Radiology slideshare

1. USG IN ABDOMINAL
TRAUMA

2. ABDOMINAL TRAUMA
1.Trauma causes 10% of deaths world wide
2.Third commonest cause of death after
malignancy and vascular disease

3. MECHANISM OF INJURY
• Direct impact or movement of organs
• Compressive , stretching or shearing forces
• Solid organs > Blood loss
• Hollow organs > Blood loss
• Retroperitoneal > often asymptomatic

4. ABDOMINAL TRAUMA –
CLASSIFICATION
1.BLUNT ABDOMINAL TRAUMA
*VEHICULAR TRAUMA
*BLOW TO THE ABDOMEN
*FALL FROM HEIGHT
*DOMESTIC ACCIDENTS
*FIGHTS
*IATOROGENIC

6. PENETRATING ABDOMINAL
TRAUMA
1.ACCIDENTAL
2.HOMICIDAL
3.IATROGENIC
4.STAB WOUNDS
5.GUN SHOT WOUNDS
6.SHRAPNEL WOUNDS
7.IMPALEMENTS

7. VECTORS OF FORCE
• RIGHT SIDED MIDLINE LEFT
SIDED
RIGHT HEPATIC LOBE LEFT HEPATIC LOBE SPLEEN
RIGHT KIDNEY PANCREATIC BODY LEFT
KIDNEY
DIAPHRAGM PANCREATIC HEAD AORTA
DIAPHRAGM
DUODENUM TRANSVERSE COLON
PANCREATIC TAIL
IVC DUODENUM
SMALL BOWEL

8. HOW TO SCAN
• Patient placed in supine position
• Low frequency curvilinear probe
• Transducer marker
• Longitudinal ---- Towards head
• Transverse – To patient right

9. FAST APPLICATION
INDICATIONS :
1.ACUTE BLUNT OR PENETRATING TORSO TRAUMA
2.TRAUMA IN PREGNANCY
3. PAEDIATRIC TRAUMA
4. SUACUTE TORSO TRAUMA

10. FAST USG SCAN
• ANATOMY
• TECHNIQUE
• FAST DEMO
• FREE FLUID
• ABDOMINAL ORGAN INJURY

11. FLUID IN THE MORRISONS POUCH

12. BLOOD IN DOUGLASS POUCH

13. FLUID IN PELVIS
• PELVIS : Longitudinally and transverse axis
• Probe placed – transversely than longitudinally
• Midline 2 cm superior to the symphysis pubis
• Aimed –caudally into the pelvis
• Probe facing towards the patients head and right side
• Best with some urine in bladder
• Evaluating : Bladder , uterus in females , Prostate in male

14. EXAMINATION OF PELVIS

15. WHERE TO SCAN
1.RUQ
2.LUQ
3.SUBXIPHOID
4.SUPRAPUBIC
5.RIGHT 3RD TO 4TH INTERCOSTAL SPACE
6.LEFT 3RD TO 4TH INTERCOSTAL SPACE

16. RIGHT SIDED TRAUMA

17. ACR APPROPIATENESS
CRITERIA
CATEGORY A
HAEMODYANAMICALLY UNSTABLE
CLINICALLY OBVIOUS MAJOR ABDOMINAL
TRAUMA
RESUSCITATION WITH VOLUME
REPLACEMENT
NOT RESPOND TO RESUSCITATION

18. HEMODYNAMIC STABILITY ?
Unstable
INVESTIGATION AVAILIBILITY
UNSTABLE
FAST—FREE FLUID –NO – CONTINUE RESUSCITATION
DPL—BLOOD ---YES --- LAPROTOMY

19. CATEGORY B
• HEMODYANAMICALLY STABLE
-MILD TO MODERATE RESPONSIVE HYPOTENSION
-SIGNIFICANT TRAUMA AND HAVE AT –LEAST MODERATE SUSPICION OF
INTRABDOMINAL INJURY BASED ON CLINICAL SIGNS AND SYMPTOMS
-THESE PATIENTS SHOULD BE EVALUATED BY IMAGING

20. HEMODYANAMIC STABILITY?
• UNSTABLE ---
• INVESTIGATION AVAILIBILITY
--- FAST : FREE FLUID ::--- CONTINUE RESUSCITATION
----DPL --- BLOOD --- YES---- LAPROTOMY
SIGNIFICANT TRAUMA AND HAVE At least moderate suspicion of intra-abdominal
injury based on clinical signs and symptoms .These patients should be evaluated by
imaging

21. FAST EXAMINATION
1.PERIHEPATIC
2.PERISPLENIC
3.PELVIC
4.PERICARDIUM

22. PERIHEPATIC SCAN

23. PERISPLENIC SCAN

24. PERISPLENIC WINDOW
• TRANSDUCER IS PLACED
• TRANSDUCER is positioned in left posterior axillary line with the beam in the
coronal plane .Demonstrates spleen , kidney and diaphragm

25. ABNORMAL PERISPLENIC
WINDOW

26. PELVIC AREA

28. MORAVELLE LAVELLE LESSON
Typically these lesions are anechoic or hypoechoic. As with a standard
hematoma, it can be predominantly echogenic in the acute phase, becoming
more hypoechoic as blood products liquefy over time 11. Internal debris,
including fat globules, can give rise to echogenic foci or even fluid-fluid
levels 1. A capsule of variable thickness may be seen. The shape may range
from flat to mass-like.

30. •lacerations that involve a hepatic vein are associated with increased risk of arterial injury and need
for operative management 8
•although not an injury, periportal edema can be seen associated with liver injuries as patients with
higher-grade injuries will have received aggressive fluid resuscitation
•lacerations that extend to the porta hepatis increase the risk of bile duct injuries, particularly delayed
biliary complications 8

31. USG FEATURES OF SPLENIC INJURY

32. SPLENIC HAEMORRHAGE

33. FAST IDENTIFICATION OF TRAUMATIC
LACERATION OF LIVER

34. LIVER TRAUMA

35. • 1. Haematoma : subcapsular ( 10%
• Laceration : capsular tear ( 1 cm , parenchymal length
• 2. Haematoma :Subcapsular 10-50% surface area ,
intraparenchymal ( 10cm
• Laceration : 1-3 cm parenchymal length ,(10cm in length
• 3. Haematoma : Subcapsular ) 50 % surface area or
expanding
• . Laceration ) 3cm parenchymal length
• 4. Laceration : ) 3 cm parenchymal depth
• Laceration or parenchymal disruption 25-75% of hepatic
lobe

36. GALL BLADDER PERFORATION

37. GALL BLADDER INJURY

38. BILE DUCT INJURY

39. SYMPTOMS OF RIGHT UPPER QUADRANT
PATHOLOGY
•Sudden and rapidly intensifying pain in the upper
right portion of your abdomen.
•Sudden and rapidly intensifying pain in the center
of your abdomen, just below your breastbone.
•Back pain between your shoulder blades.
•Pain in your right shoulder.
•Nausea or vomiting

40. USG FEATURES OF KIDNEY INJURY

41. USG SIGNS OF KIDNEY
INJURY

42. SYMPTOMS OF BLADDER INJRY
•Lower abdominal pain.
•Abdominal tenderness.
•Bruising at the site of injury.
•Blood in the urine.
•Bloody urethral discharge.
•Difficulty beginning to urinate or inability to empty the bladder.
•Leakage of urine.
•Painful urination

44. THANK YOU