Blunt Abdominal Trauma: Does the Use of a Second-Generation Sonographic Contrast Agent Help to Detect Solid Organ Injuries?
Pierre-Alexandre Poletti1,
Alexandra Platon1,
Christoph D. Becker1,
Gilles Mentha2,
Bernard Vermeulen3,
Léo H. Buhler2 and
François Terrier1
1 Department of Radiology, University Hospital of Geneva, 24, rue
Micheli-du-Crest, 1211 Genève-14, Switzerland.
2 Clinic/Policlinic of Digestive Surgery, University Hospital of Geneva, Geneva,
Switzerland.
3 Emergency Center, University Hospital of Geneva, Geneva, Switzerland.
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Fig. 1A. —37-year-old man admitted to hospital after fall. Admission
sonogram (not shown) was reported to show normal findings; neither free fluid
nor parenchymal organ injury was visible. Transverse CT image of abdomen
reveals grade 3 injury of anterior aspect of right kidney (arrow).
Arrowheads = perinephric hematoma.
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Fig. 1B. —37-year-old man admitted to hospital after fall. Admission
sonogram (not shown) was reported to show normal findings; neither free fluid
nor parenchymal organ injury was visible. Oblique long-axis control sonogram
shows right heterogenous perirenal hematoma (arrowheads) but no
parenchymal injury of kidney.
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Fig. 1C. —37-year-old man admitted to hospital after fall. Admission
sonogram (not shown) was reported to show normal findings; neither free fluid
nor parenchymal organ injury was visible. Oblique long-axis contrast-enhanced
sonogram reveals laceration of right kidney as deep hypodense rent surrounded
by enhanced hyperechoic normal parenchyma (arrow). Perirenal hematoma
is also well shown as hypoechoic rim (arrowheads).
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Fig. 2A. —26-year-old woman admitted to hospital after skiing accident.
Admission sonogram (not shown) revealed diffuse free intraperitoneal fluid and
no parenchymal organ injury. Admission transverse CT scan reveals extended
(grade 4) splenic injury (between arrows) surrounded by large
hemoperitoneum (arrowhead).
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Fig. 2B. —26-year-old woman admitted to hospital after skiing accident.
Admission sonogram (not shown) revealed diffuse free intraperitoneal fluid and
no parenchymal organ injury. Axial CT image obtained 5 cm below A, at
level of spleen hilum, shows two hyperdense blushes of contrast medium
(arrows), suggestive of pseudoaneurysms.
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Fig. 2C. —26-year-old woman admitted to hospital after skiing accident.
Admission sonogram (not shown) revealed diffuse free intraperitoneal fluid and
no parenchymal organ injury. Sagittal oblique control sonogram does not depict
any injury of spleen. Only hemoperitoneum (arrow) is depicted.
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Fig. 2D. —26-year-old woman admitted to hospital after skiing accident.
Admission sonogram (not shown) revealed diffuse free intraperitoneal fluid and
no parenchymal organ injury. Sagittal oblique contrast-enhanced sonogram shows
central deep hypoechoic area within spleen, which corresponds to CT-proven
parenchymal injury (arrowheads). Two vascular injuries
(arrows) are also well shown as hyperechoic foci. Patient underwent
surgical splenectomy, which confirmed presence of two vascular injuries
(pseudoaneurysms).
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Fig. 3A. —31-year-old man admitted 1 hr after motorbike accident.
Admission sonogram (not shown) was normal. Axial CT image obtained at level of
upper abdomen shows grade 3 liver injury (arrow). There is no
associated free fluid.
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Fig. 3B. —31-year-old man admitted 1 hr after motorbike accident.
Admission sonogram (not shown) was normal. Axial control sonogram obtained at
level of injury does not show any parenchymal abnormality.
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Fig. 3C. —31-year-old man admitted 1 hr after motorbike accident.
Admission sonogram (not shown) was normal. Axial contrast-enhanced sonogram
reveals liver injury as deep hypoechoic area (between arrows)
surrounded by enhanced hyperechoic parenchyma.
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Fig. 4A. —32-year-old man admitted to hospital after motor vehicle
accident. Sagittal oblique admission sonogram reveals presence of
heterogeneity (hyper- and hypoechoic area) of central aspect of spleen
(between arrows), which corresponds to injury.
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Fig. 4B. —32-year-old man admitted to hospital after motor vehicle
accident. Axial CT image of abdomen, obtained immediately after admission
sonogram (A), confirms grade 3 splenic laceration (arrow).
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Fig. 4C. —32-year-old man admitted to hospital after motor vehicle
accident. Axial control CT image of abdomen, obtained 3 days after admission,
shows pooling of contrast medium (arrow), which corresponds to
pseudoaneurysm.
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Fig. 4D. —32-year-old man admitted to hospital after motor vehicle
accident. Longitudinal oblique contrast-enhanced sonogram of spleen (S)
obtained after control CT (C) shows well-delineated, highly hyperechoic
spot of contrast medium (arrow) that corresponds to vascular injury
(pseudoaneurysm) seen on CT. Patient underwent angiographic procedure and was
successfully nonoperatively managed. K = kidney.
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Copyright © 2004 by the American Roentgen Ray Society.
