractureRenal fracture
Renal vein injuriesRenal vein injuries
CategoryCategory CriteriaCriteria
CatastrophicCatastrophic Shattered kidneyShattered kidney
(5%)(5%) Renal artery avulsion or occlusionRenal artery avulsion or occlusion

70. Renal InjuryRenal Injury
 Ruptured congenitalRuptured congenital
UPJ obstructed kidneyUPJ obstructed kidney
 Ruptured calycealRuptured calyceal
diverticulumdiverticulum

71. Renal InjuryRenal Injury
 Renal contusionRenal contusion  Renal laceration withRenal laceration with
perirenal hematomaperirenal hematoma

72. Renal InjuryRenal Injury
 Small lacerationSmall laceration  Delayed scan-Delayed scan-
extravasation ofextravasation of
contrastcontrast

73. Renal InjuryRenal Injury
 Extravasated contrastExtravasated contrast
on 10 min delay scanon 10 min delay scan
 Ureter intact-surgeryUreter intact-surgery
not necessarynot necessary

74. Renal InjuryRenal Injury
 Bilateral renal extravasation of contrastBilateral renal extravasation of contrast

75. Renal InjuryRenal Injury
 Fractured kidneyFractured kidney  DevascularizedDevascularized
segment,largesegment,large
hematomahematoma

76. Renal InjuryRenal Injury
 UPJ lacerationUPJ laceration  Renal artery occlusionRenal artery occlusion

77. Renal InjuryRenal Injury
Arterial occlusion causingArterial occlusion causing
renal infarctionrenal infarction
 Arterial OcclusionArterial Occlusion

78. Renal injuryRenal injury
 Renal artery pseudoaneurysmRenal artery pseudoaneurysm

79. Renal injuryRenal injury
 Renal artery pseudoaneurysmRenal artery pseudoaneurysm
embolizedembolized

80. Adrenal HematomaAdrenal Hematoma
 Adrenal hematoma and grade II liver lacerationAdrenal hematoma and grade II liver laceration
 Patient struck on right sidePatient struck on right side

81. Bladder TraumaBladder Trauma
 CT Cystography in the Evaluation ofCT Cystography in the Evaluation of
Bladder TraumaBladder Trauma
 Lis,L.E., Cohen,A.J.Lis,L.E., Cohen,A.J.
 J Comput Assist Tomogr 1990;14:386-389J Comput Assist Tomogr 1990;14:386-389

82. Bladder Rupture(intraperitoneal)Bladder Rupture(intraperitoneal)
 CT cystogram-350 cc of contrast (4%) infusedCT cystogram-350 cc of contrast (4%) infused
through Foley catheter.through Foley catheter.
 free contrast in peritoneal cavityfree contrast in peritoneal cavity

83. Bladder Rupture(intraperitoneal)Bladder Rupture(intraperitoneal)
 Free contrast aroundFree contrast around
liverliver
 Contrast in cul-de-sacContrast in cul-de-sac

84. Bladder Rupture(extraperitoneal)Bladder Rupture(extraperitoneal)
 Extravasated contrastExtravasated contrast
prevesicle spaceprevesicle space
 Contrast tracks intoContrast tracks into
scrotumscrotum

85. Mimic of bladder ruptureMimic of bladder rupture
 Paravesicle hematoma with active arterial bleedParavesicle hematoma with active arterial bleed

86. ChestChest
 Pericardial and pleural effusionPericardial and pleural effusion

87. Chest TraumaChest Trauma
 Severe Lung contusionSevere Lung contusion

88. Chest TraumaChest Trauma
 Lung contusionLung contusion  Pneumothorax, lacerationsPneumothorax, lacerations

89. Chest TraumaChest Trauma
 ParavertebralParavertebral
hematomahematoma
 T6 vertebralT6 vertebral
body fracturebody fracture

90. Chest traumaChest trauma
Traumatic rupture of inferior vena cava into pericardiumTraumatic rupture of inferior vena cava into pericardium

91. DiaphragmDiaphragm
 Huge diaphragmatic hernia-patient fell fromHuge diaphragmatic hernia-patient fell from
ladderladder

92. Diaphragmatic HerniaDiaphragmatic Hernia
 Subtle traumaticSubtle traumatic
diaphragmatic herniadiaphragmatic hernia
 Two days later,Two days later,
stomach up in cheststomach up in chest

93. Diaphragmatic HerniaDiaphragmatic Hernia
 Stomach in chestStomach in chest
 Stomach constricted passing through diaphragmStomach constricted passing through diaphragm

94. Abdominal WallAbdominal Wall
 Actively bleeding rectus muscle hematomaActively bleeding rectus muscle hematoma

95. Soft tissue injurySoft tissue injury
 Back hematomaBack hematoma

96. SpineSpine
COMBINATIONCOMBINATION
INJURIESINJURIES

97. Spine TraumaSpine Trauma
 Originally missed burst fractureOriginally missed burst fracture

98. Spine TraumaSpine Trauma
 Posterior element spinousPosterior element spinous
fracturefracture
 patient withpatient with
AnkylosingAnkylosing
SpondylitisSpondylitis

99. Combination InjuriesCombination Injuries
 Devascularized leftDevascularized left
lobe of liverlobe of liver  Pancreatic laceration andPancreatic laceration and
left renal infarctleft renal infarct

100. Combination InjuriesCombination Injuries
 Wide mediastinumWide mediastinum  Periaortic hematoma-Periaortic hematoma-
sign of aortic injurysign of aortic injury

101. Combination InjuriesCombination Injuries
 Aortic tearAortic tear  Jejunal perforationJejunal perforation

102. Combination InjuriesCombination Injuries
 Aortic tearAortic tear  Pancreatic lacerationPancreatic laceration

103. Combination InjuriesCombination Injuries
 Aortic tearAortic tear  Bladder hematoma andBladder hematoma and
rupturerupture

104. Combination InjuriesCombination Injuries
 Jejunal perforationJejunal perforation
 Intraperitoneal bladder perforationIntraperitoneal bladder perforation

105. Combination InjuriesCombination Injuries
 Pattern of Impact determines combinationPattern of Impact determines combination
injuriesinjuries
 Avoid Satisfaction of Search ErrorAvoid Satisfaction of Search Error

107. Trauma to the Hollow VisceraTrauma to the Hollow Viscera
 DuodenumDuodenum
 JejunumJejunum
 IleumIleum
 ColonColon
 StomachStomach

108. Bowel and Mesenteric InjuriesBowel and Mesenteric Injuries
- 5% of patients after blunt abdominal trauma who undergo5% of patients after blunt abdominal trauma who undergo
surgical explorationsurgical exploration
- Mortality of duodenal perforationMortality of duodenal perforation
= 65% if surgery delayed > 24 hours= 65% if surgery delayed > 24 hours
= 5% if surgery done in 1= 5% if surgery done in 1stst
24 hours24 hours
CT FindingsCT Findings
Bowel Wall InjuriesBowel Wall Injuries
- thickening- thickening
-- intense wall enhancementintense wall enhancement

109. CT FindingsCT Findings
PneumoperitoneumPneumoperitoneum
-anterior peritoneal surface-anterior peritoneal surface
-perihepatic/splenic areas-perihepatic/splenic areas
-mesentery/omentum-mesentery/omentum
-ligaments (falciform, etc)-ligaments (falciform, etc)
Free FluidFree Fluid
-small bowel, low density & no air-small bowel, low density & no air
-blood, intermediate density (high density if arterial)-blood, intermediate density (high density if arterial)
-oral contrast, very high density, > 150 HU-oral contrast, very high density, > 150 HU

110. Duodenal TraumaDuodenal Trauma
 Duodenal hematomaDuodenal hematoma
CT FindingsCT Findings
Duodenal InjuriesDuodenal Injuries
-descending/horizontal-descending/horizontal
segmentssegments
-Retro/intraperitoneal-Retro/intraperitoneal

111. Duodenal InjuryDuodenal Injury
 Duodenal perforation-Duodenal perforation-
missed originallymissed originally
 Perforation seen on UGIPerforation seen on UGI
examexam

112. Duodenal PerforationDuodenal Perforation
 Periduodenal hematomaPeriduodenal hematoma  One day later,One day later,
duodenal perforationduodenal perforation

113. Duodenal PerforationDuodenal Perforation

114. Jejunal/Ileal InjuryJejunal/Ileal Injury
 CT FindingsCT Findings
 fixation pointsfixation points
 ligament of Treitzligament of Treitz
 ileocecal valveileocecal valve

115. Jejunal InjuryJejunal Injury
 Triangles imply extraluminal fluidTriangles imply extraluminal fluid
 Jejunal perforationJejunal perforation

116. Jejunal InjuryJejunal Injury
 Mesenteric hematomaMesenteric hematoma Jejunal perforationJejunal perforation

117. Jejunal InjuryJejunal Injury
 Jejunal hematoma which perforatedJejunal hematoma which perforated

118. Jejunal PerforationJejunal Perforation
 Wall thickeningWall thickening  Seat belt signSeat belt sign

119. Jejunal PerforationJejunal Perforation
Bowel wall thickeningBowel wall thickening  Blood in pelvisBlood in pelvis

120. Jejunal PerforationJejunal Perforation
 Extravasated oralExtravasated oral
contrastcontrast
 Burst fracture of L2Burst fracture of L2

121. Free Intraperitoneal AirFree Intraperitoneal Air
 ““Little bubbles, big troubles”Little bubbles, big troubles”
 DistributionDistribution
- around liver- around liver
- in mesentery- in mesentery
- posterior to the rectus abdominis muscles- posterior to the rectus abdominis muscles
midrectus recessmidrectus recess
pararectus recessespararectus recesses
Delayed Scans May Be HelpfulDelayed Scans May Be Helpful

122. Jejunal InjuryJejunal Injury
 Occult jejunal injuryOccult jejunal injury
 Subtle bowel wallSubtle bowel wall
thickeningthickening
 Free fluid in pelvisFree fluid in pelvis

123. Jejunal PerforationJejunal Perforation
 Extraluminal airExtraluminal air
at porta hepatis,at porta hepatis,
over liverover liver
 Same patient one day laterSame patient one day later
 Extravasation of oralExtravasation of oral
contrastcontrast

124. Jejunal PerforationJejunal Perforation
 Paracolic gutter fluid and mesenteric fluid mayParacolic gutter fluid and mesenteric fluid may
have different originshave different origins

125. Jejunal PerforationJejunal Perforation
 Extraluminal gas bubblesExtraluminal gas bubbles
LITTLE BUBBLESLITTLE BUBBLES
BIG TROUBLESBIG TROUBLES

126. Ileal, Cecal, Gastric TraumaIleal, Cecal, Gastric Trauma
Intense Bowel Wall EnhancementIntense Bowel Wall Enhancement
 Low flow stateLow flow state
 Intravasation of contrastIntravasation of contrast

127. Jejunal, Ileal InjuriesJejunal, Ileal Injuries
 Bowel wallBowel wall
enhancement-jejunalenhancement-jejunal
and ileal perforationsand ileal perforations
 pneumoperitoneumpneumoperitoneum

128. Ileal InjuryIleal Injury
 Ileal wallIleal wall
enhancementenhancement
 At operation, ileal perforationAt operation, ileal perforation
 Bubble ofBubble of
extraluminal air inextraluminal air in
pararectus recesspararectus recess

129. Ileal InjuryIleal Injury
 Ileal injury – wallIleal injury – wall
thickeningthickening
 Delayed perforationDelayed perforation

130. Ileal PerforationIleal Perforation
 SubtleSubtle
pneumoperitoneumpneumoperitoneum  Ileal perforationIleal perforation

131. Colonic InjuryColonic Injury
Pneumatosis of cecal wall-degloving injury ofPneumatosis of cecal wall-degloving injury of
serosaserosa

132. Colonic InjuryColonic Injury
 Cecal perforationCecal perforation  Traumatic herniaTraumatic hernia

133. Colonic InjuryColonic Injury
 Colonic infarctColonic infarct  Traumatic herniaTraumatic hernia

134. Colonic InjuryColonic Injury
 Stab wound to colonStab wound to colon
 extravasated contrastextravasated contrast
Rectal Contrast usedRectal Contrast used
alsoalso

135. Stomach InjuryStomach Injury
 Greater curvature hematoma and perforationGreater curvature hematoma and perforation
CT FindingsCT Findings
Stomach RuptureStomach Rupture
-children > adults-children > adults
-anterior wall > greater curve >-anterior wall > greater curve >
lesser curvelesser curve
-associated with splenic trauma-associated with splenic trauma

136. Stomach RuptureStomach Rupture
 Pneumoperitoneum-falciform ligament seenPneumoperitoneum-falciform ligament seen
 CT-pneumoperitoneumCT-pneumoperitoneum

137. Stomach PerforationStomach Perforation
 Extravasated oral contrast from stomachExtravasated oral contrast from stomach

138. Mesenteric InjuriesMesenteric Injuries
CT FindingsCT Findings
 mesenteric fat streakingmesenteric fat streaking
 mass effect on bowelmass effect on bowel

139. Mesenteric InjuryMesenteric Injury
 Mesenteric hematomasMesenteric hematomas

140. Mesenteric InjuryMesenteric Injury
 Superior mesenteric vein bleedSuperior mesenteric vein bleed

141. Mesenteric InjuryMesenteric Injury
 Missed mesenteric bleedMissed mesenteric bleed
mimicking bowel loopmimicking bowel loop
 Delayed HematomaDelayed Hematoma

142. PneumoperitoneumPneumoperitoneum
 Plain filmPlain film  CT with lung windowsCT with lung windows

143. PneumoretroperitoneumPneumoretroperitoneum
 Plain filmPlain film  CTCT

144. Shock BowelShock Bowel
 Small aorta and IVCSmall aorta and IVC
 Nonexcreting kidneysNonexcreting kidneys
 Diffuse bowel wall edemaDiffuse bowel wall edema

145. Shock BowelShock Bowel
 Diffuse bowel wall edemaDiffuse bowel wall edema

146. OverhydrationOverhydration
 Periportal edemaPeriportal edema
Bowel wall thickeningBowel wall thickening
Distended IVC andDistended IVC and
aortaaorta
Periportal edemaPeriportal edema
RetroperitonealRetroperitoneal
effusionseffusions

147. OverhydrationOverhydration
 Retroperitoneal effusionRetroperitoneal effusion  Diffuse bowel wall edemaDiffuse bowel wall edema

148. Shock BowelShock Bowel
 Jejunal perforationJejunal perforation Shock bowelShock bowel

149. CT signs suggestive of small bowelCT signs suggestive of small bowel
injuryinjury
NO. (%)NO. (%)
Small bowel wall thickeningSmall bowel wall thickening 18/19 (95)18/19 (95)
Free Fluid or blood withoutFree Fluid or blood without
associated solid visceral injuryassociated solid visceral injury 9/19 (47)9/19 (47)
Casey L, Vu D, Cohen AJ. Small Bowel RuptureCasey L, Vu D, Cohen AJ. Small Bowel Rupture
after Blunt Trauma: CT signs and Their Sensitivityafter Blunt Trauma: CT signs and Their Sensitivity

150. CT signs pathognomic of bowelCT signs pathognomic of bowel
rupturerupture
NO. (%)NO. (%)
Extraluminal airExtraluminal air 7/19 (37)7/19 (37)
Oral contrast extravasationOral contrast extravasation 8/19 (42)8/19 (42)
Extraluminal air onlyExtraluminal air only 3/19 (16)3/19 (16)
Oral contrast extravasation onlyOral contrast extravasation only 4/19 (21)4/19 (21)
Both extraluminal air andBoth extraluminal air and
oral contrast extravasationoral contrast extravasation 4/19 (21)4/19 (21)
TOTALTOTAL 11/19 (58)11/19 (58)

151. Duodenal PerforationDuodenal Perforation
 Duodenal perforation extravasates into the rightDuodenal perforation extravasates into the right
anterior pararenal spaceanterior pararenal space
 Duodenal wall may be thickened by edema orDuodenal wall may be thickened by edema or
bloodblood

152. Jejunal and Ileal PerforationJejunal and Ileal Perforation
 Jejunal and ileal perforation manifests as bowelJejunal and ileal perforation manifests as bowel
wall thickeningwall thickening
 Extraluminal air and fluid may be subtleExtraluminal air and fluid may be subtle
 Lung windows help to disclose extraluminal airLung windows help to disclose extraluminal air

153. Extraluminal FluidExtraluminal Fluid
 Triangles imply extraluminal fluidTriangles imply extraluminal fluid
 Paracolic gutter fluid and mesenteric fluid mayParacolic gutter fluid and mesenteric fluid may
have different originshave different origins

154. Small Bowel InjurySmall Bowel Injury
Do not hesitate to repeat scan if the clinicalDo not hesitate to repeat scan if the clinical
condition deterioratescondition deteriorates
Shock and overhydration can cause abnormalShock and overhydration can cause abnormal
appearing small bowelappearing small bowel