Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury.

Blunt traumatic injury is one of the leading causes of morbidity and mortality in the United States. Unintentional injury represents the leading cause of death in the United States for all persons between the ages of 1 and 44 years. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Despite the relatively low rate of blunt bowel and mesenteric injury in patients with abdominal and pelvic trauma, delays in diagnosis are associated with increased rates of sepsis, a prolonged course in the intensive care unit, and increased mortality. During the past 2 decades, as multidetector computed tomography (CT) has emerged as an essential tool in emergency radiology, several direct and indirect imaging features have been identified that are associated with blunt bowel and mesenteric injury. The imaging findings in cases of blunt bowel and mesenteric injury can be subtle and may be seen in the setting of multiple complex injuries, such as multiple solid-organ injuries and spinal fractures. Familiarity with the various imaging features of blunt bowel and mesenteric injury, as well as an understanding of their clinical importance with regard to the care of the patient, is essential to making a timely diagnosis. Once radiologists are familiar with the spectrum of findings of blunt bowel and mesenteric injury, they will be able to make timely diagnoses that will lead to improved patient outcomes. ©RSNA, 2017.

Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner.

PURPOSE: The purpose of this study is to assess the performance of CT angiography (CTA) in the evaluation of penetrating vascular trauma to the extremities in a large cohort of patients at our level I trauma center. METHODS: A retrospective, IRB-approved review of consecutive CTAs for the evaluation of penetrating trauma to the extremities in 446 patients (M/F = 396:50, mean age = 27 years) from 1/1/2005 to 5/1/2015 was performed. Medical records were reviewed to correlate diagnostic imaging findings with clinical history and subsequent interventions. Image quality was quantified by measurement of CT attenuation coefficients in the major arteries of the extremities. The Fisher's exact test was used to analyze the relationships between the presence and type of vascular injury and subsequent clinical management. RESULTS: One hundred and thirty-one (29.4 %) of 446 patients with penetrating trauma demonstrated major vascular injury on CTA, 35 (26.7 %) of whom underwent subsequent surgical repair. None of the patients without vascular injury on CTA underwent subsequent vascular intervention. Fisher's exact test demonstrated a statistically significant difference in management and requirement for vascular repair in those patients with a vascular injury on CTA when compared to those without a vascular injury (p < 0.0001). The mean attenuation values achieved in upper and lower extremity CTAs in this population exceeded 250 HU. CONCLUSION: Extremity CTA is found to be an accurate tool for surgical triage in patients having sustained penetrating vascular trauma.