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CÁCH ĐỌCCÁCH ĐỌC
CHỤP CLVTCHỤP CLVT
BỤNGBỤNG
Bùi Văn GiangBùi Văn Giang
Saint Paul, 8-2008Saint Paul, 8-2008
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
Một số khái niệmMột số khái niệm
 Cửa sổCửa sổ
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).
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
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
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
Pancréatite aiguë +
thrombose splénique
Viêm t y c p + gi phìnhụ ấ ả
Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ
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
Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ
Chấn thương thận kínChấn thương thận kín
Đ 1ộĐ 1ộ
Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ
•• 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
Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ
Chấn thương thận kínChấn thương thận kín
Đ 2ộĐ 2ộ
•• 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
Chấn thương thận kínChấn thương thận kín
Đ 3ộĐ 3ộ
Chấn thương thận kínChấn thương thận kín
Đ 3ộĐ 3ộ
Chấn thương thận kínChấn thương thận kín
Đ 4ộĐ 4ộ
DIVERTICULITEDIVERTICULITE
COECALECOECALE
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
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
hemangiomahemangioma
 Globular peripheralGlobular peripheral
enhancementenhancement
 Lesion fills inLesion fills in
from peripheryfrom periphery
 Gunshot to liver with active bleedGunshot to liver with active bleed
Liver InjuryLiver Injury
 Grade 1 lacerationGrade 1 laceration  Liver laceration thought toLiver laceration thought to
be fissurebe fissure
Liver InjuryLiver Injury
 Grade 2 liver lacerationGrade 2 liver laceration
Liver InjuryLiver Injury
 Grade 3Grade 3
SubcapsularSubcapsular
hematomahematoma
 Grade 3Grade 3
IntraparenchymalIntraparenchymal
hematomahematoma
Liver LacerationLiver Laceration
 Grade 4 lacerationGrade 4 laceration  Delayed bilomaDelayed biloma
formationformation
Liver LacerationLiver Laceration
 Laceration extends to inferior vena cavaLaceration extends to inferior vena cava
Liver InjuryLiver Injury
 Devascularized leftDevascularized left
lobelobe
 Gallbladder hematomaGallbladder hematoma
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
Splenic InjurySplenic Injury
 Congenital cleftCongenital cleft
Splenic InjurySplenic Injury
 Grade 1 injuryGrade 1 injury  Grade 2 injuryGrade 2 injury
Splenic InjurySplenic Injury
 Grade 3 injuryGrade 3 injury  Grade 4 injuryGrade 4 injury
Splenic InjurySplenic Injury
 Infarcted spleenInfarcted spleen
Splenic InjurySplenic Injury
 Sentinel clot signSentinel clot sign
Splenic InjurySplenic Injury
 Active arterial bleedActive arterial bleed  Delayed hematomaDelayed hematoma
Splenic InjurySplenic Injury
 Active arterial extravasation from splenicActive arterial extravasation from splenic
lacerationlaceration
 Subcapsular and perisplenic hematomasSubcapsular and perisplenic hematomas
Splenic injurySplenic injury
 AngiographicAngiographic
embolizationembolizationActive bleedActive bleed
Pancreas injuryPancreas injury
 Pancreatic laceration with pseudocystPancreatic laceration with pseudocyst
Pancreas injuryPancreas injury
 Pancreas tail lacerationPancreas tail laceration
with blood in left anteriorwith blood in left anterior
pararenal spacepararenal space
 Pancreatic bodyPancreatic body
lacerationlaceration
Pancreas InjuryPancreas Injury
 Pancreatic neckPancreatic neck
laceration - bloodlaceration - blood
between pancreasbetween pancreas
and splenic veinand splenic vein
 Pancreatic headPancreatic head
contusioncontusion
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
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
Renal InjuryRenal Injury
 Ruptured congenitalRuptured congenital
UPJ obstructed kidneyUPJ obstructed kidney
 Ruptured calycealRuptured calyceal
diverticulumdiverticulum
Renal InjuryRenal Injury
 Renal contusionRenal contusion  Renal laceration withRenal laceration with
perirenal hematomaperirenal hematoma
Renal InjuryRenal Injury
 Small lacerationSmall laceration  Delayed scan-Delayed scan-
extravasation ofextravasation of
contrastcontrast
Renal InjuryRenal Injury
 Extravasated contrastExtravasated contrast
on 10 min delay scanon 10 min delay scan
 Ureter intact-surgeryUreter intact-surgery
not necessarynot necessary
Renal InjuryRenal Injury
 Bilateral renal extravasation of contrastBilateral renal extravasation of contrast
Renal InjuryRenal Injury
 Fractured kidneyFractured kidney  DevascularizedDevascularized
segment,largesegment,large
hematomahematoma
Renal InjuryRenal Injury
 UPJ lacerationUPJ laceration  Renal artery occlusionRenal artery occlusion
Renal InjuryRenal Injury
Arterial occlusion causingArterial occlusion causing
renal infarctionrenal infarction
 Arterial OcclusionArterial Occlusion
Renal injuryRenal injury
 Renal artery pseudoaneurysmRenal artery pseudoaneurysm
Renal injuryRenal injury
 Renal artery pseudoaneurysmRenal artery pseudoaneurysm
embolizedembolized
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
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
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
Bladder Rupture(intraperitoneal)Bladder Rupture(intraperitoneal)
 Free contrast aroundFree contrast around
liverliver
 Contrast in cul-de-sacContrast in cul-de-sac
Bladder Rupture(extraperitoneal)Bladder Rupture(extraperitoneal)
 Extravasated contrastExtravasated contrast
prevesicle spaceprevesicle space
 Contrast tracks intoContrast tracks into
scrotumscrotum
Mimic of bladder ruptureMimic of bladder rupture
 Paravesicle hematoma with active arterial bleedParavesicle hematoma with active arterial bleed
ChestChest
 Pericardial and pleural effusionPericardial and pleural effusion
Chest TraumaChest Trauma
 Severe Lung contusionSevere Lung contusion
Chest TraumaChest Trauma
 Lung contusionLung contusion  Pneumothorax, lacerationsPneumothorax, lacerations
Chest TraumaChest Trauma
 ParavertebralParavertebral
hematomahematoma
 T6 vertebralT6 vertebral
body fracturebody fracture
Chest traumaChest trauma
Traumatic rupture of inferior vena cava into pericardiumTraumatic rupture of inferior vena cava into pericardium
DiaphragmDiaphragm
 Huge diaphragmatic hernia-patient fell fromHuge diaphragmatic hernia-patient fell from
ladderladder
Diaphragmatic HerniaDiaphragmatic Hernia
 Subtle traumaticSubtle traumatic
diaphragmatic herniadiaphragmatic hernia
 Two days later,Two days later,
stomach up in cheststomach up in chest
Diaphragmatic HerniaDiaphragmatic Hernia
 Stomach in chestStomach in chest
 Stomach constricted passing through diaphragmStomach constricted passing through diaphragm
Abdominal WallAbdominal Wall
 Actively bleeding rectus muscle hematomaActively bleeding rectus muscle hematoma
Soft tissue injurySoft tissue injury
 Back hematomaBack hematoma
SpineSpine
COMBINATIONCOMBINATION
INJURIESINJURIES
Spine TraumaSpine Trauma
 Originally missed burst fractureOriginally missed burst fracture
Spine TraumaSpine Trauma
 Posterior element spinousPosterior element spinous
fracturefracture
 patient withpatient with
AnkylosingAnkylosing
SpondylitisSpondylitis
Combination InjuriesCombination Injuries
 Devascularized leftDevascularized left
lobe of liverlobe of liver  Pancreatic laceration andPancreatic laceration and
left renal infarctleft renal infarct
Combination InjuriesCombination Injuries
 Wide mediastinumWide mediastinum  Periaortic hematoma-Periaortic hematoma-
sign of aortic injurysign of aortic injury
Combination InjuriesCombination Injuries
 Aortic tearAortic tear  Jejunal perforationJejunal perforation
Combination InjuriesCombination Injuries
 Aortic tearAortic tear  Pancreatic lacerationPancreatic laceration
Combination InjuriesCombination Injuries
 Aortic tearAortic tear  Bladder hematoma andBladder hematoma and
rupturerupture
Combination InjuriesCombination Injuries
 Jejunal perforationJejunal perforation
 Intraperitoneal bladder perforationIntraperitoneal bladder perforation
Combination InjuriesCombination Injuries
 Pattern of Impact determines combinationPattern of Impact determines combination
injuriesinjuries
 Avoid Satisfaction of Search ErrorAvoid Satisfaction of Search Error
Trauma to the Hollow VisceraTrauma to the Hollow Viscera
 DuodenumDuodenum
 JejunumJejunum
 IleumIleum
 ColonColon
 StomachStomach
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
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
Duodenal TraumaDuodenal Trauma
 Duodenal hematomaDuodenal hematoma
CT FindingsCT Findings
Duodenal InjuriesDuodenal Injuries
-descending/horizontal-descending/horizontal
segmentssegments
-Retro/intraperitoneal-Retro/intraperitoneal
Duodenal InjuryDuodenal Injury
 Duodenal perforation-Duodenal perforation-
missed originallymissed originally
 Perforation seen on UGIPerforation seen on UGI
examexam
Duodenal PerforationDuodenal Perforation
 Periduodenal hematomaPeriduodenal hematoma  One day later,One day later,
duodenal perforationduodenal perforation
Duodenal PerforationDuodenal Perforation
Jejunal/Ileal InjuryJejunal/Ileal Injury
 CT FindingsCT Findings
 fixation pointsfixation points
 ligament of Treitzligament of Treitz
 ileocecal valveileocecal valve
Jejunal InjuryJejunal Injury
 Triangles imply extraluminal fluidTriangles imply extraluminal fluid
 Jejunal perforationJejunal perforation
Jejunal InjuryJejunal Injury
 Mesenteric hematomaMesenteric hematoma Jejunal perforationJejunal perforation
Jejunal InjuryJejunal Injury
 Jejunal hematoma which perforatedJejunal hematoma which perforated
Jejunal PerforationJejunal Perforation
 Wall thickeningWall thickening  Seat belt signSeat belt sign
Jejunal PerforationJejunal Perforation
Bowel wall thickeningBowel wall thickening  Blood in pelvisBlood in pelvis
Jejunal PerforationJejunal Perforation
 Extravasated oralExtravasated oral
contrastcontrast
 Burst fracture of L2Burst fracture of L2
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
Jejunal InjuryJejunal Injury
 Occult jejunal injuryOccult jejunal injury
 Subtle bowel wallSubtle bowel wall
thickeningthickening
 Free fluid in pelvisFree fluid in pelvis
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
Jejunal PerforationJejunal Perforation
 Paracolic gutter fluid and mesenteric fluid mayParacolic gutter fluid and mesenteric fluid may
have different originshave different origins
Jejunal PerforationJejunal Perforation
 Extraluminal gas bubblesExtraluminal gas bubbles
LITTLE BUBBLESLITTLE BUBBLES
BIG TROUBLESBIG TROUBLES
Ileal, Cecal, Gastric TraumaIleal, Cecal, Gastric Trauma
Intense Bowel Wall EnhancementIntense Bowel Wall Enhancement
 Low flow stateLow flow state
 Intravasation of contrastIntravasation of contrast
Jejunal, Ileal InjuriesJejunal, Ileal Injuries
 Bowel wallBowel wall
enhancement-jejunalenhancement-jejunal
and ileal perforationsand ileal perforations
 pneumoperitoneumpneumoperitoneum
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
Ileal InjuryIleal Injury
 Ileal injury – wallIleal injury – wall
thickeningthickening
 Delayed perforationDelayed perforation
Ileal PerforationIleal Perforation
 SubtleSubtle
pneumoperitoneumpneumoperitoneum  Ileal perforationIleal perforation
Colonic InjuryColonic Injury
Pneumatosis of cecal wall-degloving injury ofPneumatosis of cecal wall-degloving injury of
serosaserosa
Colonic InjuryColonic Injury
 Cecal perforationCecal perforation  Traumatic herniaTraumatic hernia
Colonic InjuryColonic Injury
 Colonic infarctColonic infarct  Traumatic herniaTraumatic hernia
Colonic InjuryColonic Injury
 Stab wound to colonStab wound to colon
 extravasated contrastextravasated contrast
Rectal Contrast usedRectal Contrast used
alsoalso
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
Stomach RuptureStomach Rupture
 Pneumoperitoneum-falciform ligament seenPneumoperitoneum-falciform ligament seen
 CT-pneumoperitoneumCT-pneumoperitoneum
Stomach PerforationStomach Perforation
 Extravasated oral contrast from stomachExtravasated oral contrast from stomach
Mesenteric InjuriesMesenteric Injuries
CT FindingsCT Findings
 mesenteric fat streakingmesenteric fat streaking
 mass effect on bowelmass effect on bowel
Mesenteric InjuryMesenteric Injury
 Mesenteric hematomasMesenteric hematomas
Mesenteric InjuryMesenteric Injury
 Superior mesenteric vein bleedSuperior mesenteric vein bleed
Mesenteric InjuryMesenteric Injury
 Missed mesenteric bleedMissed mesenteric bleed
mimicking bowel loopmimicking bowel loop
 Delayed HematomaDelayed Hematoma
PneumoperitoneumPneumoperitoneum
 Plain filmPlain film  CT with lung windowsCT with lung windows
PneumoretroperitoneumPneumoretroperitoneum
 Plain filmPlain film  CTCT
Shock BowelShock Bowel
 Small aorta and IVCSmall aorta and IVC
 Nonexcreting kidneysNonexcreting kidneys
 Diffuse bowel wall edemaDiffuse bowel wall edema
Shock BowelShock Bowel
 Diffuse bowel wall edemaDiffuse bowel wall edema
OverhydrationOverhydration
 Periportal edemaPeriportal edema
Bowel wall thickeningBowel wall thickening
Distended IVC andDistended IVC and
aortaaorta
Periportal edemaPeriportal edema
RetroperitonealRetroperitoneal
effusionseffusions
OverhydrationOverhydration
 Retroperitoneal effusionRetroperitoneal effusion  Diffuse bowel wall edemaDiffuse bowel wall edema
Shock BowelShock Bowel
 Jejunal perforationJejunal perforation Shock bowelShock bowel
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
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)
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
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
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
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

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Nhung diem-giong-va-khac-nhau-giua-hen-phe-quan-va-benh-phoi-tac-nghen-man-tinh
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Chan doan-benh-co-roi-loan-thong-khi-man-tinh-hen-phe-quan-copd
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Xu tri-toi-uu-tang-huyet-ap-dai-thao-duong
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Cach doc-phim-chup-cat-lop-vi-tinh

  • 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
  • 4.
  • 5.
  • 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
  • 8.
  • 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
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 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
  • 22.
  • 24. Viêm t y c p + gi phìnhụ ấ ả
  • 25.
  • 26.
  • 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
  • 34.
  • 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
  • 40.
  • 41.
  • 42.
  • 43.
  • 45.
  • 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
  • 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
  • 106.
  • 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
  • 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
  • 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