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Sample records for blunt aortic injury

  1. Ascending aortic injuries following blunt trauma.

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    Sun, Xiumei; Hong, Jenny; Lowery, Robert; Goldstein, Steven; Wang, Zuyue; Lindsay, Joseph; Hill, Peter C; Corso, Paul J

    2013-11-01

    The diagnosis and the management of traumatic thoracic aortic injuries have undergone significant changes due to new technology and improved prehospital care. Most of the discussions have focused on descending aortic injuries. In this review, we discuss the recent management of ascending aortic injuries. We found 5 cohort studies on traumatic aortic injuries and 11 case reports describing ascending aortic injuries between 1998 to the present through Medline research. Among case reports, 78.9% of cases were caused by motor vehicle accidents (MVA). 42.1% of patients underwent emergent open repair and the operative mortality was 12.5%. 36.8% underwent delayed repair. Associated injuries occurred in 84.2% of patients. Aortic valve injury was concurrent in 26.3% of patients. The incidence of ascending aortic injury ranged 1.9-20% in cohort studies. Traumatic injuries to the ascending aorta are relatively uncommon among survivors following blunt trauma. Aortography has been replaced by computed tomography and echocardiography as a diagnostic tool. Open repair, either emergent or delayed, remains the treatment of choice. © 2013 Wiley Periodicals, Inc.

  2. Multiple subfailures characterize blunt aortic injury.

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    Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A; Brasel, Karen J

    2007-05-01

    Blunt aortic injuries result from rapid deceleration of the thorax as may occur during automotive impacts and falls from extreme heights. Pathological findings can range from failure of specific vessel layers to immediate vessel wall rupture. The purpose of this investigation was to determine the sequence of local structural events that may lead to aortic wall disruption. Fourteen porcine aorta specimens were opened to expose the intima and longitudinally distracted until rupture. Longitudinal mechanics were quantified and subfailures were identified. Histology was used to examine internal layer subfailure. Videography demonstrated that subfailures propagated into complete vessel wall rupture. Subfailures occurred before complete vessel rupture in 93% of specimens. Intimal and medial subfailures were present at 74% of the stress and 82% of the strain to rupture. Multiple subfailures were evident in 79% of specimens. Present results supported the clinical theory that nonimmediate death as a result of blunt aortic injury is commonly caused by propagation of lesser lesions, initiating on the intimal layer, into complete vessel rupture including the adventitial layer. This finding, along with histologic evidence of subfailure pathological findings, confirms the presence of an acute window during which recognition and initiation of permissive hypotension may be lifesaving.

  3. Open Treatment of Blunt Injuries of Supra-Aortic Branches: Case Series.

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    Sladojevic, Milos; Markovic, Miroslav; Ilic, Nikola; Pejkic, Sinisa; Banzic, Igor; Djoric, Predrag; Koncar, Igor; Tomic, Ivan; Davidovic, Lazar

    2016-02-01

    Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases. We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment. When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Development of stroke-induced quadriplegia after endovascular repair of blunt aortic injury pseudoaneurysm.

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    Amoudi, Abdullah S; Merdad, Anas A; Makhdoom, Ahmed Q; Jamjoom, Reda A

    2015-01-01

    Endovascular repair of blunt aortic injury is now a first-line approach in management. This can warrant coverage of the left subclavian artery (LSA), which could lead to posterior strokes. In this case report, we present a severe complication of endovascular repair of a traumatic aortic aneurysm. A 53-year-old man presented with blunt aortic injury, endovascular repair was carried out where the left subclavian artery was covered. The intervention had a 100% technical success. Twelve hours later, he was discovered to have quadriplegia, a CT scan showed a large left cerebellar infarction extending to the medulla oblongata and proximal spinal cord. Strokes complicate 3% of thoracic endovascular aortic repairs, 80% of those strokes occur in patients who had their LSA`s covered. Most patients however, tolerate the coverage. Although our patient had a dominant right vertebral artery, and lacked risks for these strokes, he developed an extensive stroke that left him quadriplegic.

  5. Associated injuries, management, and outcomes of blunt abdominal aortic injury.

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    de Mestral, Charles; Dueck, Andrew D; Gomez, David; Haas, Barbara; Nathens, Avery B

    2012-09-01

    Blunt abdominal aortic injury (BAAI) is very rare, and current literature is limited to case series of single-center experience. Through an analysis of the National Trauma Data Bank, the largest aggregation of United States trauma registry data, our aim was to characterize the associated injury pattern, contemporary management, and in-hospital outcomes of patients with BAAI. We used a nested case-control design. The overall cohort consisted of adult patients (age ≥ 16 years) severely injured (Injury Severity Score ≥ 16) after blunt trauma who were treated at a level 1 or 2 trauma center in years 2007 to 2009. Cases were patients with BAAI and were frequency-matched by age group and mechanism to randomly selected controls at a one-to-five ratio. Multivariable matched analysis (conditional logistic regression) was used to derive adjusted measures of association between BAAI and adjacent arterial, intra-abdominal, and bony injuries. We identified 436 patients with BAAI from 180 centers. The mean Injury Severity Score was 35 ± 14, and most patients were injured in motor vehicle crashes (84%). Multivariable analysis showed injury to the thoracic aorta, renal and iliac artery, small bowel, colon, liver, pancreas, and kidney, as well as lumbar spine fractures were independently associated with BAAI. A total of 394 patients (90%) were managed nonoperatively, and 42 (10%) underwent repair. Of these 42 patients, 29 (69%) underwent endovascular repair, with 11 patients undergoing open aortic repair and two extra-anatomic bypasses. Median time from admission to repair was 1 day (interquartile range, 1-2 days). Overall mortality was 29%. A total of 271 (69%) patients managed nonoperatively survived to hospital discharge. The index of suspicion for BAAI should be raised in severely injured patients by the presence of injuries to the lumbar spine, bowel, retroperitoneal organs, and adjacent major arteries. Although endovascular repair is the most common intervention, most

  6. Traumatic Aortic Injury

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    Brianna Miner

    2016-09-01

    Full Text Available History of present illness: A 48-year-old male with unknown past medical history presents as a trauma after being hit by a car traveling approximately 25 miles per hour. On initial presentation, the patient is confused, combative, and not answering questions appropriately. The patient is hypotensive with a blood pressure of 68/40 and a heart rate of 50 beats per minute, with oxygen saturation at 96% on room air. FAST scan is positive for fluid in Morrison’s pouch, splenorenal space, and pericardial space. Significant findings: The initial chest x-ray showed an abnormal superior mediastinal contour (blue line, suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow. There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows. Discussion: Traumatic aortic injury is a life-threatening event. The incidence of blunt thoracic aortic injury is low, between 1 to 2 percent of those patients with blunt thoracic trauma.1 However, approximately 80% of patients with traumatic aortic injury die at the scene.2 Therefore it is imperative to diagnose traumatic aortic injury in a timely fashion. The diagnosis can be difficult due to the non-specific signs and symptoms and other distracting injuries. Clinical suspicion should be based on the mechanism of the injury and the hemodynamic status of the patient. In any patient with blunt or penetrating trauma to the chest that is hemodynamically unstable, traumatic aortic injury should be on the differential. Chest x-ray can be used as a screening tool. A normal chest x-ray has a negative predictive value of approximately 97%. CTA chest is the

  7. The utility of chest X-ray as a screening tool for blunt thoracic aortic injury.

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    Gutierrez, Adam; Inaba, Kenji; Siboni, Stefano; Effron, Zachary; Haltmeier, Tobias; Jaffray, Paul; Reddy, Sravanthi; Lofthus, Alexander; Benjamin, Elizabeth; Dubose, Joseph; Demetriades, Demetrios

    2016-01-01

    The early and accurate identification of patients with blunt thoracic aortic injury (BTAI) remains a challenge. Traditionally, a portable AP chest X-ray (CXR) is utilized as the initial screening modality for BTAI, however, there is controversy surrounding its sensitivity. The purpose of this study was to assess the sensitivity of CXR as a screening modality for BTAI. After IRB approval, all adult (≥18 yo) blunt trauma patients admitted to LAC+USC (01/2011-12/2013) who underwent CXR and chest CT were retrospectively reviewed. Final radiology attending CXR readings were reviewed for mediastinal abnormalities (widened mediastinum, mediastinal to chest width ratio greater than 0.25, irregular aortic arch, blurred aortic contour, opacification of the aortopulmonary window, and apical pleural haematoma) suggestive of aortic injury. Chest CT final attending radiologist readings were utilized as the gold standard for diagnosis of BTAI. The primary outcome analyzed was CXR sensitivity. A total of 3728 patients were included in the study. The majority of patients were male (72.6%); mean age was 43 (SD 20). Median ISS was 9 (IQR 4-17) and median GCS was 15 (IQR 14-15). The most common mechanism of injury was MVC (48.0%), followed by fall (20.6%), and AVP (16.9%). The total number of CXRs demonstrating a mediastinal abnormality was 200 (5.4%). Widened mediastinum was present on 191 (5.1%) of CXRs, blurred aortic contour on 10 (0.3%), and irregular aortic arch on 4 (0.1%). An acute aortic injury confirmed by chest CT was present in 17 (0.5%) patients. Only 7 of these with CT-confirmed BTAI had a mediastinal abnormality identified on CXR, for a sensitivity of 41% (95% CI: 19-67%). The results from this study suggest that CXR alone is not a reliable screening modality for BTAI. A combination of screening CXR and careful consideration of other factors, such as mechanism of injury, will be required to effectively discriminate between those who should and should not undergo chest

  8. Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

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    Rathachai Kaewlai

    2011-01-01

    Full Text Available Trauma patients with thoracic aortic injury (TAI suffer blunt cardiac injury (BCI at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG and serum creatine kinase-MB (CK-MB from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4 in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7, eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P<0.001.

  9. Concomitant aortic valve and internal mammary artery injuries in blunt chest trauma: report of a case.

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    Yeh, Chun-Chieh; Hsieh, Chi-Hsun; Wang, Yu-Chun; Chung, Ping-Kuei; Chen, Ray-Jade

    2009-01-01

    We report a case of concomitant injury to the aortic valve and internal mammary artery (IMA) from nonpenetrating chest trauma. To our knowledge, this is the first such case to be reported. Transcatheter arterial embolization (TAE) following diagnostic angiography offers an effective and minimally invasive treatment for traumatic IMA injuries. Because there might be an asymptomatic interval after traumatic aortic valve injuries, serial physical examinations and repeated echocardiography should be mandatory for patients with de novo heart failure after blunt chest trauma. Transesophageal echocardiography can provide a clearer image of cardiac injuries than transthoracic echocardiography, particularly if there is extensive anterior mediastinal hematoma resulting from IMA trauma.

  10. Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.

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    Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Boix, Ricardo; Lopez-Perez, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

    2012-09-01

    To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4). Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.

  11. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

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    Larry E. Miller

    2012-01-01

    Full Text Available Blunt thoracic aortic injury (BTAI is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology VOMIT.

  12. Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury

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    Wicky, S.; Capasso, P.; Meuli, R.; Schnyder, P.; Fischer, A.; Segesser, L. von

    1998-01-01

    The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients. (orig.)

  13. Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma

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    Scaglione, M.; Pinto, A.; Pinto, F.; Romano, L.; Ragozzino, A.; Grassi, R.

    2001-01-01

    The purpose of this retrospective study was to determine the value of contrast-enhanced helical CT for detecting and managing acute thoracic aortic injury (ATAI). Between June 1995 and February 2000, 1419 consecutive chest CT examinations were performed in the setting of major blunt trauma. The following CT findings were considered indicative of ATAI: intimal flap; pseudoaneurysm; contour irregularity; lumen abnormality; and extravasation of contrast material. On the basis of these direct findings no further diagnostic investigations were performed. Isolated mediastinal hematoma on CT scans was considered an indirect sign of ATAI: In these cases, thoracic aortography was performed even if CT indicated normal aorta. Seventy-seven patients had abnormal CT scans: Among the 23 patients with direct CT signs, acute thoracic aortic injuries was confirmed at thoracotomy in 21. Two false-positive cases were observed. The 54 remaining patients had isolated mediastinal hematoma without aortic injuries at CT and corresponding negative angiograms. The 1342 patients with negative CT scans were included in the 8-month follow-up program and did not show any adverse sequela based on clinical and radiographic criteria. Contrast-enhanced helical CT has a critical role in the exclusion of thoracic aortic injuries in patient with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of ATAI do not require further diagnostic investigations to confirm the diagnosis: Isolated aortic bands or contour vessel abnormalities should be first considered as possible artifacts or related to non-traumatic etiologies especially when mediastinal hematoma is absent. In cases of isolated mediastinal hematoma other possible sources of bleeding should be considered before directing patients to thoracic aortography. (orig.)

  14. Atypical Presentation of Traumatic Aortic Injury

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    Andrew Fu Wah Ho

    2014-01-01

    Full Text Available Background. Blunt thoracic aorta injury (BAI is second only to head injury as cause of mortality in blunt trauma. While most patients do not survive till arrival at the hospital, for the remainder, prompt diagnosis and treatment greatly improve outcomes. We report an atypical presentation of BAI, highlighting the diagnostic challenges of this condition in the emergency department. Case Presentation. A previously well 25-year-old male presented 15 hours after injury hemodynamically stable with delirium. There were no signs or symptoms suggestive of BAI. Sonography showed small bilateral pleural effusions. Chest radiograph showed a normal mediastinum. Eventually, CT demonstrated a contained distal aortic arch disruption. The patient underwent percutaneous endovascular thoracic aortic repair and recovered well. Conclusion. This catastrophic lesion may present with few reliable signs and symptoms; hence, a high index of suspicion is crucial for early diagnosis and definitive surgical management. This paper discusses the diagnostic utility of clinical features, injury mechanism, and radiographic modalities. Consideration of mechanism of injury, clinical features, and chest radiograph findings should prompt advanced chest imaging.

  15. Blunt gastric injuries.

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    Oncel, Didem; Malinoski, Darren; Brown, Carlos; Demetriades, Demetrios; Salim, Ali

    2007-09-01

    Gastric rupture after blunt abdominal trauma is a rare injury with few reports in the literature. The purpose of this study was to review our experience with blunt gastric injuries and compare outcomes with small bowel or colon injuries. All patients with hollow viscus perforations after blunt abdominal trauma from 1992 to 2005 at our level I trauma center were reviewed. Of 35,033 blunt trauma admissions, there were 268 (0.7%) patients with a total of 319 perforating hollow viscus injuries, 25 (0.07%) of which were blunt gastric injuries. When compared with the small bowel or colon injuries, the blunt gastric injury group had a higher Injury Severity Score (22 versus 17, P = 0.04), more patients with a chest Abbreviated Injury Score greater than 2 (36% versus 12%, P < 0.01), and a shorter interval from injury to laparotomy (221 versus 366 minutes, P = 0.017). Multivariate analysis identified five independent risk factors for mortality: age older than 55 years, head Abbreviated Injury Score greater than 2, chest Abbreviated Injury Score greater than 2, the presence of hypotension on admission, and Glasgow Coma Scale 8 or less. The results of this study suggest that mortality in patients with blunt hollow viscus injuries can be attributed to concurrent head and chest injuries, but not the specific hollow viscus organ that is injured.

  16. Advances in Imaging and Management Trends of Traumatic Aortic Injuries

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    Nagpal, Prashant, E-mail: drprashantnagpal@gmail.com, E-mail: Prashant-nagpal@uiowa.edu; Mullan, Brian F. [University of Iowa Hospitals and Clinics, Department of Radiology (United States); Sen, Indrani [Mayo Clinic, Department of Vascular and Endovascular Surgery (United States); Saboo, Sachin S. [UT Southwestern Medical Center, Department of Radiology (United States); Khandelwal, Ashish [Mayo Clinic, Department of Radiology (United States)

    2017-05-15

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  17. Advances in Imaging and Management Trends of Traumatic Aortic Injuries

    International Nuclear Information System (INIS)

    Nagpal, Prashant; Mullan, Brian F.; Sen, Indrani; Saboo, Sachin S.; Khandelwal, Ashish

    2017-01-01

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  18. Advances in Imaging and Management Trends of Traumatic Aortic Injuries.

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    Nagpal, Prashant; Mullan, Brian F; Sen, Indrani; Saboo, Sachin S; Khandelwal, Ashish

    2017-05-01

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  19. Endovascular management of lap belt-related abdominal aortic injury in a 9-year-old child.

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    Papazoglou, Konstantinos O; Karkos, Christos D; Kalogirou, Thomas E; Giagtzidis, Ioakeim T

    2015-02-01

    Blunt abdominal aortic trauma is a rare occurrence in children with only a few patients having been reported in the literature. Most such cases have been described in the context of lap belt injuries. We report a 9-year-old boy who suffered lap belt trauma to the abdomen during a high-speed road traffic accident resulting to the well-recognized pattern of blunt abdominal injury, that is, the triad of intestinal perforation, fractures of the lumbar spine, and abdominal aortic injury. The latter presented with lower limb ischemia due to dissection of the infrarenal aorta and right common iliac artery. Revascularization was achieved by endovascular means using 2 self-expanding stents in the infrarenal aorta and the right common iliac artery. This case is one of the few reports of lap belt-related acute traumatic abdominal aortic dissection in a young child and highlights the feasibility of endovascular management in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Traumatic aortic dissection presenting with respiratory arrest

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    C.C. Meyer

    2015-03-01

    Conclusion: Blunt aortic injury is a major cause of death in blunt chest trauma. Signs and symptoms of this injury are nonspecific and other injuries often take precedence, which makes a relatively difficult diagnosis even more challenging.

  1. Is chest x-ray an adequate screening tool for the diagnosis of blunt thoracic aortic injury?

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    Ekeh, Akpofure Peter; Peterson, Wylan; Woods, Randy J; Walusimbi, Mbaga; Nwuneli, Nancy; Saxe, Jonathan M; McCarthy, Mary C

    2008-11-01

    Blunt thoracic aortic injuries (BTAI) have a high mortality rate. For survivors, chest X-ray (CXR) findings are used to determine the need for further diagnostic testing with chest computerized tomography with angiography (CTA) or conventional angiography. We set to determine the adequacy of utilizing CXR alone as a screening tool for BTAI. All patients diagnosed with BTAI at a level I trauma-center during a 7-year-period were identified. CXRs of these patients and those of a control group of blunt trauma patients with an injury severity score >15 were reviewed by four trauma surgeons blinded to the diagnosis. Based on each CXR viewed, the surgeons decided if they would have proceeded to chest CTA, angiography, or required no further studies to rule out BTAI. In the 7-year-period, 83 patients had BTAI. CXRs were available in 45 patients. The four surgeons viewed 96 CXRs including those of 51 controls. Based on the CXR appearance in patients with BTAI, the surgeons chose to proceed to chest CTA in 38 patients (84.4%), conventional aortography in two patients (4.4%), and no further testing in five patients (11.2%). A widened mediastinum (75%) and loss of the aorto-pulmonary window (40%) were the most frequent CXR abnormalities. Patients with BTAI were more likely to have an abnormal CXR-40 of 45 (88.8%) patients when compared with the controls-25 of 51 (49%)patients-p < 0.001. Although CXR is a sensitive screening modality, it failed to identify the possibility of BTAI in 11% of patients. The liberal use of chest CTA after high speed motor vehicle crashes is recommended to minimize the incidence of missed BTAI.

  2. Chest and spine radiography abnormality in blunt chest trauma correlated with major vessel injury in an unselected patient population

    International Nuclear Information System (INIS)

    Fernandez, G.; Kadir, S.; Encarnacion, C.

    1989-01-01

    To assess the true incidence of major vessel injury, the authors retrospectively reviewed all arch aortograms obtained for blunt chest trauma (BCT) during a 24-month period beginning December 1986. Aortograms were correlated with preangiographic chest radiographic and operative findings. The goals of this review were to examine the usefulness of commonly employed screening criteria for aortography and determine whether thoracic spine fractures imply a decreased likelihood of aortic injury. One hundred twenty aortograms were obtained during this period. The incidence of aortic laceration was 6.7%, and 7.5% had brachiocerebral vascular injury. Only 51% of chest radiographs were suggestive of vascular injury. Two patients with subtle radiographic findings had aortic laceration. One patient with a burst fracture of T-4 had aortic laceration. The results of this review indicate the incidence of great vessel injury is as high as that of injury to the aorta itself and that the presence of spine fractures does not exclude vascular injury

  3. Blunt carotid and vertebral artery injuries.

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    Arthurs, Zachary M; Starnes, Benjamin W

    2008-11-01

    The recognition and treatment of blunt cerebrovascular injuries has dramatically evolved over the past two decades. As imaging technology has improved both with respect to the image quality and acquisition times, its use has become a fundamental diagnostic tool in blunt trauma evaluation. The single greatest radiological advance in the past quarter century has been the refinement and increasing use of computed tomographic imaging for the diagnosis of surgical disease. Paralleling advances in noninvasive imaging, a heightened awareness of blunt cerebrovascular injuries has emerged, and the first screening protocols were developed at high volume trauma centres. Through aggressive screening, these injuries have increasingly been recognised before devastating neurological ischaemia and adverse neurocognitive outcomes. The mainstay of treatment for these injuries is antithrombotic therapy. However, all blunt cerebrovascular injuries require short and long-term follow-up. While the majority of injuries will resolve with medical management, a proportion will require further intervention in order to reduce the risk of subsequent stroke.

  4. Blunt cerebrovascular injuries in trauma.

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    Eastham, Shannon

    2016-09-01

    Blunt cerebrovascular injury (BCVI) includes trauma to the carotid or vertebral vessels and is noted in 0.1% of hospitalized trauma patients without an initial screening system in place. Several important topics must be addressed including determination of the appropriate screening population, the best modality of screening for diagnosis, treatment types, and required follow-up of blunt cerebrovascular injuries. Copyright © 2015 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study.

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    Marc Hanschen

    Full Text Available Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients.In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009, characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6, the revised injury severity score (RISC allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6 (2.3% of patients.Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%. The overall mortality rate was 13.9%, minor cardiac injury (AIS 1 and severe cardiac injury (AIS 2-6 are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6 is associated with a higher mortality (OR 2.79 and 4.89, respectively as compared to the predicted average mortality (OR 2.49 of the study collective.Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients' outcome is dependent on the severity of cardiac injury.

  6. Gastrointestinal injuries from blunt abdominal trauma in children.

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    Ameh, E A; Nmadu, P T

    2004-04-01

    To determine the pattern, presentation and outcome of gastrointestinal injuries from blunt abdominal trauma in children. A retrospective study. Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Twenty one children managed for gastrointestinal injuries from blunt trauma from 1984-2002. The pattern, presentation, management and outcome of gastrointestinal injuries from blunt trauma. In the 19 year period, 1984-2002, 92 children were treated for blunt abdominal trauma, 21(23%) of who had injuries to the gastrointestinal tract. Three presenting after 24 hours had evidence of peritonitis. In six children with isolated gastrointestinal tract (GIT) injury who presented within two hours, abdominal signs were vague at initial evaluation but became marked over a few hours at repeated examination. In eight with associated intraabdominal injuries, abdominal signs were marked at initial examination and five presented with shock. Free peritoneal air was present on plain abdominal and chest radiograph in three of ten patients, dilated bowel loops in six and fluid levels in one. Diagnostic peritoneal lavage or paracentesis was positive in four patients with isolated GIT injuries and eight with associated intraabdominal injuries. There were 24 injuries in the 21 patients consisting of 15 perforations, five contusions, two seromuscular tears, and two gangrene from mesenteric injury. The small intestine was involved in 11 patients, colon six, stomach five, duodenum one and rectum one. Seven (35%) patients had associated extraabdominal injuries. Treatment consisted of simple closure of perforations, over sewing of contusions, resection and anastomosis for gangrene and repair with protective stoma for the rectal injury. One patient each developed prolonged ileus, urinary tract infection and chest infection, respectively postoperatively. Mortality was 28%, all of who had associated intraabdominal or extraabdominal injuries. Gastrointestinal injury from blunt abdominal trauma in

  7. CT of blunt chest trauma in children

    International Nuclear Information System (INIS)

    Manson, D.; Babyn, P.S.; Palder, S.; Bergmann, K.

    1993-01-01

    While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy. (orig.)

  8. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury.

    Science.gov (United States)

    Marcaccio, Christina L; Dumas, Ryan P; Huang, Yanlan; Yang, Wei; Wang, Grace J; Holena, Daniel N

    2018-02-13

    The traditional approach to stable blunt thoracic aortic injury (BTAI) endorsed by the Society for Vascular Surgery is early (<24 hours) thoracic endovascular aortic repair (TEVAR). Recently, some studies have shown improved mortality in stable BTAI patients repaired in a delayed manner (≥24 hours). However, the indications for use of delayed TEVAR for BTAI are not well characterized, and its overall impact on the patient's survival remains poorly understood. We sought to determine whether delayed TEVAR is associated with a decrease in mortality compared with early TEVAR in this population. We conducted a retrospective cohort study of adult patients with BTAI (International Classification of Diseases, Ninth Revision diagnosis code 901.0) who underwent TEVAR (International Classification of Diseases, Ninth Revision procedure code 39.73) from 2009 to 2013 using the National Sample Program data set. Missing physiologic data were imputed using chained multiple imputation. Patients were parsed into groups based on the timing of TEVAR (early, <24 hours, vs delayed, ≥24 hours). The χ 2 , Mann-Whitney, and Fisher exact tests were used to compare baseline characteristics and outcomes of interest between groups. Multivariable logistic regression for mortality was performed that included all variables significant at P ≤ .2 in univariate analyses. A total of 2045 adult patients with BTAI were identified, of whom 534 (26%) underwent TEVAR. Patients with missing data on TEVAR timing were excluded (n = 27), leaving a total of 507 patients for analysis (75% male; 69% white; median age, 40 years [interquartile range, 27-56 years]; median Injury Severity Score [ISS], 34 [interquartile range, 26-41]). Of these, 378 patients underwent early TEVAR and 129 underwent delayed TEVAR. The two groups were similar with regard to age, sex, race, ISS, and presenting physiology. Mortality was 11.9% in the early TEVAR group vs 5.4% in the delayed group, with the early group

  9. 64-MDCT angiography of blunt vascular injuries of the neck.

    Science.gov (United States)

    Chokshi, Falgun H; Munera, Felipe; Rivas, Luis A; Henry, Robert P; Quencer, Robert M

    2011-03-01

    CT angiography (CTA) using 64-MDCT enables timely evaluation of injuries associated with blunt neck trauma. The purpose of this article is to familiarize the reader with the most frequent CTA signs of blunt vascular injury. CTA is a valuable tool to detect blunt vascular injuries, especially using its multiplanar and 3D reconstruction capabilities.

  10. MANAGEMENT OF SPLENIC INJURY AFTER BLUNT INJURY TO ABDOMEN

    Directory of Open Access Journals (Sweden)

    J. Bharath Prakash Reddy

    2016-07-01

    Full Text Available BACKGROUND The spleen is an important organ in the body’s immune system. It is the most frequently injured organ in blunt abdominal trauma. 1 Over the past several decades, diagnosis and management of splenic trauma has been evolved. The conservative, operative approach has been challenged by several reports of successful non-operative management aided by the power of modern diagnostic imaging. The aim of our prospective study was to compare non-operative management with surgery for cases of splenic injury. METHODS We conducted a prospective study of patients admitted with blunt splenic injury to our regional hospital over a three-year period (2012-2015. Haemodynamic status upon admission, FAST examination, computed tomography 2 grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative and splenectomy. RESULTS Over a 3-year period, 24 patients were admitted with blunt splenic injury. Sixteen patients were managed operatively and eight patients non-operatively. 3,4 Non-operative management failed in one patient due to continued bleeding. The majority of grades I, II, and III splenic injuries were managed non-operatively and grades IV and V were managed operatively. Blood transfusion requirement was significantly higher among the operative group, but the operative group had a significantly longer hospital stay. Among those managed non-operatively (median age 24.5 years, a number of patients were followed up with CT scans with significant radiation exposure and unknown longterm consequences. CONCLUSION In our experience, NOM is the treatment of choice for grade I, II and III blunt splenic injuries. Splenectomy was the chosen technique in patients who met exclusion criteria for NOM, as well as for patients with grade IV and V injury.

  11. A CLINICAL STUDY ON BLUNT INJURY ABDOMEN

    Directory of Open Access Journals (Sweden)

    G. Kishore Babu

    2016-10-01

    Full Text Available BACKGROUND Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. Motor vehicle accidents and urban violence, respectively, are the leading causes of blunt and penetrating trauma to this area of the body. Unnecessary deaths and complications can be minimized by improved resuscitation, evaluation and treatment. The new techniques and diagnostic tools available are important in the management of abdominal trauma. These improved methods, however, still depend on experience and clinical judgment for application and determination of the best care for the injured patient. The aim of the study is to 1. Analyse the incidence, clinical characteristics, diagnosis, indications for laparotomy, therapeutic methods and morbidity & mortality rates. 2. To study nature of blunt abdominal trauma. 3. To assess patient for surgical intervention and to avoid negative laparotomy. 4. To assess morbidity rate in different organs injury. 5. To evaluate modalities of treatment, complications and prognosis. MATERIALS AND METHODS This study is a prospective study on 97 patients with Blunt injuries to the abdomen admitted in S.V.R.R.G.G. Hospital, Tirupati during October 2013-15. Inclusion Criteria Patients > 13 years, with Blunt injury to abdomen either by RTA, fall, object contact, assault giving written informed consent. Exclusion Criteria Patients <13 yrs. Blunt injuries due to blasts, patients with severe cardiothoracic and head injuries who are hemodynamically unstable. CONCLUSION Blunt Trauma to abdomen is on rise due to excessive use of motor vehicles. It poses a therapeutic and diagnostic dilemma for the attending surgeon due to wide range of clinical manifestations ranging from no early physical findings to progression to shock. So, the Trauma surgeon should rely on his physical findings in association with use of modalities like x-ray abdomen, USG abdomen and abdominal paracentesis. Hollow viscus perforations are

  12. A RETROSPECTIVE STUDY ON BLUNT INJURY ABDOMEN

    OpenAIRE

    Kopperundevi; Jagadeesan; Kiruthiga

    2016-01-01

    Blunt injury abdomen is the leading cause of morbidity and mortality in all age groups. Blunt trauma differs from penetrating trauma as different organs are characteristically injured by compression from blunt straining. A total of 53 cases of blunt trauma were studied in this study for the period of 1 year. In this study, commonest cause for blunt abdominal trauma was road traffic accident. The maximum incidence was noted in 20-40 middle age group of which 90% male patients were ...

  13. Selective common and uncommon imaging manifestations of blunt nonaortic chest trauma: when time is of the essence.

    Science.gov (United States)

    Altoos, Rola; Carr, Robert; Chung, Jonathan; Stern, Eric; Nevrekar, Dipti

    2015-01-01

    This is a pictorial essay in which we review and illustrate a variety of thoracic injuries related to blunt trauma. Non-aortic blunt thoracic trauma can be divided anatomically into injuries of the chest wall, lungs, pleura, mediastinum, and diaphragm. Some injuries involve more than one anatomic compartment, and multiple injuries commonly coexist. This article provides common imaging findings and discussion of both common and uncommon but critical thoracic injuries encountered. Published by Elsevier Inc.

  14. Abdominal wall hernia and aortic injury secondary to blunt trauma: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    David H. Ballard

    2014-01-01

    CONCLUSION: The patient with blunt trauma to the abdomen is at risk for TAWH and TAAI, which are often associated with other injuries. Investigations should include thorough clinical exam through secondary survey and radiologic imaging in the hemodynamically normal patient.

  15. Gastrointestinal Injuries in Blunt Abdominal Traumas.

    Science.gov (United States)

    Gönüllü, D; Ilgun, S; Gedik, M L; Demiray, O; Öner, Z; Er, M; Köksoy, F N

    2015-01-01

    To discuss the efficiency of RTS (Revised TraumaScore), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.Method and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intraabdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference.However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both

  16. Intravascular ultrasound is a critical tool for accurate endograft sizing in the management of blunt thoracic aortic injury.

    Science.gov (United States)

    Wallace, Gabriel A; Starnes, Benjamin W; Hatsukami, Thomas S; Sobel, Michael; Singh, Niten; Tran, Nam T

    2015-03-01

    Accurate measurement of true aortic luminal diameter (ALD) is critical for endograft sizing in endovascular treatment of blunt thoracic aortic injury (BTAI), but ALD is dynamic and changes with respect to patients' hemodynamic status. This study aimed to characterize how ALD at the time of diagnosis of BTAI compares with ALD at the time of endovascular repair and later at follow-up. This is an Institutional Review Board-approved, single-institution retrospective analysis of prospectively obtained data. Patients were included who presented between July 2007 and December 2012 with computed tomography angiography (CTA)-diagnosed BTAI; who underwent thoracic endovascular aortic repair (TEVAR); and who underwent preoperative CTA, intraoperative intravascular ultrasound (IVUS), and postimplantation CTA. Comparison measurements of the ALD were made among CTA and IVUS images at the level of the left subclavian artery (LSCA) and between initial CTA and postimplantation CTA at 10, 15, and 20 cm distal to the LSCA. Theoretical endograft sizes were determined and compared for each ALD at the LSCA. Twenty-two patients were included in the analysis. Mean age was 38 ± 14 years (range, 17-61 years), with 82% men and mean Injury Severity Score of 43 ± 11 (range, 24-66). Mean time from emergency department admission to initial CTA was -1.2 ± 5 hours (range, -13 to 11.5 hours; negative time implies imaging at an outside facility before admission). Mean time from initial CTA to IVUS was 1.2 ± 1.4 days (range, 2.5 hours-5.7 days) and from IVUS to postimplantation CTA 33 ± 45 days (range, 17 hours-169 days). Overall, ALD measured by IVUS was significantly larger than that by initial CTA (Δ2.5 ± 3.1 mm; P < .05). ALD was also larger at 10, 15, and 20 cm distal to the LSCA in comparing the postimplantation CTA with the initial CTA (Δ2.4, 2.0, and 2.0 mm, respectively; all P < .05). More than half the devices would be sized differently with ALD measured by IVUS at the time of TEVAR

  17. GASTROINTESTINAL INJURIES FROM BLUNT ABDOMINAL ...

    African Journals Online (AJOL)

    hi-tech

    2004-04-04

    Apr 4, 2004 ... Subjects: Twenty one children managed for gastrointestinal injuries from blunt trauma ... ileus, urinary tract infection and chest infection, respectively postoperatively. .... predictive value with CT scan, (9) the positive predictive.

  18. Endovascular repair of blunt popliteal arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Shan; Zhang, Xiquan; Chen, Zhong; Zhu, Wei; Pan, Xiaolin [Dept. of nterventional Vascular, The 148th Hospital of Chinese People' s Liberation Army, Zibo (China); Dong, Peng; Sun, Yequan [Dept. of Medical Imaging, Weifang Medical University, Weifang (China); Qi, Deming [Dept. of Medical Imaging, Qilu Medical University, Zibo (China)

    2016-09-15

    To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

  19. [The theory of cardiac lesions from blunt chest injury].

    Science.gov (United States)

    Tumanov, E V; Sokolova, Z Iu

    2010-01-01

    The main theories of myocardial lesions associated with a blunt chest injury proposed starting from the XIXth century till the present time are considered based on the overview of the literature data. It is shown that the theory of selective mechanical activation of ATP-dependent K+ channels is most promising for further investigations into the mechanisms of myocardial dysfunction resulting from blunt chest injuries. The authors emphasize the absence of the universally accepted theory explaining the mechanism behind traumatic cardiac troubles and its fatal outcome despite numerous studies of cardiac lesions in patients with a blunt chest injury. It dictates the necessity of further research, both clinical and experimental, for a deeper insight into the problem.

  20. Multidetector CT angiography influences the choice of treatment for blunt carotid artery injury.

    Science.gov (United States)

    Beliaev, Andrei M; Civil, Ian

    2014-08-06

    A 43-year-old woman presented with a 2 h history of left neck pain after striking her neck against a marble bench while playing with her son. The patient was screened for blunt cerebrovascular injury (BCVI) and a left carotid bruit was identified. Subsequently, she underwent multidetector CT angiography (MCTA) of the aortic arch and neck vessels, which demonstrated a flow-limiting dissection of the left common carotid artery (CCA). The patient was started on heparin infusion and underwent an emergency operation. At surgery, a circumferential intimal dissection was excised and the arteriotomy defect closed with an autologous venous patch. This case emphasises the importance of adequately examining patients with direct injury to the neck, screening relevant patients for BCVI and investigating them with MCTA that influences the choice of a treatment option. 2014 BMJ Publishing Group Ltd.

  1. Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis.

    Science.gov (United States)

    Holly, Brian P; Steenburg, Scott D

    2011-01-01

    Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.

  2. Predictors of abdominal injuries in blunt trauma.

    Science.gov (United States)

    Farrath, Samiris; Parreira, José Gustavo; Perlingeiro, Jacqueline A G; Solda, Silvia C; Assef, José Cesar

    2012-01-01

    To identify predictors of abdominal injuries in victims of blunt trauma. retrospective analysis of trauma protocols (collected prospectively) of adult victims of blunt trauma in a period of 15 months. Variables were compared between patients with abdominal injuries (AIS>0) detected by computed tomography or/and laparotomy (group I) and others (AIS=0, group II). Student's t, Fisher and qui-square tests were used for statistical analysis, considering p3) in head (18.5% vs. 7.9%), thorax (29.2% vs. 2.4%) and extremities (40.0% vs. 13.7%). The highest odds ratios for the diagnosis of abdominal injuries were associated flail chest (21.8) and pelvic fractures (21.0). Abdominal injuries were more frequently observed in patients with hemodynamic instability, changes in Glasgow coma scale and severe lesions to the head, chest and extremities.

  3. Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study.

    Science.gov (United States)

    Williams, Michael D; Watts, Dorraine; Fakhry, Samir

    2003-11-01

    Blunt injury to the colon is rare. Few studies of adequate size and design exist to allow clinically useful conclusions. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) Study presents a unique opportunity to definitively study these injuries. Patients with blunt HVI were identified from the registries of 95 trauma centers over 2 years (1998-1999). Patients with colon injuries (cases) were compared with blunt trauma patient undergoing a negative laparotomy (controls). Data were abstracted by chart review. Of the 227,972 patients represented, 2,632 (1.0%) had an HVI and 798 had a colonic/rectal injury (0.3%). Of patients diagnosed with HVI, 30.2% had a colon injury. No physical findings or imaging modalities were able to discriminate colonic injury. Logistic regression modeling yielded no clinically useful combination of findings that would reliably predict colonic injury. In patients undergoing laparotomy, presence of colon injury was associated with a higher risk of some complications but not mortality. Colon injury was associated with increased hospital (17.4 vs. 13.1, p colon patients (92.0%) underwent laparotomy within 24 hours of injury. Colonic injury after blunt trauma is rare and difficult to diagnose. No diagnostic test or combination of findings reliably excluded blunt colonic injury. Despite the inadequacy of current diagnostic tests, almost all patients with colonic injury were taken to the operating room within 24 hours. Even with relatively prompt surgery, patients with colon injury were at significantly higher risk for serious complications and increased length of stay. In contrast to small bowel perforation, delay in operative intervention appears to be less common but is still associated with serious morbidity.

  4. Isolated gallbladder injury in a case of blunt abdominal trauma.

    Science.gov (United States)

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-04-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  5. Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma

    OpenAIRE

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-01-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  6. Blunt splenic injury and severe brain injury: a decision analysis and implications for care

    Science.gov (United States)

    Alabbasi, Thamer; Nathens, Avery B.; Tien, Col Homer

    2015-01-01

    Background The initial nonoperative management (NOM) of blunt splenic injuries in hemodynamically stable patients is common. In soldiers who experience blunt splenic injuries with concomitant severe brain injury while on deployment, however, NOM may put the injured soldier at risk for secondary brain injury from prolonged hypotension. Methods We conducted a decision analysis using a Markov process to evaluate 2 strategies for managing hemodynamically stable patients with blunt splenic injuries and severe brain injury — immediate splenectomy and NOM — in the setting of a field hospital with surgical capability but no angiography capabilities. We considered the base case of a 40-year-old man with a life expectancy of 78 years who experienced blunt trauma resulting in a severe traumatic brain injury and an isolated splenic injury with an estimated failure rate of NOM of 19.6%. The primary outcome measured was life expectancy. We assumed that failure of NOM would occur in the setting of a prolonged casualty evacuation, where surgical capability was not present. Results Immediate splenectomy was the slightly more effective strategy, resulting in a very modest increase in overall survival compared with NOM. Immediate splenectomy yielded a survival benefit of only 0.4 years over NOM. Conclusion In terms of overall survival, we would not recommend splenectomy unless the estimated failure rate of NOM exceeded 20%, which corresponds to an American Association for the Surgery of Trauma grade III splenic injury. For military patients for whom angiography may not be available at the field hospital and who require prolonged evacuation, immediate splenectomy should be considered for grade III–V injuries in the presence of severe brain injury. PMID:26100770

  7. Emergency management of blunt chest trauma in children: an evidence-based approach.

    Science.gov (United States)

    Pauzé, Denis R; Pauzé, Daniel K

    2013-11-01

    Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

  8. MAIN CONTROVERSIES IN THE NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC INJURIES.

    Science.gov (United States)

    Carlotto, Jorge Roberto Marcante; Lopes-Filho, Gaspar de Jesus; Colleoni-Neto, Ramiro

    2016-03-01

    The nonoperative management of traumatic spleen injuries is the modality of choice in patients with blunt abdominal trauma and hemodynamic stability. However, there are still questions about the treatment indication in some groups of patients, as well as its follow-up. Update knowledge about the spleen injury. Was performed review of the literature on the nonoperative management of blunt injuries of the spleen in databases: Cochrane Library, Medline and SciELO. Were evaluated articles in English and Portuguese, between 1955 and 2014, using the headings "splenic injury, nonoperative management and blunt abdominal trauma". Were selected 35 articles. Most of them were recommendation grade B and C. The spleen traumatic injuries are frequent and its nonoperative management is a worldwide trend. The available literature does not explain all aspects on treatment. The authors developed a systematization of care based on the best available scientific evidence to better treat this condition.

  9. Establishment of a blunt impact-induced brain injury model in rabbits

    OpenAIRE

    LI Kui; CAO Yun-xing; YANG Yong-qiang; YIN Zhi-yong; ZHAO Hui; WANG Li-jun

    2012-01-01

    【Abstract】 Objective: To establish an animal model to replicate the blunt impact brain injury in forensic medicine. Methods: Twenty-four New Zealand white rabbits were randomly divided into control group (n=4), minor injury group (n=10) and severe injury group (n=10). Based on the BIM-Ⅱ Horizontal Bio-impact Machine, self-designed iron bar was used to produce blunt brain injury. Two rabbits from each injury group were randomly selected to monitor the change of in...

  10. Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database.

    Science.gov (United States)

    Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Matter, Ibrahim; Olsha, Oded; Ashkenazi, Itamar; Givon, Adi; Kessel, Boris

    2014-09-01

    Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries. A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined. Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group. The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients

  11. Determinants of splenectomy in splenic injuries following blunt abdominal trauma.

    Science.gov (United States)

    Akinkuolie, A A; Lawal, O O; Arowolo, O A; Agbakwuru, E A; Adesunkanmi, A R K

    2010-02-01

    The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.

  12. Diagnosis and management of colonic injuries following blunt trauma.

    Science.gov (United States)

    Zheng, Yi-Xiong; Chen, Li; Tao, Si-Feng; Song, Ping; Xu, Shao-Ming

    2007-01-28

    To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injury-related abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

  13. Pleural effusion following blunt splenic injury in the pediatric trauma population.

    Science.gov (United States)

    Kulaylat, Afif N; Engbrecht, Brett W; Pinzon-Guzman, Carolina; Albaugh, Vance L; Rzucidlo, Susan E; Schubart, Jane R; Cilley, Robert E

    2014-09-01

    Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children. Ten-year retrospective review (January 2000-December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury. Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5days. Median time from diagnosis to tube thoracostomy was 2days. Median length of stay was 4days for those without and 7.5days for those with pleural effusions (psplenic injury (IV-V) (OR 16.5, p=0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I-III). Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Non-operative management of adult blunt splenic injuries

    Institute of Scientific and Technical Information of China (English)

    YANG Jun; GAO Jin-mou; Jean-Claude Baste

    2006-01-01

    Objective: To investigate the indication of nonoperative management of adult blunt splenic injuries.Methods: A retrospective review was performed on all adult patients (age > 15 years ) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.Results: During the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6 %. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.Conclusions: Non-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti' s CT (computed tomography)scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of nonoperative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

  15. Applicability of an established management algorithm for colon injuries following blunt trauma.

    Science.gov (United States)

    Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Shahan, Charles P; Cullinan, Darren R; Fabian, Timothy C; Croce, Martin A

    2013-02-01

    Operative management at our institution for all colon injuries have followed a defined algorithm (ALG) based on risk factors originally identified for penetrating injuries. The purpose of this study was to evaluate the applicability of the ALG to blunt colon injuries. Patients with blunt colon injuries during 13 years were identified. As per the ALG, nondestructive (ND) injuries are treated with primary repair. Patients with destructive wounds (serosal tear of ≥50% colon circumference, mesenteric devascularization, and perforations) and concomitant risk factors (transfusion of >6 U packed red blood cells and/or presence of significant comorbidities) are diverted, while patients with no risk factors undergo resection plus anastomosis (RA). Outcomes included suture line failure (SLF), abscess, and mortality. Stratification analysis was performed to determine additional risk factors in the management of blunt colon injuries. A total 151 patients were identified: 76 with destructive injuries and 75 with ND injuries. Of those with destructive injuries, 44 (59%) underwent RA and 29 (39%) underwent diversion. All ND injuries underwent primary repair. Adherence to the ALG was 95%: three patients with destructive injuries underwent primary repair, and five patients with risk factors underwent RA. There were three SLFs (2%) (one involved deviation from the ALG) and eight abscesses (5%). Colon-related mortality was 2.1%. Stratification analysis based on mesenteric involvement, degree of shock, and need for abbreviated laparotomy failed to identify additional risk factors for SLF following RA for blunt colon injuries. Adherence to an ALG, originally defined for penetrating colon injuries, simplified the management of blunt colon injuries. ND injuries should be primarily repaired. For destructive wounds, management based on a defined ALG achieves an acceptably low morbidity and mortality rate. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

  16. Duodenal Transection without Pancreatic Injury following Blunt Abdominal Trauma

    OpenAIRE

    Bankar, Sanket Subhash; Gosavi, Vikas S.; Hamid, Mohd.

    2014-01-01

    With the inventions of faster cars and even more faster motorbikes there is a worldwide increase in road traffic accidents, which has increased the incidence of blunt abdominal trauma but still duodenal injury following a blunt abdominal trauma is uncommon and can pose a formidable challenge to the surgeon and failure to manage it properly can result in devastating results. It may typically occur in isolation or with pancreatic injury. Here, we report a case of an isolated transection of the ...

  17. When and how should we manage thoracic aortic injuries in the modern era?

    Science.gov (United States)

    Bottet, Benjamin; Bouchard, François; Peillon, Christophe; Baste, Jean-Marc

    2016-12-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was what are the optimum treatment modality and timing of intervention for blunt thoracic aortic injury (BTAI) in the modern era? Of the 697 papers found using the reported search, 14 (5 meta-analyses, 2 prospective and 7 retrospective studies) represented the best evidence to answer the clinical question. The author, journal, country, date of publication, patient group studied, study type, relevant outcomes, results and weakness of these papers are tabulated. All five meta-analyses reported a reduction in mortality with thoracic endovascular aortic repair (TEVAR) compared with open repair (OR), but only four found the same benefit on paraplegia rate. Similarly, the two prospective and four retrospective studies showed significantly lower mortality with TEVAR than with OR. Only one study (a meta-analysis) reported a significantly lower stroke rate with TEVAR than with OR, whereas the 13 others reported a similar or even higher stroke rate. Other complication rates were identical. Four studies demonstrated that non-operative management (NOM) as a treatment option for BTAI was associated with increased mortality, even if it has declined in recent years. One study emphasized that some cases with minimal aortic injuries (Grade I and II on CT scan) could benefit from NOM. Regarding the timing of repair, only three studies analysed outcomes of delayed repair and reported significantly lower mortality than for early repair. We conclude that with lower mortality and similar overall complications including paraplegia but higher stroke rate, TEVAR is the most suitable treatment for BTAI in the modern era, where expertise exists, especially for cases of multiple associated injuries and in the older age group. Delayed aortic repair can be proposed based on CT scan analysis, but emergent repair should still be advocated for imminent free aortic rupture. NOM

  18. Splenic injury after blunt abdominal trauma during a soccer (football) game.

    Science.gov (United States)

    Padlipsky, Patricia S; Brindis, Seth; Young, Kelly D

    2014-10-01

    The spleen is the most commonly injured abdominal organ in children who sustain blunt abdominal trauma, and pediatric splenic injury may result from minor mechanisms of injury, including sports participation. We present 2 cases of splenic injury in soccer goalies because of blunt abdominal trauma sustained during game play. Although abdominal organ injuries are uncommon in soccer, emergency medicine and primary care physicians must be aware of the possibility. A high index of suspicion and careful physical examination are key in making the diagnosis.

  19. The role of computed tomography in blunt hepatic injury

    International Nuclear Information System (INIS)

    Kaji, Tatsumi

    1988-01-01

    Computed tomography (CT) images and medical records of 283 patients with blunt abdominal trauma were reviewed. There were 67 patients with hepatic injury. Liver was the most frequently injured organ in blunt abdominal trauma. Most hepatic injuries occurred in the right lobe of the liver. Of the 67 patients with hepatic injury, 60 patients had associated other injuries. There was a high incidence of associated lung injuries (35.8 %). Of importance is the high incidence of associated head injuries (22.4 %), because, in some patients such as those with concomitant head trauma, abdominal symptom is not obvious. The associated hemoperitoneum were correlated with the mode of therapy used in each case (operative vs. nonoperative). 32 patients with hepatic injury but no hemoperitoneum were managed nonoperatively. 9 patients with hepatic injury and little hemoperitoneum were also managed conservatively. 22 patients with high density hemoperitoneum were surgically treated. By combining information on the clinical state of the patient and CT finding, therapy of hepatic injury can be individualized and the incidence of nontherapeutic laparotomies decreased. (author)

  20. Role of CT in blunt hepatic injury

    International Nuclear Information System (INIS)

    Park, Hyun Joo; Yang, Dal Mo; Kang, Sook Wook; Kim, Hyung Sik; Chung, Hyo Sun; Lee, Young Seok

    1994-01-01

    The aim of this study was to determine the role of the CT scan in blunt hepatic injury and the significance of CT degree of hepatic injury in the decision making of treatment plan. We retrospectively analyzed the CT findings of 22 patients with hepatic injury. We graded hepatic injury on CT scan into five according to the severity. Clinical records, type of management and clinical outcome of the patients were also reviewed. Of the 22 patients, 17 had conservative treatment and five had surgery. The numbers of patients treated conservatively were 0, 4, 11, 2 and 0 in the grade 1, 2, 3, 4, and 5, retrospectively and the numbers of surgically treated cases were 0, 0, 3, 2 and 0 respectively. There was no significant statistical difference between surgically and conservatively treated groups(p-value > 0.05). All patients with conservatively treated group were hemodynamically stable and had no complication during hospitalization. Hemoperitoneum was observed in 11 of 22 patients. In blunt hepatic injury, CT plays an important role in the demonstration of location and extent of the hepatic injury, size of hemoperitoneum and the post operative course. However, we believe that physiologic status of the patients may be more important than the extent of CT based hepatic injury for determining a mode of treatment

  1. Role of Postmortem Multislice Computed Tomography Scan in Close Blunt Head Injury

    Directory of Open Access Journals (Sweden)

    Prijo Sidipratomo

    2014-08-01

    Full Text Available BACKGROUND: Conventional autopsy in Indonesia is not well accepted as it is contrary to religion and culture. New radiological imaging method such as multislice computed tomography (MSCT scan has potential to be a diagnostic tool in forensic pathology. The purpose of this study is to determine the ability of MSCT scan in finding abnormalities in close blunt head injury compared with autopsy. METHODS: This study used descriptive qualitative method. Postmortem cases in Department of Forensic Medicine and Radiology of Dr. Cipto Mangunkusumo Hospital were selected based on inclusion criteria. Then MSCT scan and autopsy were conducted. MSCT scan and autopsy results were compared and analyzed. RESULTS: There were 491 postmortem cases of blunt head injury. However, only 10 cases fulfilled inclusion criteria. Subarachnoid haemorrhages were identified 100% with MSCT scan and 80% with autopsy. Cerebral oedemas were identified 100% either with MSCT scan and autopsy. Subdural haemorrhages were identified 100% with MSCT scan, while 50% with autopsy. Multiple fractures were identified 80% with MSCT scan, while 40% with auto. CONCLUSIONS: MSCT scan showed a sensitive detection in finding abnormalities in close blunt head injury. Therefore it could be as an alternative choice of examination in close blunt head injury cases. KEYWORDS: multislice computed tomography scan, postmortem, blunt head injury, autopsy.

  2. Imaging of acute traumatic injuries of the thoracic aorta

    International Nuclear Information System (INIS)

    Wintermark, Max; Wicky, Stefan; Schnyder, Pierre

    2002-01-01

    Blunt traumatic aortic injuries are a major concern in the settings of high-speed deceleration accidents, since they are associated with a very high mortality rate; however, with prompt diagnosis and surgery, 70% of the patients with a blunt aortic lesion who reach the hospital alive will survive. This statement challenges the emergency radiologist in charge to evaluate the admission radiological survey in a severe chest trauma patient. With a 95% negative predictive value for the identification of blunt traumatic aortic lesions, plain chest film represents an adequate screening test. If aortography remains the gold standard, it tends, at least in hemodynamically stable trauma patients, to be replaced by spiral-CT angiography (SCTA), which demonstrates a 96.2% sensitivity, a 99.8% specificity, and a 99.7% accuracy. In unstable patients, trans-esophageal echography (TEE) plays a major diagnostic role. Knowledge of advantages and pitfalls of these imaging techniques, as reviewed in this article, will help the emergency radiologist to choose the appropriate algorithm in the diagnosis of traumatic aortic injury, for each trauma patient. (orig.)

  3. [Alleged assault in a forest: An unusual case of self-inflicted blunt injury].

    Science.gov (United States)

    Kunz, Sebastian Niko; Tutsch-Bauer, Edith

    2014-01-01

    The medico-legal assessment of potentially self-inflicted injuries is an important field of clinical forensic medicine. Compared with sharp force injuries, it is much more difficult to distinguish blunt injuries caused by another party from self-inflicted lesions. We present a case of a young female doctor, who was allegedly attacked by an unknown stranger during her evening walk in the woods. She claimed to have been hit repeatedly on the head and arms with a stone. During the forensic investigation, blunt injuries could be confirmed on her head and forearms. Based on the arrangement and intensity of the injuries, together with the result of a bloodstain pattern analysis of the weapon, the victim's statement could be disproved. After being confronted with the results of the investigation, the woman admitted to have inflicted the injuries herself. This case is an unusual and rare example of self-inflicted blunt injury. It shows that the criteria of self-inflicted injuries can also be applied to blunt trauma. However, due to the small number of cases, a high degree of caution is required from the forensic expert.

  4. Duodenal Transection without Pancreatic Injury following Blunt ...

    African Journals Online (AJOL)

    following blunt abdominal trauma and its clinical picture is often ... Here we report a case of complete duodenal ... Key words: Duodenal injury, peritonitis, transection. Department of ... When our patient was brought to the emergency room, he.

  5. Imaging of Combat-Related Thoracic Trauma - Blunt Trauma and Blast Lung Injury.

    Science.gov (United States)

    Lichtenberger, John P; Kim, Andrew M; Fisher, Dane; Tatum, Peter S; Neubauer, Brian; Peterson, P Gabriel; Carter, Brett W

    2018-03-01

    Combat-related thoracic trauma (CRTT) is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries are the most common mechanisms of trauma to the chest. Imaging plays a key role in the battlefield management of CRTT casualties. This work discusses the imaging manifestations of thoracic injuries from blunt trauma and blast injury, emphasizing epidemiology and diagnostic clues seen during OEF and OIF. The assessment of radiologic findings in patients who suffer from combat-related blunt thoracic trauma and blast injury is the basis of this work. The imaging modalities for this work include multi-detector computed tomography (MDCT) and chest radiography. Multiple imaging modalities are available to imagers on or near the battlefront, including radiography, fluoroscopy, and MDCT. MDCT with multi-planar reconstructions is the most sensitive imaging modality available in combat hospitals for the evaluation of CRTT. In modern combat, blunt and blast injuries account for a significant portion of CRTT. Individual body armor converts penetrating trauma to blunt trauma, leading to pulmonary contusion that accounted for 50.2% of thoracic injuries during OIF and OEF. Flail chest, a subset of blunt chest injury, is caused by significant blunt force to the chest and occurs four times as frequently in combat casualties when compared with the civilian population. Imaging features of CRTT have significant diagnostic and prognostic value. Pulmonary contusions on chest radiography appear as patchy consolidations in the acute setting with ill-defined and non-segmental borders. MDCT of the chest is a superior imaging modality in diagnosing and evaluating pulmonary contusion. Contusions on MDCT appear as crescentic ground-glass opacities (opacities through which lung interstitium and vasculature are still visible) and areas of consolidation that often do not

  6. Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Paul M. Foreman

    2017-04-01

    Full Text Available Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI. The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

  7. Forensic medical study on morphology and formative mechanism of blunt head injury

    Directory of Open Access Journals (Sweden)

    LI Hong-wei

    2012-12-01

    Full Text Available 【Abstract】 Objective: To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise. Methods: The statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries. Results: Among the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%, followed by suicide (49, 24.3% and accident (44, 21.8%. The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants. Conclusion: Studies on the morphology and its forma-tive rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury. Key words: Brain; Head injuries, closed; Cranioce-rebral trauma; Forensic medicine

  8. Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma.

    Science.gov (United States)

    Schnüriger, B; Inderbitzin, D; Schafer, M; Kickuth, R; Exadaktylos, A; Candinas, D

    2009-01-01

    Little is known about the clinical importance of concomitant injuries in polytraumatized patients with high-grade blunt liver injury. A retrospective single-centre study was performed to investigate the safety of non-operative management of liver injury and the impact of concomitant intra- and extra-abdominal injuries on clinical outcome. Some 183 patients with blunt liver injury were admitted to Berne University Hospital, Switzerland, between January 2000 and December 2006. Grade 3-5 injuries were considered to be high grade. Immediate laparotomy was required by 35 patients (19.1 per cent), owing to extrahepatic intra-abdominal injury (splenic and vascular injuries, perforations) in 21 cases. The mortality rate was 16.9 per cent; 22 of the 31 deaths were due to concomitant lesions. Of 81 patients with high-grade liver injury, 63 (78 per cent) were managed without surgery; liver-related and extra-abdominal complication rates in these patients were 11 and 17 per cent respectively. Grades 4 and 5 liver injury were associated with hepatic-related and extra-abdominal complications. Concomitant injuries are a major determinant of outcome in patients with blunt hepatic injury and should be given high priority by trauma surgeons. An algorithm for the management of blunt liver injury is proposed. Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  9. Predictors of "occult" intra-abdominal injuries in blunt trauma patients.

    Science.gov (United States)

    Parreira, José Gustavo; Malpaga, Juliano Mangini Dias; Olliari, Camilla Bilac; Perlingeiro, Jacqueline A G; Soldá, Silvia C; Assef, José Cesar

    2015-01-01

    to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries) or Group 2 (without intra-abdominal injuries). Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting ptrauma mechanism (ptrauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22) and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85). Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

  10. Traumatic abdominal aortic dissection in a 16-month-old child

    International Nuclear Information System (INIS)

    Heck, Josh M.; Bittles, Mark A.

    2009-01-01

    Abdominal aortic injury after blunt trauma is rare in the pediatric population. There have been fewer than 20 reported cases in the literature since 1960, and most were the result of motor vehicle collisions. We report the case of a 16-month-old boy who is the youngest reported patient to sustain this type of injury. We discuss the radiologic findings in multiple imaging modalities, mechanisms, associated injuries and management options. (orig.)

  11. Rib fractures in blunt chest trauma - associated thoracic injuries

    Directory of Open Access Journals (Sweden)

    Iv. Dimitrov

    2017-09-01

    Full Text Available PURPOSE. The aim of our retrospective study was to analyze the patterns of associated thoracic injuries in patients underwent blunt chest trauma and rib fractures. METHODS. The study included 212 patients with rib fractures due to blunt thoracic trauma. The mechanism of trauma, the type of rib fracture and the type of associated injuries were analyzed. RESULTS. The patients were divided in two groups according to the number of fractured ribs-group I included the patients with up to two fractured ribs (72 patients-33,9%, and group II – with ≥3 fractured ribs (140 patients-66,1%. Associated chest injuries were present in 36 of the patients from group I (50%, and in 133 patients from group II (95%. Pulmonary contusion was the most common intrathoracicinjurie-65,6% of the cases. The mean hospital stay was 8, 7 days. The lethality rate was 16,9% -all of them due to the associated chest injuries. CONCLUSIONS. The mortality related to rib fractures is affected by the associated thoracic injuries, the advanced age, and the number of fractured ribs.

  12. Non-operative management versus operative management in high-grade blunt hepatic injury.

    Science.gov (United States)

    Cirocchi, Roberto; Trastulli, Stefano; Pressi, Eleonora; Farinella, Eriberto; Avenia, Stefano; Morales Uribe, Carlos Hernando; Botero, Ana Maria; Barrera, Luis M

    2015-08-24

    Surgery used to be the treatment of choice in cases of blunt hepatic injury, but this approach gradually changed over the last two decades as increasing non-operative management (NOM) of splenic injury led to its use for hepatic injury. The improvement in critical care monitoring and computed tomographic scanning, as well as the more frequent use of interventional radiology techniques, has helped to bring about this change to non-operative management. Liver trauma ranges from a small capsular tear, without parenchymal laceration, to massive parenchymal injury with major hepatic vein/retrohepatic vena cava lesions. In 1994, the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST) revised the Hepatic Injury Scale to have a range from grade I to VI. Minor injuries (grade I or II) are the most frequent liver injuries (80% to 90% of all cases); severe injuries are grade III-V lesions; grade VI lesions are frequently incompatible with survival. In the medical literature, the majority of patients who have undergone NOM have low-grade liver injuries. The safety of NOM in high-grade liver lesions, AAST grade IV and V, remains a subject of debate as a high incidence of liver and collateral extra-abdominal complications are still described. To assess the effects of non-operative management compared to operative management in high-grade (grade III-V) blunt hepatic injury. The search for studies was run on 14 April 2014. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (Ovid), PubMed, ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), clinical trials registries, conference proceedings, and we screened reference lists. All randomised trials that compare non-operative management versus operative management in high-grade blunt hepatic injury. Two authors independently

  13. Isolated gallbladder rupture following blunt abdominal injury

    African Journals Online (AJOL)

    2015-05-26

    May 26, 2015 ... Kaohsiung Medical University, Kaohsiung, Taiwan. Abstract. Isolated traumatic gallbladder rupture subsequent to blunt abdominal injury is rare. Most literatures on the subjects consist of case reports. We reported a rare case of isolated gallbladder rupture and discussed the possible predisposing factors to ...

  14. Computed Tomography (CT) Imaging of Injuries from Blunt Abdominal Trauma: A Pictorial Essay

    OpenAIRE

    Hassan, Radhiana; Abd. Aziz, Azian

    2010-01-01

    Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. T...

  15. Complications of nonoperative management of high-grade blunt hepatic injuries.

    Science.gov (United States)

    Kozar, Rosemary A; Moore, John B; Niles, Sarah E; Holcomb, John B; Moore, Ernest E; Cothren, C Clay; Hartwell, Elizabeth; Moore, Frederick A

    2005-11-01

    Nonoperative management of blunt hepatic injuries is highly successful. Complications associated with high-grade injuries, however, have not been well characterized. The purpose of the present study was therefore to define hepatic-related complications and associated treatment modalities in patients undergoing nonoperative management of high-grade blunt hepatic injuries. Three hundred thirty-seven patients from two regional Level I trauma centers with grade 3 to 5 blunt hepatic injuries during a 40-month period were reviewed. Complications and treatment of hepatic-related complications in patients not requiring laparotomy in the first 24 hours were identified. Of 337 patients with a grade 3 to 5 injury, 230 (68%) were managed nonoperatively. There were 37 hepatic-related complications in 25 patients (11%); 63% (5 of 8) of patients with grade 5 injuries developed complications, 21% (19 of 92) of patients with grade 4 injuries, but only 1% (1 of 130) of patients with grade 3 injuries. Complications included bleeding in 13 patients managed by angioembolization (n = 12) and laparotomy (n = 1), liver abscesses in 2 patients managed with computed tomography-guided drainage (n = 2) and subsequent laparotomy (n = 1). In one patient with bleeding, hepatic necrosis followed surgical ligation of the right hepatic artery and required delayed hepatic lobectomy. Sixteen biliary complications were managed with endoscopic retrograde cholangiopancreatography and stenting (n = 7), drainage (n = 5), and laparoscopy (n = 4). Three patients had suspected abdominal sepsis and underwent a negative laparotomy, whereas an additional three patients underwent laparotomy for abdominal compartment syndrome. Nonoperative management of high-grade liver injuries can be safely accomplished. Mortality is low; however, complications in grade 4 and 5 injuries should be anticipated and may require a combination of operative and nonoperative management strategies.

  16. Blunt chest trauma: bony injury in the thorax.

    Science.gov (United States)

    Zreik, Nasri H; Francis, Irene; Ray, Arun; Rogers, Benedict A; Ricketts, David M

    2016-02-01

    The management of blunt chest trauma is an evolving concept with no clear current guidelines. This article explores the bony injuries associated with this, focusing on rib fractures and flail segments and the themes around investigation and best management.

  17. Tracheobronchial injuries in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    vahid Montazeri

    2004-01-01

    Full Text Available Introduction: Tracheobronchial injuries are uncommon but potentially fatal complication of blunt thoracic trauma harboring a high morbidity and mortality if not diagnosed early . A recent series gleaning cases from four major Trauma Center in Los Angeles nine cases in a seven- year period , but the incidence of these injuries has been increasing recently. This has been attributed to improvement in hospital care and advanced Trauma Centers and earlier diagnosis of such injuries. Disruption of tight main bronchus is more common, such injuries are often associated with rib or clavicular fractures. Findings: Clinical and paraclinical data gathered from records of three patients referred with tracheobronchial injuries during the recent ten years have been reviewed .These include clinical manifestations, diagnostic findings, treatment modality and clinical course. The outcome has been satisfactory in all three patients who have undergone operation 2-5 hours after sustaining the injury. We have not had any mortality. Conclusion: These results are similar to those of other series emphasizing over early diagnosis and treatment of such injuries .

  18. The safety of low molecular-weight heparin after blunt liver and spleen injuries.

    Science.gov (United States)

    Rostas, Jack W; Manley, Justin; Gonzalez, Richard P; Brevard, Sidney B; Ahmed, Naveed; Frotan, Mohammad Amin; Mitchell, Ellen; Simmons, Jon D

    2015-07-01

    Anticoagulation is routinely administered to all trauma patients owing to the high incidence of venous thromboembolism (VTE). However, the timing of administration of anticoagulation is not clearly defined when patients have blunt spleen or liver injuries because of the perceived risk of hemorrhage with early administration. A retrospective chart review was performed of all blunt trauma patients who sustained blunt liver and/or spleen injuries during the 5-year period from 2007 to 2011. Data were collected for all patients managed with nonoperative therapy for these injuries while also receiving routine prophylactic anticoagulation with low molecular-weight heparin. Patients were categorized based on the initiation of enoxaparin therapy after injury: early (72 hours). Primary and secondary outcomes were designated as need for operative or radiologic intervention secondary to spleen or liver hemorrhage, number of transfusions, and incidence of VTE. Three hundred and twenty-eight patients were included. There were no enoxaparin-related hemorrhagic complications or hemorrhage necessitating operative intervention. Patients in the early, intermediate, and late groups received an average of .9, .93, and 1.55 units of blood, respectively. There was 1 pulmonary embolism in the early group, and there were 6 VTE complications in the late group (3 deep venous thromboses and 3 pulmonary embolisms). There are currently no standards for the initiation of prophylactic anticoagulation in trauma patients with blunt liver and spleen injuries. Early administration may be safe and reduce the incidence of thrombotic complications in patients with blunt spleen and liver injuries. Prospective studies in this area are warranted. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Blunt injury of the infrarenal inferior vena cava — imaging and ...

    African Journals Online (AJOL)

    Blunt injury of the infrarenal inferior vena cava — imaging and conservative management. Ian C Duncan, Basil J Sher, Leslie M Fingleson. Abstract. Isolated rupture of the infrarenal segment of the inferior vena cava due to blunt trauma is relatively rare. It may be missed clinically and even diagnostic peritoneal lavage may ...

  20. Blunt injuries to the abdomen in Makurdi, Benue State: Nigeria ...

    African Journals Online (AJOL)

    Splenic rupture was the commonest intra abdominal injury and was managed by splenectomy in all cases. Delay in presentation and slow reaction time were observed. These worsened the haemodynamic instability and further accounted for the high mortality rate of 26.6%. Keywords: blunt injuries, road traffic accidents

  1. Pancreatic injuries after blunt abdominal trauma: an analysis of 110 ...

    African Journals Online (AJOL)

    Background and objective. Injuries to the pancreas are uncommon, but may result in considerable morbidity and mortality. This study evaluated the management of blunt pancreatic injuries using a previously defined protocol to determine which factors predicted morbidity and mortality. Methods. The study design was a ...

  2. Rupture of the aorta following road traffic accidents in the United Kingdom 1992-1999. The results of the co-operative crash injury study.

    Science.gov (United States)

    Richens, D; Kotidis, K; Neale, M; Oakley, C; Fails, A

    2003-02-01

    The true incidence and survivability of blunt traumatic aortic rupture following road traffic accidents in the UK is unclear. The objective of this study was to determine the extent of blunt traumatic aortic rupture in the UK after road traffic accidents and the conditions under which it occurs. Data for the study was obtained from the Co-operative Crash Injury Study database. Road traffic accidents that happened between 1992 and 1999 and included in the Co-operative Crash Injury Study database were retrospectively investigated. A total of 8285 vehicles carrying 14,435 occupants were involved in 7067 accidents. There were 132 cases of blunt traumatic aortic rupture, of which the scene survival was 9% and the overall mortality was 98%. Twenty-one percent of all fatalities had blunt traumatic aortic rupture (130/613). Twenty-nine percent were due to frontal impacts and 44% were due to side impacts. Twelve percent of the blunt traumatic aortic rupture cases in frontal vehicle impacts were wearing seat belts and had airbag protection and 19% had no restraint mechanism. The Equivalent Test Speed of the accident vehicles, (where equivalent test speed provides an estimate of the vehicle impact severity and not an estimate of the vehicle speed at the time of the accident), ranged from 30 to 110 km/h in frontal impacts and from 15 to 82 km/h in side impacts. Blunt traumatic aortic rupture carries a high mortality and occurred in 21% of car occupant deaths in this sample of road traffic accidents. Impact scenarios varied but were most common from the side. The use of an airbag or seat belt does not eliminate risk. The injury can occur at low severity impacts particularly in side impact. Copyright 2002 Elsevier Science B.V.

  3. Anterior capsular rupture following blunt ocular injury

    Science.gov (United States)

    Gremida, Anas; Kassem, Iris; Traish, Aisha

    2011-01-01

    Summary A 10-year-old boy suffered a large, oblique anterior capsular tear following blunt injury to his right eye. The boy was followed daily for hyphema resolution and progressive traumatic cataract formation. After the hyphema had resolved, the lens was removed using an anterior approach and an intraocular lens was placed with excellent visual outcome. PMID:23362402

  4. TREATMENT OF BLUNT LIVER INJURIES IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Ana Kostić

    2003-04-01

    Full Text Available Liver is the largest parenchymatous organ, well vascularized, weighing approximately 1.8-3.0% of the whole body weight. Among all abdominal traumas liver injuries account for 25%. For more serious liver injuries the mortality is around 40% in children below 10 years of age. For lesions of the juxtahepatic veins (three major hepatic veins or the retrohepatic portion of v. cava or for complex, combined intraabdominal injuries, the mortality is even up to 70%.This work analyzed the period 1988-2000 during which there were 19 children admitted and treated for blunt liver injuries at the Clinic of Pediatric Surgery and Orthopedics in Nis; I, II and III scale injuries prevailed (17 cases; 89.4%. These injuries were surgically treated for the most part (17 cases; 89.4%. In 7 children (36.8% there were combined injuries. The lethality was 26.3%-5 cases, with three major complications: two intrahepatic hematomas and one biliary fistula associated with biliary peritonitis and biloma formation.

  5. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

    Science.gov (United States)

    Stassen, Nicole A; Bhullar, Indermeet; Cheng, Julius D; Crandall, Marie; Friese, Randall; Guillamondegui, Oscar; Jawa, Randeep; Maung, Adrian; Rohs, Thomas J; Sangosanya, Ayodele; Schuster, Kevin; Seamon, Mark; Tchorz, Kathryn M; Zarzuar, Ben L; Kerwin, Andrew

    2012-11-01

    During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be

  6. Computed Tomography (CT) Imaging of Injuries from Blunt Abdominal Trauma: A Pictorial Essay.

    Science.gov (United States)

    Hassan, Radhiana; Abd Aziz, Azian

    2010-04-01

    Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.

  7. ACR appropriateness criteria blunt chest trauma.

    Science.gov (United States)

    Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

    2014-04-01

    Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. Spleen artery embolization increases the success of nonoperative management following blunt splenic injury

    Directory of Open Access Journals (Sweden)

    Isaac Chun-Jen Chen

    2011-08-01

    Conclusion: Performance of SAE for the patients with blunt splenic injury could increase the successful rate of NOM significantly and safely. An algorithm including the angioembolization might be beneficial in the management of patients with blunt spleen trauma.

  9. Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury.

    Science.gov (United States)

    Koyama, Tomohide; Hamada, Hirohisa; Nishida, Masamichi; Naess, Paal A; Gaarder, Christine; Sakamoto, Tetsuya

    2016-01-25

    Patients with blunt trauma to the liver have elevated levels of liver enzymes within a short time post injury, potentially useful in screening patients for computed tomography (CT). This study was performed to define the optimal cut-off values for serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in patients with blunt liver injury diagnosed with contrast enhanced multi detector-row CT (CE-MDCT). All patients admitted from May 2006 to July 2013 to Teikyo University Hospital Trauma and Critical Care Center, and who underwent abdominal CE-MDCT within 3 h after blunt trauma, were retrospectively enrolled. Using receiver operating characteristic (ROC) curve analysis, the optimal cut-off values for AST and ALT were defined, and sensitivity and specificity were calculated. Of a total of 676 blunt trauma patients 64 patients were diagnosed with liver injury (Group LI+) and 612 patients without liver injury (Group LI-). Group LI+ and LI- were comparable for age, Revised Trauma Score, and Probability of survival. The groups differed in Injury Severity Score [median 21 (interquartile range 9-33) vs. 17 (9-26) (p tool for CT scan in patients otherwise eligible for observation only or as a transfer criterion to a facility with CT scan capability.

  10. TRIAGE OF PATIENTS TO ANGIOGRAPHY FOR DETECTION OF AORTIC RUPTURE AFTER BLUNT CHEST TRAUMA - COST-EFFECTIVENESS ANALYSIS OF USING CT

    NARCIS (Netherlands)

    HUNINK, MGM; BOS, JJ

    OBJECTIVE. The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest

  11. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

    Science.gov (United States)

    Stassen, Nicole A; Bhullar, Indermeet; Cheng, Julius D; Crandall, Marie L; Friese, Randall S; Guillamondegui, Oscar D; Jawa, Randeep S; Maung, Adrian A; Rohs, Thomas J; Sangosanya, Ayodele; Schuster, Kevin M; Seamon, Mark J; Tchorz, Kathryn M; Zarzuar, Ben L; Kerwin, Andrew J

    2012-11-01

    During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline. The National Library of Medicine and the National Institute of Health MEDLINE database was searched using Pub Med (www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords splenic injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 125 were used to create the current practice management guideline for the selective nonoperative management of blunt splenic injury. There has been a plethora of literature regarding nonoperative management of blunt splenic injuries published since the original EAST practice management guideline was written. Nonoperative management of blunt splenic injuries is now the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury, patient age, or the presence of associated injuries. Its use is associated with a low overall morbidity and mortality when applied to an appropriate patient population. Nonoperative management of blunt splenic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and has an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention

  12. Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma.

    Science.gov (United States)

    Tan, Ker-Kan; Bang, Shieh-Ling; Vijayan, Appasamy; Chiu, Ming-Terk

    2009-09-01

    Delayed diagnosis of patients with severe liver injuries is associated with an adverse outcome. As computed tomographic (CT) scan is not always available in the management of blunt abdominal trauma worldwide, the present study was undertaken to determine the accuracy of selected haematological markers in predicting the presence of hepatic injury and its severity after blunt abdominal trauma. A retrospective review of all patients with blunt abdominal trauma presented to our institution over a 3-year period was performed. Patients were excluded if they suffered penetrating injuries, died in the emergency department or if the required blood tests were not performed within 24h of the accident. The grading of the hepatic injury was verified using CT scans or surgical findings. Ninety-nine patients with blunt abdominal trauma had the required blood tests performed and were included in the study. The median injury severity score was 24 (range 4-75). Fifty-five patients had hepatic injuries, of which 47.3% were minor (Grades I and II) while 52.7% had major hepatic injuries (Grades III-V). There were no patients with Grade VI injuries. A raised ALT was strongly associated with presence of hepatic injuries (OR, 109.8; 95% CI, 25.81-466.9). This relation was also seen in patients with raised AST>2 times (OR, 21.33; 95% CI, 7.27-62.65). This difference was not seen in both bilirubin and ALP. ALT>2 times normal was associated with major hepatic injuries (OR, 7.15; 95% CI, 1.38-37.14; p=0.012) while patients with simultaneous raised AST>2 times and ALT>2 times had a stronger association for major hepatic injuries (OR, 8.44; 95% CI, 1.64-43.47). Abnormal transaminases levels are associated with hepatic injuries after blunt abdominal trauma. Patients with ALT and AST>2 times normal should be assumed to possess major hepatic trauma and managed accordingly. Patients with normal ALT, AST and LDH are unlikely to have major liver injuries.

  13. Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years.

    Science.gov (United States)

    Tan, K K; Chiu, M T; Vijayan, A

    2010-12-01

    Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

  14. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy.

    Science.gov (United States)

    Helling, T S; Gyles, N R; Eisenstein, C L; Soracco, C A

    1989-10-01

    Tube thoracostomy (TT) is required in the treatment of many blunt and penetrating injuries of the chest. In addition to complications from the injuries, TT may contribute to morbidity by introducing microorganisms into the pleural space or by incomplete lung expansion and evacuation of pleural blood. We have attempted to assess the impact of TT following penetrating and blunt thoracic trauma by examining a consecutive series of 216 patients seen at two urban trauma centers with such injuries who required TT over a 30-month period. Ninety-four patients suffered blunt chest trauma; 122 patients were victims of penetrating wounds. Patients with blunt injuries had longer ventilator requirements (12.6 +/- 14 days vs. 3.7 +/- 7.1 days, p = 0.003), longer intensive care stays (12.2 +/- 12.5 days vs. 4.1 +/- 7.5 days, p = 0.001), and longer periods of TT, (6.5 +/- 4.9 days vs. 5.2 +/- 4.5 days, p = 0.018). Empyema occurred in six patients (3%). Residual hemothorax was found in 39 patients (18%), seven of whom required decortication. Recurrent pneumothorax developed in 51 patients (24%) and ten required repeat TT. Complications occurred in 78 patients (36%). Patients with blunt trauma experienced more complications (44%) than those with penetrating wounds (30%) (p = 0.04). However, only seven of 13 patients developing empyema or requiring decortication had blunt trauma. Despite longer requirements for mechanical ventilation, intensive care, and intubation, victims of blunt trauma seemed to have effective drainage of their pleural space by TT without increased risk of infectious complications.

  15. Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries.

    Science.gov (United States)

    Hammer, Mark M; Raptis, Demetrios A; Cummings, Kristopher W; Mellnick, Vincent M; Bhalla, Sanjeev; Schuerer, Douglas J; Raptis, Constantine A

    2016-05-01

    Blunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described. To evaluate CT findings and associated injuries in patients with clinically diagnosed BCI. We identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries. CT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT. CT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Bilateral Chylothorax Due to Blunt Trauma Without Radiographic Evidence of Traumatic Injury

    Directory of Open Access Journals (Sweden)

    Mohamed Mohamed

    2017-03-01

    Full Text Available Chylothorax represents an uncommon clinical entity with multiple etiologies. Chylothorax following blunt thoracic trauma is typically associated with posterior rib fractures or thoracic vertebral fractures or dislocations. The occurrence of a traumatic chylothorax in the absence of associated injuries is a rare event. We report a case of a 51-year-old patient who developed bilateral chylothorax after sustaining blunt trauma without radiographic evidence of traumatic injury. A 51-year-old male presented to the emergency department complaining of progressively worsening shortness of breath and associated chest pain for the prior one week following a fall down several concrete steps. On evaluation, the patient was found to have bilateral pleural effusions with no radiographic evidence of traumatic injury, including posterior rib or thoracic vertebral fractures. Subsequent thoracentesis and pleural fluid analysis were performed confirming the diagnosis of chylothorax. Management included repeated thoracentesis, diet modification and octreotide administration, which resulted in dramatic improvement and eventual resolution of symptoms. Non-iatrogenic traumatic bilateral chylothorax in the absence of other radiographically demonstrated bony or soft tissue injury is a rare event. Chylothorax should be considered in the differential diagnosis of patients presenting with chest pain or shortness of breath following blunt trauma and evidence of pleural effusion, even in the absence of obvious traumatic fracture or injury on radiographic imaging.

  17. Splenic abscess after splenic blunt injury angioembolization.

    Science.gov (United States)

    Tartaglia, Dario; Galatioto, Christian; Lippolis, Piero Vincenzo; Modesti, Matteo; Gianardi, Desirée; Bertolucci, Andrea; Cucinotta, Monica; Zocco, Giuseppe; Seccia, Massimo

    2014-11-03

    Splenic Angioembolization (SAE), during Nonoperative Management (NOM) of Blunt Splenic Injury (BSI), is an effective therapy for hemodynamically stable patients with grade III, IV, and V OIS splenic injuries. We report a case of a patient with a blunt abdominal trauma due to an accidental fall, who presented splenic abscess a week after SAE and a review of the literature. A 38-year-old male arrived at Emergency after an accidental fall with contusion of the left upper quadrant of the abdomen. Abdominal CT scan revealed the fracture of the lower splenic pole with intraparenchymal pseudoaneurysms (OIS spleen injury scale IV). Considering the hemodynamic stability, NOM was undertaken and SAE was performed. After a week, the patient developed a splenic abscess confirmed by Abdominal CT; therefore, splenectomy was performed. There was no evidence of bacterial growing in the perisplenic hematoma cultures but the histological examination showed multiple abscess and hemorrhagic areas in the spleen. Splenic abscess after SAE during NOM of BSI is a rare major complication. The most frequently cultured organisms include Clostridium perfringens, Alpha-Hemoliticus Streptococcus, gram-positive Staphylococcus, gram-negative Salmonella, Candida, and Aspergillus. This case represents our first reported splenic abscess after SAE. SAE is a very useful tool for BSI managing; splenic abscess can occur in a short time, even if it is a rare major complication, so it may be useful to monitor patients undergoing SAE, focusing not only on the hemodynamic parameters but also on the inflammatory and infectious aspects.

  18. Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma.

    Science.gov (United States)

    Fu, Chen Ju; Wong, Yon Cheong; Tsang, Yuk Ming; Wang, Li Jen; Chen, Huan Wu; Ku, Yi Kang; Wu, Cheng Hsien; Chen, Huan Wen; Kang, Shih Ching

    2015-01-01

    Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.

  19. Reliability of injury grading systems for patients with blunt splenic trauma

    NARCIS (Netherlands)

    Olthof, D. C.; van der Vlies, C. H.; Scheerder, M. J.; de Haan, R. J.; Beenen, L. F. M.; Goslings, J. C.; van Delden, O. M.

    2014-01-01

    The most widely used grading system for blunt splenic injury is the American Association for the Surgery of Trauma (AAST) organ injury scale. In 2007 a new grading system was developed. This 'Baltimore CT grading system' is superior to the AAST classification system in predicting the need for

  20. Clinical features and outcomes of blunt splenic injury in children

    Science.gov (United States)

    Yang, Kaiying; Li, Yanan; Wang, Chuan; Xiang, Bo; Chen, Siyuan; Ji, Yi

    2017-01-01

    Abstract Although the spleen is the most commonly injured intra-abdominal organ after blunt trauma, there are limited data available in China. The objectives of this study were to investigate the clinical features and determine the risk factors for operative management (OM) in children with blunt splenic injury (BSI). A review of the medical records of children diagnosed with BSI between January 2010 and September 2016 at West China Hospital of Sichuan University was performed. A total of 101 patients diagnosed with BSI were recruited, including 76 patients transferred from other hospitals. The male-to-female ratio was 2.06:1, with a mean age of 7.8 years old. The most common injury season was summer and the most common injury mechanism was road traffic accidents. Sixty-eight patients suffered multiple injuries. Thirty-four patients received blood transfusions. Two patients died from multiple organ failure or hemorrhagic shock. Significant differences were observed in the injury season, injury mechanism, injury date, and hemoglobin levels between the isolated injury group and the multiple injuries group. The overall operative rate was 29.7%. Multivariate regression analysis revealed that age, blood transfusion, and grade of injury were independent risk factors for OM. Our study provided evidence that the management of pediatric BSI was variable. The operative rate in pediatric BSI may be higher in certain patient groups. Although nonoperative management is one of the standard treatment options, our data suggest that OM is an appropriate way to treat patients who are hemodynamically unstable. PMID:29390566

  1. Analysis of Urobilinogen and Urine Bilirubin for Intra-Abdominal Injury in Blunt Trauma Patients

    Directory of Open Access Journals (Sweden)

    Gorchynski, Julie

    2009-05-01

    Full Text Available OBJECTIVE: To determine the point prevalence of urine bilirubin, urine hemoglobin and urobilinogen in blunt trauma patients, and to evaluate its utility as a screening tool for intra-abdominal injury.METHODS: Data analysis of 986 consecutive trauma patients of which 698 were adult blunt trauma patients. Five-hundred sixteen subjects had a urinalysis and a CT scan of the abdomen/pelvis or exploratory laparotomy. We reviewed initial urinalysis results from trauma patients in the emergency department (ED for the presence of urine hemoglobin, uroblinogen and urine bilirubin. Computed tomography (CT scan results and operative reports were reviewed from the trauma registry for evidence of liver laceration, spleen laceration, bowel or mesenteric injuries.RESULTS: There were 73 injuries and 57/516 patients (11% with intra-abdominal injury. Urinalysis was positive for urobilinogen in 28/516 (5.4% patients, urine bilirubin in 15/516 (2.9% patients and urine hemoglobin in 313/516 (61% patients. Nineteen/forty-seven (4% subjects had liver lacerations, 28/56 (5% splenic lacerations, and 15/5 (3% bowel or mesenteric injury. Comparing the proportion of patients that had urobilinogen detected in the group with and without intra-abdominal injury, 8/28 (29% subjects with urobilinogen, 5/15 (33% subjects with bilirubin and 47/313 (15% subjects with urine hemoglobin were found to have liver lacerations, spleen lacerations, or bowel/mesenteric injuries. Preexisting liver or biliary conditions were not statistically associated with elevation of urine bilirubin, urine hemoglobin or urobilinogen on initial urinalysis after blunt abdominal trauma. Point prevalence for urobilinogen, urine bilirubin and urine hemoglobin are 5.43% (28/516, 2.91% (15/516 and 60.7% (313/516 respectively.CONCLUSIONS: The utility of the initial routine urinalysis in the ED for adult blunt abdominal trauma patients should not be used as a screening tool for the evaluation of intra

  2. Analysis of urobilinogen and urine bilirubin for intra-abdominal injury in blunt trauma patients.

    Science.gov (United States)

    Gorchynski, Julie; Dean, Kevin; Anderson, Craig L

    2009-05-01

    To determine the point prevalence of urine bilirubin, urine hemoglobin and urobilinogen in blunt trauma patients, and to evaluate its utility as a screening tool for intra-abdominal injury. Data analysis of 986 consecutive trauma patients of which 698 were adult blunt trauma patients. Five-hundred sixteen subjects had a urinalysis and a CT scan of the abdomen/pelvis or exploratory laparotomy. We reviewed initial urinalysis results from trauma patients in the emergency department (ED) for the presence of urine hemoglobin, uroblinogen and urine bilirubin. Computed tomography (CT) scan results and operative reports were reviewed from the trauma registry for evidence of liver laceration, spleen laceration, bowel or mesenteric injuries. There were 73 injuries and 57/516 patients (11%) with intra-abdominal injury. Urinalysis was positive for urobilinogen in 28/516 (5.4%) patients, urine bilirubin in 15/516 (2.9%) patients and urine hemoglobin in 313/516 (61%) patients. Nineteen/forty-seven (4%) subjects had liver lacerations, 28/56 (5%) splenic lacerations, and 15/5 (3%) bowel or mesenteric injury. Comparing the proportion of patients that had urobilinogen detected in the group with and without intra-abdominal injury, 8/28 (29%) subjects with urobilinogen, 5/15 (33%) subjects with bilirubin and 47/313 (15%) subjects with urine hemoglobin were found to have liver lacerations, spleen lacerations, or bowel/mesenteric injuries. Preexisting liver or biliary conditions were not statistically associated with elevation of urine bilirubin, urine hemoglobin or urobilinogen on initial urinalysis after blunt abdominal trauma. Point prevalence for urobilinogen, urine bilirubin and urine hemoglobin are 5.43% (28/516), 2.91% (15/516) and 60.7% (313/516) respectively. The utility of the initial routine urinalysis in the ED for adult blunt abdominal trauma patients should not be used as a screening tool for the evaluation of intra-abdominal injury.

  3. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

    OpenAIRE

    Ertugrul, Gokhan; Coskun, Murat; Sevinc, Mahsuni; Ertugrul, Fisun; Toydemir, Toygar

    2012-01-01

    Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; ex...

  4. Provider perceptions concerning use of chest x-ray studies in adult blunt trauma assessments.

    Science.gov (United States)

    Calderon, Georgina; Perez, Daniel; Fortman, Jonathan; Kea, Bory; Rodriguez, Robert M

    2012-10-01

    Although they infrequently lead to management changing diagnoses, chest x-rays (CXRs) are the most commonly ordered imaging study in blunt trauma evaluation. To determine: 1) the reasons physicians order chest X-ray studies (CXRs) in blunt trauma assessments; 2) what injuries they expect CXRs to reveal; and 3) whether physicians can accurately predict low likelihood of injury on CXR. At a Level I Trauma Center, we asked resident and attending physicians treating adult blunt trauma patients: 1) the primary reason(s) for getting CXRs; 2) what, if any, significant intrathoracic injuries (SITI) they expected CXRs to reveal; and 3) the likelihood of these injuries. An expert panel defined SITI as two or more rib fractures, sternal fracture, pulmonary contusion, pneumothorax, hemothorax, or aortic injury on official CXR readings. There were 484 patient encounters analyzed--65% of participating physicians were residents and 35% were attendings; 16 (3.3%) patients had SITI. The most common reasons for ordering CXRs were: "enough concern for significant injury" (62.9%) and belief that CXR is a "standard part of trauma work-up" (24.8%). Residents were more likely than attendings to cite "standard trauma work-up" (mean difference = 13.5%, p = 0.003). When physicians estimated a 25% likelihood, 9.1% (95% CI 3.0-20.0%) had SITI. Physicians order CXRs in blunt trauma patients because they expect to find injuries and believe that CXRs are part of a "standard" work-up. Providers commonly do not expect CXRs to reveal SITI. When providers estimated low likelihood of SITI, the rate of SITI was very low. Published by Elsevier Inc.

  5. Impact of concomitant trauma in the management of blunt splenic injuries.

    Science.gov (United States)

    Lo, Albert; Matheson, Anne-Marie; Adams, Dave

    2004-09-10

    Conservative management of isolated blunt splenic injuries has become widely accepted for haemodynamically stable patients, but may be untenable in those with multiple injuries. A retrospective review was performed to evaluate of our cumulative experience with non-operative management of splenic injuries, and to identify the risk factors for operative management. Eighty patients were identified. Demographics, mechanism of injury, injury severity score (ISS), clinical signs at presentation, utility of computed tomography scans and methods of treatment (operative management vs conservative management) were documented and statistically analysed to identify predictors for operative management. Initially, 45 patients (56%) were managed without operation, while 35 patients underwent urgent laparotomy - with 26 (74% in operative group) of these having splenectomy performed. Two patients (out of 45) failed conservative management and required delayed splenectomy, a 96% success rate for intended conservative management. Thus, overall rates of 54% non-operative management and 65% splenic conservation were achieved. The mean ISS of the operative management group (ISS=30) was higher than that of the non-operative treatment group (ISS=13, ptrauma. Risk factors for patients with blunt splenic injuries requiring operative management include ISS > or =16, hypotension, GCS trauma, there is an increasing trend towards operative management.

  6. Pediatric blunt cerebrovascular injury: the McGovern screening score.

    Science.gov (United States)

    Herbert, Joseph P; Venkataraman, Sidish S; Turkmani, Ali H; Zhu, Liang; Kerr, Marcia L; Patel, Rajan P; Ugalde, Irma T; Fletcher, Stephen A; Sandberg, David I; Cox, Charles S; Kitagawa, Ryan S; Day, Arthur L; Shah, Manish N

    2018-03-16

    OBJECTIVE The objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing. METHODS This is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0-15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI. Recently, the Utah score has emerged as a screening tool specifically targeted toward evaluating BCVI risk in the pediatric population. Using logistical regression and adding mechanism of injury as a logit, the McGovern score was able to use the Utah score as a starting point to create a more sensitive screening tool to identify which pediatric trauma patients should receive angiographic imaging due to a high risk for BCVI. RESULTS A total of 12,614 patients (mean age 6.6 years) were admitted with blunt trauma and prospectively registered in the trauma database. Of these, 460 (3.6%) patients underwent angiography after blunt trauma: 295 (64.1%), 107 (23.3%), 6 (1.3%), and 52 (11.3%) patients underwent CT angiography, MR angiography, digital subtraction angiography, and a combination of imaging modalities, respectively. The BCVI incidence (n = 21; 0.17%) was lower than that in a comparable adult group (p tools for BCVI, misclassified 6 (28.6%), 6 (28.6%), 7 (33.3%), and 10 (47.6%) patients with BCVI, respectively, as "low risk" and not in need of subsequent angiographic imaging. By incorporating the mechanism of injury into the score, the McGovern score only misclassified 4 (19.0%) children, all of whom were managed conservatively with no treatment or aspirin. CONCLUSIONS With a low incidence of pediatric BCVI and a nonsurgical treatment paradigm, a more conservative approach

  7. Mitral Perivalvular Leak after Blunt Chest Trauma: A Rare Cause of Severe Subacute Mitral Regurgitation.

    Science.gov (United States)

    Marchese, Nicola; Facciorusso, Antonio; Vigna, Carlo

    2015-12-01

    Blunt chest trauma is a very rare cause of valve disorder. Moreover, mitral valve involvement is less frequent than is aortic or tricuspid valve involvement, and the clinical course is usually acute. In the present report, we describe the case of a 49-year-old man with a perivalvular mitral injury that became clinically manifest one year after a violent, nonpenetrating chest injury. This case is atypical in regard to the valve involved (isolated mitral damage), the injury type (perivalvular leak in the absence of subvalvular abnormalities), and the clinical course (interval of one year between trauma and symptoms).

  8. A Rare Entity: Traumatic Thoracic Aortic Injury in a Patient with Aberrant Right Subclavian Artery.

    Science.gov (United States)

    Patel, Hiten Mohanbhai; Banerjee, Shubhabrata; Bulsara, Shahzad; Sahu, Tapish; Sheorain, Virender K; Grover, Tarun; Parakh, Rajiv

    2017-05-01

    Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure. A 40-year male patient was brought to the emergency in shock with an alleged history of road traffic accident an hour back. After initial resuscitation as per advance trauma life support protocol, imaging revealed thoracic aortic injury with aberrant right subclavian artery with multiple rib and bilateral humerus fracture. After primary stabilization of arm fractures, the patient was shifted to a hybrid operation room. As the aortic injury was within 10 mm of the origin of both subclavian arteries, it was decided to cover the origin of both subclavian arteries and land the endograft distal to the left carotid artery origin. Since there was a right dominant vertebral artery on imaging, right carotid to right subclavian artery bypass was done with expanded polytetrafluoroethylene graft to prevent posterior circulatory stroke along with thoracic endovascular aortic repair to seal the thoracic aortic injury. After endovascular repair of thoracic aortic injury, left subclavian artery perfusion was maintained through left vertebral artery; and hence, revascularization of left subclavian artery was deferred. After management of all fractures, the patient was discharged 3 weeks after the date of admission without any complications. At 6 months follow-up, patient was stable and images showed patent bypass graft and sealed aortic injury. In a trauma setting with multiple injuries, hybrid procedure with a thoracic endograft is associated with low mortality and morbidity; hence, it is the treatment

  9. Predicting hollow viscus injury in blunt abdominal trauma with computed tomography.

    Science.gov (United States)

    Bhagvan, Savitha; Turai, Matthew; Holden, Andrew; Ng, Alexander; Civil, Ian

    2013-01-01

    Evaluation of blunt abdominal trauma is controversial. Computed tomography (CT) of the abdomen is commonly used but has limitations, especially in excluding hollow viscus injury in the presence of solid organ injury. To determine whether CT reports alone could be used to direct operative treatment in abdominal trauma, this study was undertaken. The trauma database at Auckland City Hospital was accessed for patients who had abdominal CT and subsequent laparotomy during a five-year period. The CT scans were reevaluated by a consultant radiologist who was blinded to operative findings. The CT findings were correlated with the operative findings. Between January 2002 and December 2007, 1,250 patients were evaluated for blunt abdominal injury with CT. A subset of 78 patients underwent laparotomy, and this formed the study group. The sensitivity and specificity of CT scan in predicting hollow viscus injury was 55.33 and 92.06 % respectively. The positive and negative predictive values were 61.53 and 89.23 % respectively. Presence of free fluid in CT scan was sensitive in diagnosing hollow viscus injury (90 %). Specific findings for hollow viscus injuries on CT scan were free intraperitoneal air (93 %), retroperitoneal air (100 %), oral contrast extravasation (100 %), bowel wall defect (98 %), patchy bowel enhancement (97 %), and mesenteric abnormality (94 %). CT alone cannot be used as a screening tool for hollow viscus injury. The decision to operate in hollow viscus injury has to be based on mechanism of injury and clinical findings together with radiological evidence.

  10. A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients.

    Science.gov (United States)

    Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Olsha, Oded; Givon, Adi; Kessel, Boris

    2017-03-01

    Pelvic fractures are a marker of severe injury, mandating a thorough investigation for the presence of associated injuries. Anatomical and physiological differences between adults and children may lead to a different impact of pelvic fractures on these populations. The purpose of this study is to compare pelvic fractures between pediatric and adult blunt trauma victims, mainly regarding their severity and associated intraabdominal injuries. A retrospective study involving blunt trauma patients suffering pelvic fractures, according to the records of the Israeli National Trauma Registry. Patients included children, aged 0-14years, and adults between 15 and 64years. The presence and severity of associated injuries were assessed. Overall, 7621 patients aged 0-64years were identified with pelvic fractures following blunt trauma. The incidence of pelvic fractures in children was (0.8%), as compared to 4.3% in adults, p 25. Adults sustained significantly more moderate to severe pelvic fractures (AIS≥3) than children (26.7% vs. 17.4%, psplenic and hepatic injuries (p=0.026, p=0.0004, respectively). Among children, a similar correlation was not demonstrated. Adults involved in blunt trauma are more likely to sustain pelvic fractures, and these are generally more severe fractures, as compared to children suffering from blunt trauma. Nonetheless, mortality rates were found similar in both groups. The only associated injury with statistically significant difference in incidence among the two groups was rectal injury. In adults, but not in children, higher grade pelvic fractures correlated with more severe concomitant splenic or hepatic injuries. The level of evidence for this study is III (3). Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Reliability of injury grading systems for patients with blunt splenic trauma.

    Science.gov (United States)

    Olthof, D C; van der Vlies, C H; Scheerder, M J; de Haan, R J; Beenen, L F M; Goslings, J C; van Delden, O M

    2014-01-01

    The most widely used grading system for blunt splenic injury is the American Association for the Surgery of Trauma (AAST) organ injury scale. In 2007 a new grading system was developed. This 'Baltimore CT grading system' is superior to the AAST classification system in predicting the need for angiography and embolization or surgery. The objective of this study was to assess inter- and intraobserver reliability between radiologists in classifying splenic injury according to both grading systems. CT scans of 83 patients with blunt splenic injury admitted between 1998 and 2008 to an academic Level 1 trauma centre were retrospectively reviewed. Inter and intrarater reliability were expressed in Cohen's or weighted Kappa values. Overall weighted interobserver Kappa coefficients for the AAST and 'Baltimore CT grading system' were respectively substantial (kappa=0.80) and almost perfect (kappa=0.85). Average weighted intraobserver Kappa's values were in the 'almost perfect' range (AAST: kappa=0.91, 'Baltimore CT grading system': kappa=0.81). The present study shows that overall the inter- and intraobserver reliability for grading splenic injury according to the AAST grading system and 'Baltimore CT grading system' are equally high. Because of the integration of vascular injury, the 'Baltimore CT grading system' supports clinical decision making. We therefore recommend use of this system in the classification of splenic injury. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. A novel decision tree approach based on transcranial Doppler sonography to screen for blunt cervical vascular injuries.

    Science.gov (United States)

    Purvis, Dianna; Aldaghlas, Tayseer; Trickey, Amber W; Rizzo, Anne; Sikdar, Siddhartha

    2013-06-01

    Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach. This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M-mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures. We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications. In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient-specific hemodynamic information from transcranial Doppler assessment has the potential to alter

  13. Management of adult blunt hepatic trauma.

    Science.gov (United States)

    Kozar, Rosemary A; McNutt, Michelle K

    2010-12-01

    To review the nonoperative and operative management of blunt hepatic injury in the adult trauma population. Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to a patient at increased risk of hepatic complications following nonoperative management. Blunt hepatic injury remains a frequent intraabdominal injury in the adult trauma population. The management of blunt hepatic injury has undergone a major paradigm shift from mandatory operative exploration to nonoperative management. Hemodynamic instability with a positive focused abdominal sonography for trauma and peritonitis are indications for emergent operative intervention. Although surgical intervention for blunt hepatic trauma is not as common as in years past, it is imperative that the current trauma surgeon be familiar with the surgical skill set to manage complex hepatic injuries. This study represents a review of both nonoperative and operative management of blunt hepatic injury.

  14. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center.

    Science.gov (United States)

    Johnson, Jeremy J; Garwe, Tabitha; Raines, Alexander R; Thurman, Joseph B; Carter, Sandra; Bender, Jeffrey S; Albrecht, Roxie M

    2013-03-01

    Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P = .0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively. DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury.

    Science.gov (United States)

    Hershkovitz, Yehuda; Zoarets, Itai; Stepansky, Albert; Kozer, Eran; Shapira, Zahar; Klin, Baruch; Halevy, Ariel; Jeroukhimov, Igor

    2014-07-01

    Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury. Forty-two pediatric patients up to 15 years old were prospectively enrolled. All patients presented with a suspicious mechanism of blunt trauma and multisystem injury. They were neurologically intact and had no signs of injury to the abdomen or chest. Patients underwent CT imaging of the chest and abdomen as part of the initial evaluation. Thirty-one patients (74%) had a normal CT scan. Two patients of 11 with an abnormal CT scan required a change in management and were referred for observation in the Intensive Care Unit. None of the patients required surgical intervention. The routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Specific Radiological Findings of Traumatic Gastrointestinal Tract Injuries in Patients With Blunt Chest and Abdominal Trauma.

    Science.gov (United States)

    Kokabi, Nima; Harmouche, Elie; Xing, Minzhi; Shuaib, Waqas; Mittal, Pardeep K; Wilson, Kenneth; Johnson, Jamlik-Omari; Nicolaou, Savvas; Khosa, Faisal

    2015-05-01

    Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such injuries significantly decreases morbidity and mortality. Since physical examination is not accurate in detecting such injuries, contrast-enhanced computed tomography has been the mainstay for diagnosis in many emergency departments. This pictorial essay aims to review the incidence, mechanisms, and signs of gastrointestinal hollow viscus injuries in the setting of blunt chest and abdominal trauma. Copyright © 2015 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  17. The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas.

    Science.gov (United States)

    Sabzghabaei, Anita; Shojaee, Majid; Safari, Saeed; Hatamabadi, Hamid Reza; Shirvani, Reza

    2016-01-01

    In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT) scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4), 58.5% (95% CI: 51.2-65.5), 56% (95% CI: 48.5-63.3), 79.6% (95% CI: 71.8-85.7), 1.27% (95% CI: 1.30-1.57), and 0.25% (95% CI: 0.18-0.36), respectively. The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging.

  18. The diagnosis and management of children with blunt injury of the chest.

    Science.gov (United States)

    Sartorelli, Kennith H; Vane, Dennis W

    2004-05-01

    Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.

  19. Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

    Science.gov (United States)

    Kong, Jennifer P. L; Bultitude, Matthew F; Royce, Peter; Gruen, Russell L; Cato, Alex; Corcoran, Niall M

    2011-01-01

    Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence. PMID:22114545

  20. Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients.

    Science.gov (United States)

    Wu, Shih-Chi; Fu, Chih-Yuan; Chen, Ray-Jade; Chen, Yung-Fang; Wang, Yu-Chun; Chung, Ping-Kuei; Yu, Shu-Fen; Tung, Cheng-Cheng; Lee, Kun-Hua

    2011-02-01

    Nonoperative management (NOM) of blunt splenic injuries has been widely accepted, and the application of splenic artery embolization (SAE) has become an effective adjunct to NOM. However, complications do occur after SAE. In this study, we assess the factors leading to the major complications associated with SAE. Focusing on the major complications after SAE, we retrospectively studied patients who received SAE and were admitted to 2 major referral trauma centers under the same established algorithm for management of blunt splenic injuries. The demographics, angiographic findings, and factors for major complications after SAE were examined. Major complications were considered to be direct adverse effects arising from SAE that were potentially fatal or were capable of causing disability. There were a total of 261 patients with blunt splenic injuries in this study. Of the 261 patients, 53 underwent SAE, 11 (21%) of whom were noted to have 12 major complications: 8 cases of postprocedural bleeding, 2 cases of total infarction, 1 case of splenic abscess, and 1 case of splenic atrophy. Patients older than 65 years were more susceptible to major complications after SAE. Splenic artery embolization is considered an effective adjunct to NOM in patients with blunt splenic injuries. However, risks of major complications do exist, and being elderly is, in part, associated with a higher major complication incidence. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Blunt chest trauma--an audit of injuries diagnosed by the MDCT examination.

    Science.gov (United States)

    Turkalj, Ivan; Petrović, Kosta; Stojanović, Sanja; Petrović, Djordje; Brakus, Alma; Ristić, Jelena

    2014-02-01

    Multidetector computed tomography (MDCT) characterised by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

  2. Massive hemothorax due to inferior phrenic artery injury after blunt trauma.

    Science.gov (United States)

    Aoki, Makoto; Shibuya, Kei; Kaneko, Minoru; Koizumi, Ayana; Murata, Masato; Nakajima, Jun; Hagiwara, Shuichi; Kanbe, Masahiko; Koyama, Yoshinori; Tsushima, Yoshito; Oshima, Kiyohiro

    2015-01-01

    Injury to the inferior phrenic artery after blunt trauma is an extremely rare event, and it may occur under unanticipated conditions. This case report describes an injury to the left inferior phrenic artery caused by blunt trauma, which was complicated by massive hemothorax, and treated with transcatheter arterial embolization (TAE). An 81 year-old female hit by a car while walking at the traffic intersection was transferred to the emergency department, computed tomography scanning revealed active extravasations of the contrast medium within the retrocrural space and from branches of the internal iliac artery. The patient underwent repeated angiography, and active extravasation of contrast medium was observed between the retrocrural space and the right pleural space originating from the left inferior phrenic artery. The injured left inferior phrenic artery was successfully embolized with N-butyl cyanoacrylate, resulting in stabilization of the patient's clinical condition. Inferior phrenic artery injury should be recognized as a rare phenomenon and causative factor for hemothorax. TAE represents a safe and effective treatment for this complication and obviates the need for a thoracotomy.

  3. The efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury

    International Nuclear Information System (INIS)

    Park, Si Kyun; Kim, Young Ju; Kwon, Taek Sang; Kim, Jong Jin; Ko, Sung Min; Sung, Ki Joon

    1998-01-01

    The purpose of this study is to evaluate the efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury. The results of transcatheter splenic arterial embolization in nine children who suffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated by CT, and the findings were evaluated according to the classification of Mirvis et al.; two patients were grade 3 and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if a patient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintain hemodynamic stability; or (2) rapid Hb/Hct decrease; or (3) both. Splenic function was subsequently estimated according to the results of 09m Tc-sulfur colloid scintigraphy and/or CT scanning. TAE was successful in all nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil. Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches. Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. TAE of the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injury in children, and can preserve splenic function. (author). 18 refs., 2 tabs., 3 figs

  4. The efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury

    Energy Technology Data Exchange (ETDEWEB)

    Park, Si Kyun; Kim, Young Ju; Kwon, Taek Sang; Kim, Jong Jin; Ko, Sung Min; Sung, Ki Joon [Yonsei University, Wonju (Korea, Republic of). Wonju Coll. of Medicine

    1998-06-01

    The purpose of this study is to evaluate the efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury. The results of transcatheter splenic arterial embolization in nine children who suffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated by CT, and the findings were evaluated according to the classification of Mirvis et al.; two patients were grade 3 and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if a patient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintain hemodynamic stability; or (2) rapid Hb/Hct decrease; or (3) both. Splenic function was subsequently estimated according to the results of {sup 09m}Tc-sulfur colloid scintigraphy and/or CT scanning. TAE was successful in all nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil. Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches. Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. TAE of the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injury in children, and can preserve splenic function. (author). 18 refs., 2 tabs., 3 figs.

  5. Traumatic Mitral Valve and Pericardial Injury

    Directory of Open Access Journals (Sweden)

    Nissar Shaikh

    2013-01-01

    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  6. Comparison of External and Internal Injury in Cases of Fatal Blunt Trauma Head Injury Autopsied at Tertiary Care Centre in Eastern Nepal

    Directory of Open Access Journals (Sweden)

    Bikash Sah

    2017-07-01

    Full Text Available Background & Objectives: Blunt trauma is more likely to be missed because clinical signs are less obvious in many regions of the body. This study was done with an objective to compare external and internal injuries of autopsy cases with fatal blunt trauma head injuries.Materials & Methods: This was a hospital based, cross sectional and analytical study done on the autopsy cases at B. P. Koirala Institute of Health Sciences, Dharan, Nepal (tertiary hospital in eastern Nepal from 13th April 2012 to 13th April 2013 with Head injuries by blunt trauma with or without concomitant non-head injuries. The decomposed bodies and the bodies where cause of trauma could not be differentiated were excluded. Postmortem examination was conducted on all the cases and the injuries present on all the body parts were noted. Abbreviated Injury Scale (AIS score was given for each injury. Appropriate statistical tool was used to compare the AIS scores of external and internal injuries. The test of significance was fixed at p < 0.01. Results: The correlation of scalp injuries with that of skull fracture, intracranial hemorrhage, cerebral injury and overall internal head injury were 0.591, 0.772, 0.439 and 0.600 respectively and all these correlations were statistically significant whereas the correlation between concomitant external and internal non-head injuries is -0.092 which is statistically not significant.Conclusion: Within the limits of this study it is possible to conclude that there was significant association between periodontitis and anxiety, and depression.

  7. CT analysis of pulmonary injuries from blunt chest trauma

    International Nuclear Information System (INIS)

    Konno, Shoko

    1996-01-01

    The purpose of this paper is to analyze the CT findings of pulmonary parenchymal injuries due to blunt chest trauma and to categorize CT findings on the basis of their outcome. The materials of this study consist of 62 patients who had pulmonary injuries on CT obtained within 6 hours after blunt chest trauma. CT findings were analysed with regards to the shape, size, and distribution of the lesions. Follow-up CT scans were obtained in 35 patients at intervals from 1 day to 1 month after the initial CT study. CT showed ill-defined opacities in 59 patients (64 lesions in the peripheral area and 95 in the non-peripheral area) and pulmonary nodules with or without cavitary lesions in 30 patients (7 lesions in the peripheral area and 31 in the non-peripheral area). Follow-up CT allowed the classification of these pulmonary injuries into 3 types; the non-peripheral, ill-defined opacities showing immediate clearing, nodules with or without cavitary lesions over 1 cm in diameter showing prolongation, and the peripheral ill-defined opacities adjacent to the thoracic cage, and small nodules with or without cavitary lesions within 1 cm in diameter, showing various courses. CT has marked advantage over plain chest radiographs not only in the detection rate but in accurate estimation of the prognosis of the lesions. (author)

  8. The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas

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    Anita Sabzghabaei

    2016-01-01

    Full Text Available Introduction: In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Methods: Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. Results: 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4, 58.5% (95% CI: 51.2-65.5, 56% (95% CI: 48.5-63.3, 79.6% (95% CI: 71.8-85.7, 1.27% (95% CI: 1.30-1.57, and 0.25% (95% CI: 0.18-0.36, respectively. Conclusion: The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging.

  9. Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

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    Somsekhar Ganti

    2006-03-01

    Full Text Available Abstract Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon.

  10. Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan.

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    Tanaka, Chie; Tagami, Takashi; Matsumoto, Hisashi; Matsuda, Kiyoshi; Kim, Shiei; Moroe, Yuta; Fukuda, Reo; Unemoto, Kyoko; Yokota, Hiroyuki

    2017-01-01

    Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from the 2004-2014 Japan Trauma Data Bank. We grouped the records of these patients into 3 time phases: phase I (2004-2008), phase II (2009-2012), and phase III (2013-2014). Over the 3 phases, we analysed 30-day mortality rates and investigated their association with the prevalence of certain initial interventions (Mantel-Haenszel trend test). We further performed multiple imputation and multivariable analyses for comparing the characteristics and outcomes of patients who underwent TAE or splenectomy/splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation. Over time, there was a significant decrease in 30-day mortality after splenic injury (p splenic injury between 2004 and 2014, even after adjustment for within-hospital clustering and other factors independently associated with mortality. Over time, mortality rates decreased significantly after splenectomy/splenorrhaphy, but not after non-operative management. This information is useful for clinicians when making decisions about treatments for patients with blunt splenic injury.

  11. Early endoscopic treatment of blunt traumatic pancreatic injury.

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    Björnsson, Bergthor; Kullman, Eric; Gasslander, Thomas; Sandström, Per

    2015-01-01

    Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.

  12. Extrahepatic duct injury in blunt trauma: two case reports and a literature review.

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    Zago, Thiago Messias; Pereira, Bruno Monteiro Tavares; Calderan, Thiago Rodrigues Araujo; Hirano, Elcio Shiyoiti; Fraga, Gustavo Pereira

    2014-08-01

    Traumatic injuries of the extrahepatic biliary tract are rare. Associated injuries are usually responsible for immediate indication for surgical treatment, the time when an injury to the extrahepatic biliary ducts may be diagnosed. However, missed injuries are often common. The primary aim of this paper is to describe the clinical features, diagnosis, treatment, and outcome of two patients with left hepatic duct injury after blunt abdominal trauma. As a secondary objective, a literature review is presented. The two cases presented in this study are as follows: (1) A young male, involved in a motor vehicle crash, was admitted with blunt hepatic trauma in a general hospital. Endoscopic retrograde cholangiography was conducted 3 weeks later and revealed a large leakage at the left hepatic duct. Exploratory laparotomy was performed 26 days after the initial traumatic event and identified a complete section of the left hepatic duct, treated with anastomosis. (2) A male fell from a height. On exploratory laparotomy, a 30 % partial injury of the left hepatic duct was found in addition to hemoperitoneum, liver injury, gallbladder detachment together with cystic duct rupture, retroperitoneal hematoma to the right, and cecum hematoma. A high level of suspicion is necessary to identify injuries to the hepatic ducts. Early diagnosis that occurs during laparotomy due to associated injuries is important to reduce complications.

  13. Penetrating cardiac injuries in blunt chest wall trauma.

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    Kanchan, Tanuj; Menezes, Ritesh G; Sirohi, Parmendra

    2012-08-01

    The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  14. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children.

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    Acker, Shannon N; Petrun, Branden; Partrick, David A; Roosevelt, Genie E; Bensard, Denis D

    2015-12-01

    Current management protocols for children with blunt solid organ injury to the liver and spleen call for serial monitoring of the child's hemoglobin and hematocrit every 6, 12, or 24 hours, depending on the injury grade. We hypothesized that children who require emergent intervention in the form of laparotomy, angioembolization, or packed red blood cell (PRBC) transfusion because of bleeding from a solid organ injury will have changes in their vital signs that alert the clinician to the need for intervention, making scheduled laboratory evaluation unnecessary. We performed a retrospective review of all children admitted to either of two pediatric trauma centers following blunt trauma with any grade liver or spleen injury from January 2009 to December 2013. Data evaluated include a need for intervention, indication for intervention, and timing of intervention. A total of 245 children were admitted with blunt liver or spleen injury. Six patients (2.5%) underwent emergent exploratory laparotomy for hypotension a median of 4 hours after injury (range, 2-4 hours), four of who required splenectomy. No child required laparotomy for delayed bleeding from a solid organ injury. One child (0.4%) underwent angioembolization for blunt splenic injury. Forty-one children (16.7%) received a PRBC transfusion during hospitalization, 32 of whom did not undergo laparotomy or angioembolization. Children who underwent an intervention had a lower nadir hematocrit (median, 22.9 vs. 32.8; p hematocrit (median, 35.5 vs. 16 hours; p hemoglobin and hematocrit monitoring (median, 20 vs. 5; p hemoglobin and hematocrit values may not be necessary. Retrospective study with no negative criteria, prognostic study, level III.

  15. Blunt liver injury with intact ribs under impacts on the abdomen: a biomechanical investigation.

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    Yu Shao

    Full Text Available Abdominal trauma accounts for nearly 20% of all severe traffic injuries and can often result from intentional physical violence, from which blunt liver injury is regarded as the most common result and is associated with a high mortality rate. Liver injury may be caused by a direct impact with a certain velocity and energy on the abdomen, which may result in a lacerated liver by penetration of fractured ribs. However, liver ruptures without rib cage fractures were found in autopsies in a series of cases. All the victims sustained punches on the abdomen by fist. Many studies have been dedicated to determining the mechanism underlying hepatic injury following abdominal trauma, but most have been empirical. The actual process and biomechanism of liver injury induced by blunt impact on the abdomen, especially with intact ribs remained, are still inexhaustive. In order to investigate this, finite element methods and numerical simulation technology were used. A finite element human torso model was developed from high resolution CT data. The model consists of geometrically-detailed liver and rib cage models and simplified models of soft tissues, thoracic and abdominal organs. Then, the torso model was used in simulations in which the right hypochondrium was punched by a fist from the frontal, lateral, and rear directions, and in each direction with several impact velocities. Overall, the results showed that liver rupture was primarily caused by a direct strike of the ribs induced by blunt impact to the abdomen. Among three impact directions, a lateral impact was most likely to cause liver injury with a minimum punch speed of 5 m/s (the momentum was about 2.447 kg.m/s. Liver injuries could occur in isolation and were not accompanied by rib fractures due to different material characteristics and injury tolerance.

  16. [The mechanisms of formation of liver injuries associated with the blunt abdominal trauma].

    Science.gov (United States)

    Pigolkin, Iu I; Dubrovina, I A; Dubrovin, I A

    2012-01-01

    The mechanisms of liver damage associated with the blunt abdominal trauma are considered based on the analysis of the literature publications. The general characteristic of these mechanisms and the processes underlying the development of liver injuries is presented. It is argued that the mechanisms underlying the formation of damages to the liver differ depending on the form of the traumatic impact, the injurious factor, and the processes leading to the destruction of the hepatic tissue. The main forms of traumatic impact in the case of a blunt abdominal trauma include the strike (blow), pressure, and concussion of the organ while the major traumatic factors are deformation, displacement, and "shock-resistant effects". The mechanisms underlying tissue destruction are compression and stretching. These two mechanisms are responsible for the formation of different variants of liver destruction. The results of the study suggest the necessity of the search for other mechanisms of degradation of the hepatic tissue following a blunt abdominal trauma for the improvement of forensic medical diagnostics of its cause and the underlying mechanism.

  17. [Aortic valve insufficiency due to rupture of the cusp in a patient with multiple trauma].

    Science.gov (United States)

    Vidmar, J; Brilej, D; Voga, G; Kovacic, N; Smrkolj, V

    2003-06-01

    Lesions of the heart valve caused by blunt chest trauma is rare, but when it does occur it can significantly injure the patient. On the basis of autopsy studies, research shows that heart valves are injured in less than 5% of patients who have died due to impact thoracic trauma. Among the heart valves, the aortic valve is the most often lacerated, which has been proved by relevant autopsy and clinical studies. Aortic valve lesions can be the only injury, but it is possible that additional heart or large vessel injuries are also present (myocardial contusion, rupture of the atrial septum, aortic rupture, rupture of the left common carotid artery). The force that causes such an injury is often great and often causes injuries to other organs and organ systems. In a multiple trauma patient, it is very important to specifically look for heart-related injuries because it is possible that they may be overlooked or missed by the surgeon, because of other obvious injuries. We describe the case of a 41-year-old man with multiple trauma who was diagnosed with aortic valve insufficiency due to rupture of the left coronary cusp 6 weeks after a road accident. Valvuloplasty was performed. Seven years later the patient is free of symptoms and is in good physical condition. Echocardiography showed normal dimensions of the heart chambers, a normal thickness of the heart walls, and normal systolic and diastolic function of the left ventricle. Heart valves are morphologically normal, and only an unimportant aortic insufficiency was noticed by echocardiography.

  18. Defining acute aortic syndrome after trauma: Are Abbreviated Injury Scale codes a useful surrogate descriptor?

    Science.gov (United States)

    Leach, R; McNally, Donal; Bashir, Mohamad; Sastry, Priya; Cuerden, Richard; Richens, David; Field, Mark

    2012-10-01

    The severity and location of injuries resulting from vehicular collisions are normally recorded in Abbreviated Injury Scale (AIS) code; we propose a system to link AIS code to a description of acute aortic syndrome (AAS), thus allowing the hypothesis that aortic injury is progressive with collision kinematics to be tested. Standard AIS codes were matched with a clinical description of AAS. A total of 199 collisions that resulted in aortic injury were extracted from a national automotive collision database and the outcomes mapped onto AAS descriptions. The severity of aortic injury (AIS severity score) and stage of AAS progression were compared with collision kinematics and occupant demographics. Post hoc power analyses were used to estimate maximum effect size. The general demographic distribution of the sample represented that of the UK population in regard to sex and age. No significant relationship was observed between estimated test speed, collision direction, occupant location or seat belt use and clinical progression of aortic injury (once initiated). Power analysis confirmed that a suitable sample size was used to observe a medium effect in most of the cases. Similarly, no association was observed between injury severity and collision kinematics. There is sufficient information on AIS severity and location codes to map onto the clinical AAS spectrum. It was not possible, with this data set, to consider the influence of collision kinematics on aortic injury initiation. However, it was demonstrated that after initiation, further progression along the AAS pathway was not influenced by collision kinematics. This might be because the injury is not progressive, because the vehicle kinematics studied do not fully represent the kinematics of the occupants, or because an unknown factor, such as stage of cardiac cycle, dominates. Epidemiologic/prognostic study, level IV.

  19. Non-operative management of blunt splenic injuries in a paediatric population: a 12-year experience.

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    Kirkegård, Jakob; Avlund, Tue Højslev; Amanavicius, Nerijus; Mortensen, Frank Viborg; Kissmeyer-Nielsen, Peter

    2015-02-01

    Non-operative management (NOM) is now the primary treatment for blunt splenic injuries in children. Only one study has examined the use of NOM in a Scandinavian population. Thus, the purpose of this study is to report our experience in treating children with blunt splenic injuries with NOM at a Danish university hospital. We conducted a retrospective observational study of 34 consecutive children (aged 16 years or less) admitted to our level 1-trauma centre with blunt splenic injury in the 12-year period from 1 January 2001 to 31 December 2012. Data on patients and procedures were obtained by review of all medical records and re-evaluation of all initial computed tomographies (CT). We included 34 children with a median age of 10.5 years (67.6% males) in this study. All patients were scheduled for NOM, and two (5.9%) patients underwent splenic artery embolisation (SAE). Two (5.9%) patients later needed surgical intervention. The NOM success rate was 88% (95% confidence interval (CI): 73-97%) without SAE and 94% (95% CI: 80-99%) with SAE. We found no difference in the American Association for the Surgery of Trauma grade when comparing the initial CT evaluation (mean 2.59 ± 1.1) with the CT re-evaluation (mean 2.71 ± 0.94); p = 0.226. We demonstrated a high degree of success and safety of non-operative treatment in children with blunt splenic injury in a Scandinavian setting. Our results are comparable to international findings.

  20. Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

    International Nuclear Information System (INIS)

    Sutherland, G.R.; Driedger, A.A.; Holliday, R.L.; Cheung, H.W.; Sibbald, W.J.

    1983-01-01

    Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly lower (31 +/- 11% and 47 +/- 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 +/- 8% and 58 +/- 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle

  1. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

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    Ceri Battle

    Full Text Available INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  2. Treatment for unstable pulmonary sequestration injury in patient with severe blunt trauma: A case report

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    Sakiko Hiraki

    2017-08-01

    Full Text Available Case: Pulmonary sequestration is a congenital malformation characterized by nonfunctioning tissue not communicating with the tracheobronchial tree. As the blood pressure in the artery feeding the sequestrated lung tissue is higher than that in the normal pulmonary artery, the risk of massive hemorrhage in pulmonary sequestration is high. We herein present the first case of a severe blunt trauma patient with unstable pulmonary sequestration injury. Outcome and conclusion: The mechanism of pulmonary sequestration injury is vastly different than that of injury to normal lung. We suggest that proximal feeding artery embolization should be performed before surgical intervention in patients with massive hemorrhage of pulmonary sequestration due to severe chest trauma. Keywords: Blunt trauma, Coil embolization, Massive hemorrhage, Pulmonary sequestration

  3. Predictors of "occult" intra-abdominal injuries in blunt trauma patients

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    José Gustavo Parreira

    Full Text Available Objective: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. Methods: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries or Group 2 (without intra-abdominal injuries. Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. Results: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05 lower mean AIS score for the head segment (1.0±1.4 vs. 1.8±1.9, as well as higher mean AIS thorax score (1.6±1.7 vs. 0.9±1.5 and ISS (25.7±14.5 vs. 17,1±13,1. The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3% and in motorcyclists (36.0% (p<0.001. The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64, presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14, run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22 and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85. Conclusion Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

  4. Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends.

    Science.gov (United States)

    Nagpal, P; Policeni, B A; Bathla, G; Khandelwal, A; Derdeyn, C; Skeete, D

    2017-10-12

    Blunt cerebrovascular injury is a relatively uncommon but sometimes life-threatening injury, particularly in patients presenting with ischemic symptoms in that vascular territory. The decision to pursue vascular imaging (generally CT angiography) is based on clinical and imaging findings. Several grading scales or screening criteria have been developed to guide the decision to pursue vascular imaging, as well as to recommend different treatment options for various injuries. The data supporting many of these guidelines and options are limited however. The purpose of this article is to review and compare these scales and criteria and the data supporting clinical efficacy and to make recommendations for future research in this area. © 2017 by American Journal of Neuroradiology.

  5. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

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    Ertugrul Gokhan

    2012-08-01

    Full Text Available Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.

  6. Delayed Presentations of Blunt Mesenteric and Intestinal Trauma in the Wake of Injury.

    Science.gov (United States)

    Yair, Edden; Miklosh, Bala; Orit, Pappo; Avraham, Rivkind; Gidon, Almogy

    2008-06-01

    To analyze the presentation and timing of blunt mesenteric and intestinal trauma requiring surgical intervention. The Hadassah-Hebrew University trauma registry was scanned for patients who required surgery following blunt mesenteric and/or bowel trauma. Demographic data, mechanism of injury, time to diagnosis and pathology reports were recorded. A literature search was also performed. The majority of patients were injured in motor vehicle accidents (26/30, 86.7%). Patients were divided into three groups. Seventeen patients diagnosed within 4 h of admission were defined as the immediate group. Indication for surgery was hemodynamic instability and/or peritonitis. The most commonly injured region was the terminal ileum (10/17 patients, 59%). The second group (n = 4) had surgery within 2 weeks of injury (early group). These patients presented initially with hemodynamic instability. The operative findings were consistent with a low-flow state of the terminal ileum and cecum. The third group (n = 9) consisted of patients who were operated later than 2 weeks from the date of injury (late group). These patients presented with prolonged abdominal symptoms, chiefly partial small bowel obstruction. Operative findings were bowel strictures, most commonly of the terminal ileum (7/9 patients, 77.8%). Acceleration-deceleration abdominal injury affects the terminal ileum more commonly. We propose that the ensuing clinical picture depends on the level of energy transmitted: high-energy trauma leads to extensive mesenteric and bowel tears and is diagnosed immediately. Low-energy trauma may lead to chronic ischemia, fibrosis and stricture-formation. The right colon appears to be more vulnerable to lowflow states following blunt trauma.

  7. Traumatic partial avulsion of a single right subclavian artery from the aortic arch and definitive repair.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Sears-Rogan, Pamela; Young, Richard S; Kanda, Louis T; Ellis, Jennifer L

    2006-01-01

    Blunt injury to the right subclavian artery is a rare complication of severe deceleration trauma often associated with significant morbidity and mortality. We describe an atypical presentation in a patient who sustained a traumatic avulsion of his right subclavian artery arising off the aortic arch. An interposition graft was used to restore the continuity of the artery to the ascending thoracic aorta.

  8. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis.

    Science.gov (United States)

    Olthof, Dominique C; Joosse, Pieter; Bossuyt, Patrick M M; de Rooij, Philippe P; Leenen, Loek P H; Wendt, Klaus W; Bloemers, Frank W; Goslings, J Carel

    2016-05-01

    Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE with historical controls. The aim of this study was to investigate whether SAE improves success rate compared to observation alone in contemporaneous patients with blunt splenic injury. We included adult patients with blunt splenic injury admitted to five Level 1 Trauma Centers between January 2009 and December 2012 and selected for NOM. Successful treatment was defined as splenic salvage and no splenic re-intervention. We calculated propensity scores, expressing the probability of undergoing SAE, using multivariable logistic regression and created five strata based on the quintiles of the propensity score distribution. A weighted relative risk (RR) was calculated across strata to express the chances of success with SAE. Two hundred and six patients were included in the study. Treatment was successful in 180 patients: 134/146 (92 %) patients treated with observation and 48/57 (84 %) patients treated with SAE. The weighted RR for success with SAE was 1.17 (0.94-1.45); for complications, the weighted RR was 0.71 (0.41-1.22). The mean number of transfused blood products was 4.4 (SD 9.9) in the observation group versus 9.1 (SD 17.2) in the SAE group. After correction for confounders with propensity score stratification technique, there was no significant difference between embolization and observation alone with regard to successful treatment in patients with blunt splenic injury after trauma.

  9. Delayed splenic vascular injury after nonoperative management of blunt splenic trauma.

    Science.gov (United States)

    Furlan, Alessandro; Tublin, Mitchell E; Rees, Mitchell A; Nicholas, Dederia H; Sperry, Jason L; Alarcon, Louis H

    2017-05-01

    Delayed splenic vascular injury (DSVI) is traditionally considered a rare, often clinically occult, harbinger of splenic rupture in patients with splenic trauma that are managed conservatively. The purpose of our study was to assess the incidence of DSVI and associated features in patients admitted with blunt splenic trauma and managed nonoperatively. A retrospective analysis was conducted over a 4-y time. Patients admitted with blunt splenic trauma, managed no-operatively and with a follow-up contrast-enhanced computed tomography (CT) scan study during admission were included. The CT scans were reviewed for American Association for the Surgery of Trauma splenic injury score, amount of hemoperitoneum, and presence of DSVI. Logistic regression models were used to investigate the risk factors associated with DSVI. A total of 100 patients (60 men and 40 women) constituted the study group. Follow-up CT scan demonstrated a 23% incidence of DSVI. Splenic artery angiography validated DSVI in 15% of the total patient population. Most DSVIs were detected only on arterial phase CT scan imaging. The American Association for the Surgery of Trauma splenic injury score (odds ratio = 1.73; P = 0.045) and the amount of hemoperitoneum (odds ratio = 1.90; P = 0.023) on admission CT scan were associated with the development of DSVI on follow-up CT scan. DSVI on follow-up CT scan imaging of patients managed nonoperatively after splenic injury is common and associated with splenic injury score assessed on admission CT scan. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Simplified pancreatoduodenectomy for complex blunt pancreaticoduodenal injury

    Directory of Open Access Journals (Sweden)

    FENG Xin-fu

    2013-10-01

    Full Text Available 【Abstract】A 34-year-old man admitted to our department with complex blunt pancreaticoduodenal injury after a car accident. The wall of the first, second, and third portions of the duodenum was extensively lacerated, and the pancreas was longitudinally transected along the superior mesenteric vein-portal vein trunk. The pancreatic head and the uncinate process were devitalized and the distal common bile duct and the proximal main pancreatic duct were completely detached from the Vater ampulla. The length of the stump of distal common bile located at the cut surface of remnant pancreas was approximately 0.6 cm. A simplified Kausch-Whipple’s procedure was performed after debridement of the devitalized pancreatic head and resection of the damaged duodenum in which the stump of distal common bile duct and the pancreatic remnant were embedded into the jejunal loop. Postoperative wound abscess appeared that eventually recovered by conservative treatment. During 16 months follow-up the patient has been stable and healthy. A simplified pancreaticoduodenectomy is a safe alternative for the Whipple procedure in managing complex pancreaticoduodenal injury in a hemodynamically stable patient. Key words: Pancreaticoduodenectomy; Abdominal injuries; Pancreas; Duodenum

  11. Right hepatic vein injury after blunt abdominal trauma in a 12-year-old boy- case report

    International Nuclear Information System (INIS)

    Roik, D.; Konecka, A.; Brzewski, M.; Marcinski, A.; Kaminski, A.; Piotrowska, A.; Jasinska, A.

    2008-01-01

    Blunt abdominal trauma in children is one of the most frequent causes of hospitalization. We present a rare case of traumatic liver injury. A 12-year-old boy was admitted to the Surgery Department after a bicycle fall and handlebar impact injury to the right infracostal area. At admission he was stable, with no abnormalities except for a subcutaneous hepatoma found in the injured area. Abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography (CT) revealed irregular branching laceration of the right superior hepatic segments with extension into the hepatic veins. No active extravasation of contrast material was seen. On the next day, cause of the deterioration of the patient's condition, CT examination was repeated and revealed focal extravasation of contrast material in the portal hilum posterior to the gallbladder. An injury of the right hepatic vein was found on laparotomy. Hepatic vein injury is a rare but very serious complication after blunt liver trauma and it is an indication for surgical treatment. Diagnostic imaging is essential for therapeutic decisions, but its value is sometimes limited.The precise analysis of injury mechanism and localization may be very helpful.CT is currently the modality of choice for the evaluation of blunt liver trauma. If an active bleeding is suspected the delayed scans seem to be recommended. (author)

  12. AN ANALYSIS ON HOLLOW VISCERAL INJURY AND ITS MANAGEMENT FOLLOWING BLUNT TRAUMA ABDOMEN AT A TERTIARY HEALTHCARE CENTRE

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    Niranjan Sahoo

    2017-10-01

    Full Text Available BACKGROUND Trauma is “the neglected disease of modern developing nations.” Hollow viscous injury following blunt trauma to abdomen is not common. The incidence of hollow viscous injuries following abdominal trauma varies from 2 to 15%. The following study was conducted at Department of General Surgery, MKCG Medical College and Hospital, Berhampur, a tertiary care hospital. MATERIALS AND METHODS All the patients admitted to MKCG Medical College and Hospital, Berhampur, with history of blunt trauma to abdomen were examined carefully. Those patients with symptoms and signs suggestive of visceral injury were identified and subjected to xray chest and abdomen erect view and ultrasound abdomen/CT scan. Those with features of pneumoperitoneum are subjected to laparotomy and treated according to location of perforation. Duration of study was from January 2016 to July 2017. RESULTS This study included people of different age groups from 13 to 65 years. Majority of the patients were men (83.5% and most common mode was found to be road traffic accident (69.6%. Most of the patients injured were young and belonged to earning group (81.44%. Most common viscera injured was ileum (37.85% Most common type of injury encountered in our study was isolated perforation and the common surgical procedure was primary closure. CONCLUSION In cases of polytrauma, blunt abdominal trauma contributes significantly to morbidity and mortality. Both the sexes were affected with a male preponderance. The most common mode of blunt trauma was found to be Road Traffic Accident (RTA. Adequate knowledge regarding suspecting intra-abdominal injuries and timely management at tertiary care centre can definitely bring a marked difference in the prognosis of polytrauma patients with history of blunt trauma to abdomen.

  13. Diagnostic and therapeutic value of laparoscopy for small bowel blunt injuries: A case report.

    Science.gov (United States)

    Addeo, Pietro; Calabrese, Daniela Paola

    2011-01-01

    Small bowel injuries after blunt abdominal trauma represent both a diagnostic and a therapeutic challenge. Early diagnosis and prompt treatment are necessary in order to avoid a dangerous diagnostic delay. Laparoscopy can represent a diagnostic and therapeutic tool in patients with uncertain clinical symptoms. We report the case of a 25-year-old man, haemodynamically stable, admitted for acute abdominal pain a few hours after a physical assault. Giving the persistence of the abdominal pain and the presence of free fluids at the computed tomography examination, an exploratory laparoscopy was performed. At the laparoscopic exploration, an isolated small bowel perforation was found, 60 cm distal from the ligament of Treitz. The injury was repaired by laparoscopic suturing and the patient was discharged home at postoperative day 3 after an uneventful postoperative course. Laparoscopy represents a valuable tool for patients with small bowel blunt injuries allowing a timely diagnosis and a prompt treatment.

  14. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  15. Arterial phase CT for the detection of splenic injuries in blunt trauma: would it improve clinical outcomes?

    Science.gov (United States)

    Corwin, Michael T; Fananapazir, Ghaneh; Lamba, Ramit; Salcedo, Edgardo S; Holmes, James F

    2016-01-01

    To determine if the addition of an arterial phase abdominal computed tomography (CT) improves clinical outcomes in patients with blunt splenic injuries. Retrospective review of patients who underwent CT of the abdomen revealing splenic injuries. Clinical management in these patients was determined. Fifty-one of three thousand five hundred twenty-five patients had splenic injuries. Twenty-five patients underwent nonsurgical management, and 3 failed. The theoretical additional arterial phase resulted in a 62% increase in mean effective dose compared to the portal venous phase alone. Routine use of arterial phase CT in blunt trauma patients may not be warranted as there is minimal improvement in outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Limitations of nonoperative management of type IIIb blunt hepatic injuries in hemodynamically stable patients after fluid resuscitation

    International Nuclear Information System (INIS)

    Sekine, Kazuhiko; Kitano, Mitsuhide; Shimizu, Masayuki; Matsumoto, Shokei; Yoshii, Hiroshi; Yamazaki, Motoyasu; Aikawa, Naoki

    2007-01-01

    Nonoperative management (NOM) of hepatic injuries caused by blunt trauma in hemodynamically stable patients is widely accepted, but the feasibility of NOM for severe hepatic injuries has not been fully evaluated. Among all patients with blunt severe hepatic injury (type IIIb) admitted to Saiseikai Kanagawa-ken Hospital and Keio University Hospital from 1988 to 2004, those who had been hemodynamically stable after fluid resuscitation at the emergency department were initially managed nonoperatively. We reviewed demographic, physiological, and laboratory data; computed tomography (CT) findings; 80-day cumulative laparotomy rate; and complications. The anatomical severity of the hepatic injuries was evaluated based on the CT findings, such as hepatic vein injuries and area lacerated according to the Couinaud liver segment. In patients who underwent surgery after admission, the surgical indications and operative findings were reviewed. Overall, 34 consecutive patients were enrolled in this study. Five patients underwent surgery, and all of their surgical indications were attributable to liver-related complications after injury. The indication for surgery was hemodynamic instability in 3 patients with hepatic vein injures in the early phase (<15 hours after estrogen receptor (ER) arrival) and intra-abdominal septic complications in 2 patients in the late phase (hospital days 14 and 64). The cumulative 80-day laparotomy rate in the early phase was significantly higher (p<0.0001) in the patients suspected of having hepatic vein injury, and in the late phase it was higher (p=0.002) in those with injuries in 4 or more segments of hepatic injuries. For the successful NOM of blunt hepatic injury type IIIb in patients who are hemodynamically stable after fluid resuscitation, a strong suspicion of concurrent hepatic vein injury is critical in the early phase, and laceration in 4 or more segments should be noted in the late phase. (author)

  17. Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

    Science.gov (United States)

    Kremer, B.; Lloyd, D. M.; Meyer-Pannwitt, U.

    1993-01-01

    Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries. PMID:8489966

  18. An unusual case of a serious blunt injury of the eye

    Directory of Open Access Journals (Sweden)

    Jovanović Miloš

    2009-01-01

    Full Text Available Introduction. Optic nerve avulsion is a serious injury of the eye. The objective of the paper was to present the peculiarity of the eye injury caused by a penetrating orbital wound with foreign body being retained in the orbit. Case report. A 15-year-old boy who sustained injury by chain link is presented. While he was turning the chain round in his hand, the last link broke off, piercing the lower lid, penetrated the left orbital cavity and remained behind the eyeball at the top of orbit. While passing towards the top of the orbit, the foreign body caused a blunt injury of the eyeball and avulsion of the ocular nerve. The accurate localization of the foreign body was verified by X-ray and CT imaging. The foreign body was removed through the entry wound. The eye injury resulted in amaurosis. Conclusion. This injury was one of those that could have been prevented.

  19. Intrauterine and lactation exposure to fluoxetine blunted in the offspring the aortic adaptive response induced by acute restraint stress.

    Science.gov (United States)

    Marques, Bruno V D; Higashi, Carolina M; da S Novi, Daniella R B; Zanluqui, Nagela G; Gregório, Thais F; Pinge-Filho, Phileno; Gerardin, Daniela C C; Pelosi, Gislaine G; Moreira, Estefânia G; Ceravolo, Graziela S

    2017-10-15

    Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants to women during pregnancy. Maternal treatment with fluoxetine can expose fetuses and neonates to higher levels of serotonin that plays a role in stress response. Thus, the aim of the study was to evaluate whether maternal treatment with fluoxetine interferes with aorta reactivity of adult male offspring after acute restraint stress. Wistar rats were gavaged with fluoxetine (5mg/kg/day) or water (control) during pregnancy and lactation. The experiments were performed in adult male offspring, treated or not with reserpine (4mg/Kg, ip, 28h before the experimental protocol). Fluoxetine and control rats were submitted to a single restraint stress session (ST) for 1h. Curves to phenylephrine were performed in thoracic aorta with endothelium. Aortic nitric oxide (NOx) were evaluated by the Griess method. The aortic contraction induced by phenylephrine was similar between control and fluoxetine rats. The acute stress reduced contraction in aorta of control ST compared to control, and L-NAME equaled this response. In fluoxetine rats, ST did not change the aortic constriction. Reserpine treatment restored the vasoconstriction in control ST, but did not interfere with aortic contraction in control, fluoxetine or fluoxetine ST. The NOx concentration was higher in aortas from control ST than control rats, and reserpine reduced NOx levels of control ST. The NOx concentration was similar between fluoxetine and fluoxetine ST rats, treated or not with reserpine. In conclusion, maternal treatment with fluoxetine blunted acute restraint stress-induced NO system activation and aortic adaptation in adult offspring. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Detection of metal residues on bone using SEM-EDS. Part I: Blunt force injury.

    Science.gov (United States)

    Pechníková, Markéta; Porta, Davide; Mazzarelli, Debora; Rizzi, Agostino; Drozdová, Eva; Gibelli, Daniele; Cattaneo, Cristina

    2012-11-30

    Previous studies have indicated that metal particles remain on bone after sharp force injury or gunshot and that their detection by scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDS) could greatly help in tool identification. However, the presence of metal particles on bone surfaces in the context of blunt force trauma has never been assessed experimentally. For this reason the present paper represents an experimental study of the behaviour of metal residues on bone following blunt force injury. Ten fresh sub-adult bovine metatarsal bones were manually cleaned of soft tissues. They were then struck by metal bars (copper, iron or aluminium) on the external surface of the mid-diaphysis. All blunt metal instruments used in this study left a sign in the form of single particles, a smear or a powder-like deposit on the bone surface. The residues of all three metal implements were detected on the bone surface, 0.3-10 mm from the fracture border. The presence of metal particles was confirmed in all samples struck with iron and copper and in two of six aluminium samples; no particles were detected on the negative control. Chemical composition of residues highly corresponded with the composition of applied bars. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Blunt trauma pancreatic duct injury managed by non-operative technique, a case study and literature review

    Directory of Open Access Journals (Sweden)

    A. Zala

    2015-02-01

    Full Text Available We describe the case of a 15 year old boy who presented with generalised abdominal pain following a seemingly minor collision at weekend soccer. Investigation revealed a grade IV pancreatic injury that was subsequently managed with pancreatic stent insertion by endoscopic retrograde cholangiopancreatography (ERCP and total parenteral nutrition (TPN prior to recommencing low fat diet 10 days post-injury. Keywords: Trauma, Blunt injury, Pancreas, Non-operative

  2. [Delayed perforation of the cecum and sigmoid colon after blunt abdominal trauma in a patient with multiple injuries].

    Science.gov (United States)

    Miranda, E; Arroyo, A; Ronda, J M; Muñoz, J L; Alonso, C; Martínez-Peñuelas, F; Martí-Viaño, J L

    2007-01-01

    Blunt abdominal trauma can damage the intestinal vasculature and may occasionally lead to delayed intestinal perforation, associated with a combined rate of morbidity and mortality of 25%. The diagnosis of such complications is hindered by sedation in critical patients, however, and morbimortality in this population is therefore higher. We report the case of a man with multiple injuries admitted to the intensive care unit, where delayed perforations of the sigmoid colon and cecum were diagnosed. The management of blunt abdominal trauma is reviewed and the possible causes, diagnostic approaches, and treatment options for colon injuries are discussed.

  3. Traumatic pulmonary pseudocysts after blunt chest trauma: Prevalence, mechanisms of injury, and computed tomography findings.

    Science.gov (United States)

    Cho, Hyun Jin; Jeon, Yang Bin; Ma, Dae Sung; Lee, Jung Nam; Chung, Min

    2015-09-01

    Traumatic pulmonary pseudocyst (TPP) is a rare complication of blunt chest trauma and closely related with severe injury. However, it has been poorly documented. We present a retrospective review of TPP cases treated at our hospital. The medical records and chest computed tomography scans of patients with TPP treated from January 2010 to December 2013 were retrospectively studied. A total of 978 patients underwent chest computed tomography for blunt chest trauma during the study period, and 81 (8.3%) had a total of 150 TPPs. The most common mechanism of injury was being struck by a motorized vehicle (n = 25, 30.9%). The mean (SD) Injury Severity Score (ISS) of the 81 patients was 33.2 (11.4). The prevalence of TPP was higher in younger patients (p = 0.011), but the total number of fractured ribs was significantly lower (p = 0.001). In a subgroup analysis performed according to pseudocyst location, the intraparenchymal group had more severe injuries than the subpleural group (ISS, 23.3 vs. 32.4, p chest Abbreviated Injury Scale [AIS] score, 3.4 vs. 4.0, p chest trauma was 8.3% and was higher in those struck by a vehicle and younger patients. Intraparenchymal pseudocyst was found to be related to more severe injuries. TPP was a self-limiting condition that does not require specific treatment. Prognostic/epidemiologic study, level IV.

  4. Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma.

    Science.gov (United States)

    El-Menyar, Ayman; Abdelrahman, Husham; Al-Hassani, Ammar; Peralta, Ruben; AbdelAziz, Hiba; Latifi, Rifat; Al-Thani, Hassan

    2017-11-01

    We aimed to describe the pattern of solid organ injuries (SOIs) and analyze the characteristics, management and outcomes based on the multiplicity of SOIs. A retrospective study in a Level 1 trauma center was conducted and included patients admitted with blunt abdominal trauma between 2011 and 2014. Data were analyzed and compared for patients with single versus multiple SOIs. A total of 504 patients with SOIs were identified with a mean age of 28 ± 13 years. The most frequently injured organ was liver (45%) followed by spleen (30%) and kidney (18%). One-fifth of patients had multiple SOIs, of that 87% had two injured organs. Patients with multiple SOIs had higher frequency of head injury and injury severity scores (p hepatic injuries (13%) than the other SOIs. SOIs represent one-tenth of trauma admissions in Qatar. Although liver was the most frequently injured organ, the rate of mortality was higher in pancreatic injury. Patients with multiple SOIs had higher morbidity which required frequent operative management. Further prospective studies are needed to develop management algorithm based on the multiplicity of SOIs.

  5. Independent predictors of morbidity and mortality in blunt colon trauma.

    Science.gov (United States)

    Ricciardi, R; Paterson, C A; Islam, S; Sweeney, W B; Baker, S P; Counihan, T C

    2004-01-01

    We sought to determine the impact of (1) grade of the colon injury, (2) the formation of an ostomy, and (3) associated injuries on outcomes such as morbidity and mortality after blunt colon injuries. We retrospectively reviewed 16,814 cases of blunt abdominal trauma. Patients with colonic injuries were selected and charts reviewed for demographic, clinical, and outcomes data. Injuries were grouped by the Colon Injury Scale (grades I-V). Independent risk factors of morbidity included spine and lung injuries, as well as increased age. A higher grade of colon injury trended toward a significant association with intra-abdominal complications. Independent risk factors of mortality included liver, heart, and lung injuries, as well as intracerebral blood and female gender. The grade of colon injury, the formation of an ostomy, and management of the colon trauma did not independently predict increased intra-abdominal complications, morbidity, or mortality. These results indicate that patients afflicted with blunt colon trauma experience a high rate of morbidity and mortality from associated injuries and or increased age. Treatment regimens directed at these factors will be most helpful in reducing the high morbidity and mortality after blunt colon trauma. Factors such as ostomy formation and management strategy are not associated with increased morbidity or mortality after blunt colon trauma.

  6. Acute alcohol intoxication, diffuse axonal injury and intraventricular bleeding in patients with isolated blunt traumatic brain injury.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Shinoda, Masaki; Fujii, Motoharu; Takahashi, Osamu; Murakata, Atsushi; Yamamoto, Daisuke

    2013-01-01

    The influence of blood alcohol level (BAL) on outcome remains unclear. This study investigated the relationships between BAL, type and number of diffuse axonal injury (DAI), intraventricular bleeding (IVB) and 6-month outcome. This study reviewed 419 patients with isolated blunt traumatic brain injury. First, it compared clinical and radiological characteristics between patients with good recovery and disability. Second, it compared BAL among DAI lesions. Third, it evaluated the correlation between the BAL and severity of IVB, number of DAI and corpus callosum injury lesions. Regardless of BAL, older age, male gender, severe Glasgow Coma Scale score (injury lesions. Acute alcohol intoxication was not associated with type and number of DAI lesion, IVB and disability. This study suggested that a specific type of traumatic lesion, specifically lesion on genu of corpus callosum and IVB, might be more vital for outcome.

  7. Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury

    Directory of Open Access Journals (Sweden)

    Yun Mi Kim

    2011-02-01

    Full Text Available Traumatic ventricular septal defect (VSD resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

  8. Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma.

    Science.gov (United States)

    Noh, Dongsub; Lee, Chan-Kyu; Hwang, Jung Joo; Cho, Hyun Min

    2018-04-01

    Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

  9. Safety and efficacy of pharmacologic thromboprophylaxis following blunt head injury: a systematic review.

    Science.gov (United States)

    Reeves, Fairleigh; Batty, Lachlan; Pitt, Veronica; Chau, Marisa; Pattuwage, Loyal; Gruen, Russell L

    2013-10-01

    Patients with blunt head injury are at high risk of venous thromboembolism. However, pharmacologic thromboprophylaxis (PTP) may cause progression of intracranial hemorrhage, and clinicians must often weigh up the risks and benefits. This review aimed to determine whether adding PTP to mechanical prophylaxis confers net benefit or harm and the optimal timing, dose, and agent for PTP in patients with blunt head injury. We searched MEDLINE, EMBASE, The Cochrane Library Central Register of Controlled Trials (CENTRAL), and www.clinicaltrials.gov on April 24, 2013, to identify controlled studies and ongoing trials that assessed the efficacy or safety of thromboprophylaxis interventions in the early management of head-injured patients. Studies were classified based on types of interventions and comparisons, and the quality of included studies was assessed using Cochrane risk-of-bias tool and the Newcastle-Ottawa Quality Assessment Scale. We intended to undertake a meta-analysis if studies were sufficiently similar. Sixteen studies met the inclusion criteria, including four randomized controlled trials. At least two randomized controlled trials were at high risk of bias owing to inadequate randomization and concealment of allocation, and observational studies were potentially confounded by substantial differences between comparison groups. Heterogeneity of included studies precluded meta-analysis. Results were mixed, with some studies supporting and others refuting addition of PTP to mechanical interventions. Little evidence was available about dose or choice of agent. The safety and efficacy of early PTP in patients without early progression of hemorrhage is unclear. There is currently insufficient evidence to guide thromboprophylaxis in patients with blunt head injury. Standardized definitions and outcome measurements would facilitate comparison of outcomes across future studies. Studies in mixed populations should report head-injured specific subgroup data. Future

  10. Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations.

    Science.gov (United States)

    McNamara, Caitlin; Mironova, Irina; Lehman, Erik; Olympia, Robert P

    2017-06-01

    Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. We performed a retrospective chart review of pediatric patients (trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma : A Propensity Score Analysis

    NARCIS (Netherlands)

    Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

    Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

  12. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis

    NARCIS (Netherlands)

    Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

    2016-01-01

    Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

  13. Observation Versus Embolization in Patients with Blunt Splenic Injury after Trauma: A Propensity Score Analysis

    NARCIS (Netherlands)

    D.C. Olthof; P. Joosse (Pieter); P.M.M. Bossuyt (Patrick); P.P. de Rooij (Philippe); L.P.H. Leenen (Luke); K.W. Wendt (Klaus); F.W. Bloemers (Frank); J.C. Goslings (Carel)

    2016-01-01

    textabstractBackground: Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE

  14. Significance of magnetic resonance imaging in the diagnosis of vertebral artery injury associated with blunt cervical spine trauma

    International Nuclear Information System (INIS)

    Yokota, Hiroyuki; Atsumi, Takahiro; Araki, Takashi; Fuse, Akira; Sato, Hidetaka; Kawai, Makoto; Yamamoto, Yasuhiro

    2007-01-01

    Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. All of the patients had documented cervical spine fractures and dislocations. In three patients, the diagnosis of complete occlusion of the vertebral artery was made on the basis of MRI and digital subtraction angiography (DSA). In the other patients, mural injuries of the vertebral artery were demonstrated with DSA. These 11 patients presented with acute, nonspecific changes in neurological status. Two had infarctions of the cerebellum and brainstem. None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma. (author)

  15. Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury.

    Science.gov (United States)

    Wang, Anthony C; Charters, Michael A; Thawani, Jayesh P; Than, Khoi D; Sullivan, Stephen E; Graziano, Gregory P

    2012-06-01

    Digital subtraction angiography (DSA) is the gold standard for radiographic diagnosis of blunt cerebrovascular injury (BCVI), but use of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) has increased dramatically in BCVI screening. This study explores the utility, effectiveness, and cost of noninvasive CTA and MRA screening for BCVI. Medical records of 2,025 consecutive adults evaluated for acute blunt neck trauma and BCVI were reviewed retrospectively. The incidence of BCVI, level(s) of cervical injury, involvement of foramina transversaria and internal carotid canals, presence of bony dislocation or subluxation, and subsequent treatment received were assessed. Asymptomatic patients were analyzed based on fracture and injury patterns. The cost effectiveness of CTA compared with DSA and the effects of CTA sensitivity and screening yield were determined. Of reviewed patients, 196 received CTA or MRA. Thirty-eight patients (19.4%) were diagnosed with BCVI. Screening yield in patients symptomatic at presentation was 48.8%. Large-vessel internal carotid, vertebral, anterior spinal, and basilar artery occlusion were associated with a positive screen, as were concurrent stroke and spinal cord injury (p tool for BCVI screening. Symptomatic presentation was the best predictor of BCVI. Significant cost savings were realized using CTA rather than DSA, with similar effectiveness and patient outcomes. Diagnostic study, level III; economic analysis, level IV. Copyright © 2012 by Lippincott Williams & Wilkins

  16. Missed Gastric Injuries in Blunt Abdominal Trauma; Case report with review of literature

    Directory of Open Access Journals (Sweden)

    Ahmed A. Naiem

    2016-11-01

    Full Text Available Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate.

  17. Computed tomography has an important role in hollow viscus and mesenteric injuries after blunt abdominal trauma.

    Science.gov (United States)

    Tan, Ker-Kan; Liu, Jody Zhiyang; Go, Tsung-Shyen; Vijayan, Appasamy; Chiu, Ming-Terk

    2010-05-01

    Computed tomographic (CT) scans have become invaluable in the management of patients with blunt abdominal trauma. No clear consensus exists on its role in hollow viscus injuries (HVI) and mesenteric injuries (MI). The aim of this study was to correlate operative findings of HVI and MI to findings on pre-operative CT. All patients treated for blunt abdominal trauma at Tan Tock Seng Hospital from January 2003 to January 2008 were reviewed. CT scans were only performed if the patients were haemodynamically stable and indicated. All scans were performed with intravenous contrast using a 4-slice CT scanner from 2003 to December 2004 and a 64-slice CT scanner from January 2005 onwards. All cases with documented HVI/MI that underwent both CT scans and exploratory laparotomy were analysed. Thirty-one patients formed the study group, with median age of 40 (range, 22-65) years and a significant male (83.9%) predominance. Vehicular-related incidents accounted for 67.7% of the injuries and the median Injury Severity Score (ISS) was 13 (4-50). The 2 commonest findings on CT scans were extra-luminal gas (35.5%) and free fluid without significant solid organ injuries (93.5%). During exploratory laparotomy, perforation of hollow viscus (51.6%) occurred more frequently than suspected from the initial CT findings of extra-luminal gas. Other notable findings included haemoperitoneum (64.5%), and mesenteric tears (67.7%). None of our patients with HVI and MI had a normal pre-operative CT scan. Our study suggests that patients with surgically confirmed HVI and MI found at laparotomy were very likely to have an abnormal pre-operative CT scan. Unexplained free fluid was a very common finding in blunt HVI/MI and is one major indication to consider exploratory laparotomy. (c) 2009 Elsevier Ltd. All rights reserved.

  18. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  19. Consensus strategies for the nonoperative management of patients with blunt splenic injury: A Delphi study

    NARCIS (Netherlands)

    Olthof, Dominique C.; van der Vlies, Cornelius H.; Joosse, Pieter; van Delden, Otto M.; Jurkovich, Gregory J.; Goslings, J. C.; Angle, J. F.; Chakraverty, S.; Coimbra, R.; Demetriades, D.; Denys, A.; Duchesne, J. C.; Fabian, T. C.; Feliciano, D. V.; Fingerhut, A.; Gaarder, C.; Haan, J. M.; Hanks, S. E.; Hauser, C. J.; Heuer, M.; Hoffer, E. K.; Hoyt, D. B.; Ivatury, R. R.; Jurkovich, G. J.; Leenen, L. P.; Leppaniemi, A.; Maegele, M.; Michel, L. A.; Moore, E. E.; Peitzman, A. B.; Reekers, J. A.; Scalea, T. M.; Velmahos, G. C.; de Waele, J. J.; Wisner, D. H.

    2013-01-01

    BACKGROUND: Nonoperative management is the standard of care in hemodynamically stable patients with blunt splenic injury. However, a number of issues regarding the management of these patients are still unresolved. The aim of this study was to reach consensus among experts concerning optimal

  20. Evaluation and Management of Blunt Solid Organ Trauma.

    Science.gov (United States)

    Martin, Jonathan G; Shah, Jay; Robinson, Craig; Dariushnia, Sean

    2017-12-01

    Trauma is a leading cause of death in patients under the age of 45 and generally associated with a high kinetic energy event such as a motor vehicle accident or fall from extreme elevations. Blunt trauma can affect every organ system and major vascular structure with potentially devastating effect. When we consider abdominal solid organ injury from blunt trauma, we usually think of the liver, spleen, and kidneys. However, all of the abdominal organs, including the pancreas and adrenal glands, may be involved. Blunt hepatic trauma is more commonly associated with venous bleeding rather than arterial injury. Stable venous injury is often managed conservatively; when the patient is hemodynamically unstable from venous hepatic injury, operative management should be first-line therapy. When the injury is arterial, endovascular therapy should be initiated. Blunt trauma to the spleen is the most common cause of traumatic injury to the spleen. Management is controversial. In our institution unstable patients are taken to the operating room, and stable patients with Grades IV-V injuries and patients with active arterial injury are taken for endovascular treatment. Renal injuries are less common, and evidence of arterial injury such as active extravasation or pseudoaneurysm is warranted before endovascular therapy. Pancreatic trauma is uncommon and usually secondary to steering wheel/handlebar mechanism injuries. Adrenal injuries are rare in the absence of megatrauma or underlying adrenal abnormality. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Increasing number of fractured ribs is not predictive of the severity of splenic injury following blunt trauma: an analysis of a National Trauma Registry database.

    Science.gov (United States)

    Boris, Kessel; Forat, Swaid; Itamar, Ashkenazi; Oded, Olsha; Kobi, Peleg; Adi, Givon; Igor, Jeroukhimov; Ricardo, Alfici

    2014-05-01

    Association between rib fractures and incidence of abdominal solid organs injury is well described. However, the correlation between the number of fractured ribs and severity of splenic injury is not clear. The purpose of this study was to assess whether an increasing number of rib fractures predicts the severity of splenic injury in blunt trauma patients. A retrospective cohort study involving blunt trauma patients with concomitant splenic injuries and rib fractures, between the years 1998 and 2012, registered in the Israeli National Trauma Registry. Of 321,618 patients with blunt mechanism of trauma, 57,130 had torso injuries, and of these 14,651 patients sustained rib fractures, and 3691 patients suffered from splenic injury. Concomitant splenic injury occurred in 1326 of the patients with rib fractures (9.1%), as compared to 2365 patients sustaining splenic injury without rib fractures (5.6%). The incidence of splenic injury among patients sustaining 5 or more rib fractures was significantly higher compared to patients suffering from 1 to 4 rib fractures. Among patients with splenic injury, the tendency to sustain associated rib fractures increased steadily with age. Patients with concomitant rib fractures had higher Injury Severity Score (ISS), but similar mortality rates, compared to patients with splenic injury without rib fractures. Among patients with concomitant rib fractures and splenic injury, there was no relation between the number of fractured ribs and the severity of splenic injury, neither as a whole group, nor after stratification according to the mechanism of injury. Although the presence of rib fractures increases the probability of splenic injury in blunt torso trauma, there is no relation between the number of fractured ribs and splenic injury severity. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement.

    Science.gov (United States)

    Zaleska-Kociecka, Marta; Skrobisz, Anna; Wojtkowska, Izabela; Grabowski, Maciej; Dabrowski, Maciej; Kusmierski, Krzysztof; Piotrowska, Katarzyna; Imiela, Jacek; Stepinska, Janina

    2017-10-01

    Acute kidney injury complicating both transcatheter and surgical aortic valve replacement is associated with high rates of morbidity and mortality. The aim of this study was to investigate the role of serum beta 2 (β2) microglobulin, cystatin C and neutrophil gelatinase-associated lipocalin levels in detecting periprocedural acute kidney injury. Eighty consecutive patients who were 70 years of age or older and who were having surgical (n = 40) or transcatheter (n = 40) aortic valve replacement were recruited in a prospective study. The biomarkers were tested before the procedure, 6 times afterwards, at discharge and at a 6-month follow-up visit. The baseline β2-microglobulin level was the strongest predictor of acute kidney injury as a complication of transcatheter aortic valve replacement [odds ratio (OR) 5.277, P = 0.009]. Its level 24 h after the procedure reached the largest area under the curve (AUC) of 0.880 (P regression analysis, the levels of β2-microglobulin and cystatin C 24 h after the procedure were significantly associated with acute kidney injury after transcatheter valve replacement (OR 38.15, P = 0.044; OR 1782, P = 0.019, respectively). In the surgical aortic valve replacement group, the highest AUCs belonged to β2-microglobulin and cystatin C at 24 h (AUC = 0.808, P = 0.003 and AUC = 0.854, P = 0.001, respectively). Their higher values were also associated with acute kidney injury (OR 17.2, P = 0.018; OR 965.6, P = 0.02, respectively). A persistent increase in the postoperative levels of β2-microglobulin following acute kidney injury was associated with the progression of chronic kidney disease for 6 months after both transcatheter (OR 6.56, P = 0.030) and surgical (OR 7.67, P = 0.03) aortic valve replacements. Serum β2-microglobulin had the potential to predict acute kidney injury complicating transcatheter valve replacement and to diagnose it as early as 24 h after both the

  3. Computed tomography evaluation of traumatic rupture of the thoracic aorta: an outcome study

    International Nuclear Information System (INIS)

    Ellis, J.D.; Mayo, J.R.

    2007-01-01

    To assess the long-term outcome of blunt trauma patients with suspected thoracic aortic or great vessel injury that was evaluated with contrast-enhanced chest computed tomography (CT). We studied the outcome of 278 consecutive patients who received contrast enhanced CT for blunt chest trauma with computerized searches of the regional trauma database, hospital medical records, universal government medical coverage plan billing records, and regional vital statistics databases. Data retrieved included patient demographics, mechanism of injury, status of the aorta and proximal great vessels at contrast-enhanced CT, hospital discharge diagnoses, and outpatient procedural billings with specific attention to aortic or great vessel injury. Median follow-up was 615 days following the traumatic event. Six subjects demonstrated direct signs of aortic or proximal great vessel injury on contrast-enhanced chest CT, as follows: aortic pseudoaneurysm and intimal flap (n = 4), carotid artery dissection (n = 1), and aortic dissection (n 1). All were surgically treated, except the patient with aortic dissection, who was treated medically. In the other subjects, contrast-enhanced CT was negative (n = 230) or showed isolated mediastinal hematoma (n = 42). The computerized searches of the medical databases showed that none of these 272 subjects had procedures for, or died from, aortic or great vessel injury during the follow-up period. Computerized searches of medical databases found no evidence of missed thoracic aortic or proximal great vessel injury in blunt trauma patients who were evaluated with contrast-enhanced chest CT. (author)

  4. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial.

    Science.gov (United States)

    Zarzaur, Ben L; Dunn, Julie A; Leininger, Brian; Lauerman, Margaret; Shanmuganathan, Kathirkamanthan; Kaups, Krista; Zamary, Kirellos; Hartwell, Jennifer L; Bhakta, Ankur; Myers, John; Gordy, Stephanie; Todd, Samuel R; Claridge, Jeffrey A; Teicher, Erik; Sperry, Jason; Privette, Alicia; Allawi, Ahmed; Burlew, Clay Cothren; Maung, Adrian A; Davis, Kimberly A; Cogbill, Thomas; Bonne, Stephanie; Livingston, David H; Coimbra, Raul; Kozar, Rosemary A

    2017-12-01

    Following blunt splenic injury, there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with pseudoaneurysm or blush. Data were collected on adult (aged ≥18 years) patients with blunt splenic injury and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. Two hundred patients with a vascular abnormality on computed tomography scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining patients, 59% underwent angiography and embolization (ANGIO), and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO, and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO, and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 computed tomography scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist's interpretation was 56.3%. Based on expert review, the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a nonbleeding vascular injury. In this series, the vast majority of patients are managed with ANGIO and usually embolization, whereas splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of nonoperative failure, no matter the strategy used for management. This group may warrant closer observation or

  5. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    International Nuclear Information System (INIS)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo

    2000-01-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or 99m Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of radionuclide in

  6. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    Energy Technology Data Exchange (ETDEWEB)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo [Wonju Christian Hospital, College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    2000-07-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or {sup 99m}Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of

  7. Traumatic injuries: imaging of thoracic injuries

    International Nuclear Information System (INIS)

    Gavelli, G.; Canini, R.; Bertaccini, P.; Battista, G.; Bna, C.; Fattori, R.

    2002-01-01

    Chest trauma is one of the most important causes of death, in particular in individuals under the age of 40 years. The mortality rate for chest trauma, often related to motor vehicle accidents, is approximately 15.5%; it increases dramatically to 77% with associated shock and head injury (Glasgow scores of 3-4). The accurate diagnosis of pathologies consequent to blunt chest trauma depends on a complete knowledge of the different clinical and radiological manifestations. The first diagnostic approach is classically based on chest X-ray often carried out on supine position at the hospital admission. A CT study must then be performed in all chest trauma patients in whom there is even the smallest diagnostic doubt on plain film. In particular, spiral CT (SCT) assumes a fundamental role in the demonstration of mediastinal hemorrhage and direct signs of aortic lesions. At present, SCT is routinely part of a diagnostic evaluation which also includes scans of the brain and the abdomen in polytraumatized patients. Magnetic resonance is the ideal method for visualizing diaphragmatic lesions. Furthermore, recent reports have demonstrated the high diagnostic value of MR in evaluating aortic injuries. The purpose of this article is to review the most common radiological patterns related to chest trauma. (orig.)

  8. [The forensic medical assessment of the results of a study of laryngeal injuries in blunt trauma to the neck].

    Science.gov (United States)

    Svetlakov, A V; Korenev, S A; Akishin, A N

    1997-01-01

    Presents the methodological principles and succession of examination of the basic formations of the larynx in cases with blunt injuries of the neck. Describes variants of anatomic structure of the sublingual bone and laryngeal cartilages influencing the morphology of injuries thereof. Offers differential diagnostic criteria of various mechanisms of fractures of the basic formations and recommendations on medical criminological assessment of laryngeal injuries.

  9. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

    International Nuclear Information System (INIS)

    Becker, C.D.; Terrier, F.; Mentha, G.

    1998-01-01

    Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.)

  10. One Stage Emergency Pancreatoduodenectomy for Isolated Injury to Pancreatic Head Following Blunt Abdominal Trauma: Case Report and Review of Literature

    OpenAIRE

    Sumanta Kumar Ghosh

    2013-01-01

    Major pancreatic injury following blunt abdominal trauma by itself is a relatively rare occurrence, and in vast majority of cases (95%) it is associated with injury to adjacent major vessels and organs; thus making isolated major pancreatic injury even rarer. While most pancreatic injuries are managed by simple measures like debridement and drainage, complex proximal injury poses surgical challenge regarding surgical skill and judgement. Disproportionate approach at any stage of management ...

  11. Role of computed tomography in blunt chest trauma

    International Nuclear Information System (INIS)

    Cho, Jae Hyun; Kim, Sang Jin; Lee, Chan Wha; Kim, Hae Kyoon

    1994-01-01

    In patient with blunt trauma of chest, supine AP x-ray cannot differentiate the lung contusion, laceration, atelectasis, and hemothorax definitely. Therefore, computed tomographic evaluation is needed for accurate evaluation of the injuries. In our knowledge, there are few reports about CT findings of blunt chest trauma, in our country, therefore we tried to fluid the characteristic CT findings in patients with blunt trauma. We analyzed the plain x-ray and CT image of 4 patients with blunt chest trauma. Location and morphology of lung parenchymal contusion and laceration, hemopneumothorax, chest wall injuries and location of chest tube. Lung parenchymal contusion was noted in 53 segments., of 16 patients infiltration(n=27 segment), and multiple nodular pattern was noted in 15 segment, pattern of consolidation along the lung periphery was seen in 11 segment. Laceration was noted in 18 lesion and most commonly located in paravertebral area(b=8). CT scan of chest in patient with blunt chest trauma, provides accurate information of the pattern of injuries, and localization, therefore, should be performed as possible

  12. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: A systematic review

    NARCIS (Netherlands)

    Olthof, Dominique C.; Joosse, Pieter; van der Vlies, Cornelis H.; de Haan, Rob J.; Goslings, J. Carel

    2013-01-01

    BACKGROUND: Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or

  13. Role of Postmortem Multislice Computed Tomography Scan in Close Blunt Head Injury

    OpenAIRE

    Sidipratomo, Prijo; Prija, Trijono Karmawan Sukana; Murtala, Bachtiar; Purwadianto, Agus; Lawrence, Gatot Susilo

    2014-01-01

    BACKGROUND: Conventional autopsy in Indonesia is not well accepted as it is contrary to religion and culture. New radiological imaging method such as multislice computed tomography (MSCT) scan has potential to be a diagnostic tool in forensic pathology. The purpose of this study is to determine the ability of MSCT scan in finding abnormalities in close blunt head injury compared with autopsy. METHODS: This study used descriptive qualitative method. Postmortem cases in Department of Forensic M...

  14. Blunt splenic injuries in the adolescent trauma population: the role of angiography and embolization.

    Science.gov (United States)

    Mayglothling, Julie A; Haan, James M; Scalea, Thomas M

    2011-07-01

    Splenic artery embolization (SAE) improves non-operative splenic salvage rates in adults, but its utility and safety in the pediatric population is less well defined. Because adolescent trauma patients are often triaged to adult trauma centers, we were interested in evaluating SAE in this particular population. We hypothesize that angiography and embolization is a safe and effective adjunct to non-operative management in the adolescent population. A retrospective review of all patients aged 13-17 years admitted to our Level I Trauma Center with blunt splenic injury from 1997-2005 was performed. We reviewed patient demographics, operative reports, admission, and follow-up abdominal computed tomography (ACT) results, angiographic reports, and patient outcomes. A total of 97 patients were reviewed. Eighteen patients underwent immediate surgery, and 79 of the remaining patients had planned non-operative management. Of those participating in non-operative management, 35/79 (44%) were initially observed and 44/79 (56%) underwent initial angiography, 23/44 having embolization. Patients in the embolization group had an overall high grade of injury (American Association for the Surgery of Trauma mean grade 3.3, SD 0.6). The overall splenic salvage rate was 96% (76/79) in the non-operative management group; 100% splenic salvage was seen in the observational group; 100% salvage was also seen in patients with negative angiography, and 87% salvage (20/23) in the splenic artery embolization group. Splenic artery embolization may be a valuable adjunct in adolescent blunt splenic injury, especially in higher grade injuries or with evidence of splenic vascular injury on ACT. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

    NARCIS (Netherlands)

    van der Vlies, C. H.; Hoekstra, J.; Ponsen, K. J.; Reekers, J. A.; van Delden, O. M.; Goslings, J. C.

    2012-01-01

    Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to

  16. Blunt cardiac rupture in a toddler

    Directory of Open Access Journals (Sweden)

    Peep Talving

    2016-08-01

    Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

  17. Treatment for unstable pulmonary sequestration injury in patient with severe blunt trauma: A case report.

    Science.gov (United States)

    Hiraki, Sakiko; Okada, Yohei; Arai, Yusuke; Ishii, Wataru; Iiduka, Ryoji

    2017-08-01

    Pulmonary sequestration is a congenital malformation characterized by nonfunctioning tissue not communicating with the tracheobronchial tree. As the blood pressure in the artery feeding the sequestrated lung tissue is higher than that in the normal pulmonary artery, the risk of massive hemorrhage in pulmonary sequestration is high. We herein present the first case of a severe blunt trauma patient with unstable pulmonary sequestration injury. The mechanism of pulmonary sequestration injury is vastly different than that of injury to normal lung. We suggest that proximal feeding artery embolization should be performed before surgical intervention in patients with massive hemorrhage of pulmonary sequestration due to severe chest trauma.

  18. Knocked by the shuttlecock: twelve sight-threatening blunt-eye injuries in Australian badminton players.

    Science.gov (United States)

    Jao, Kathy K; Atik, Alp; Jamieson, Michael P; Sheales, Mariana P; Lee, Matthew H; Porter, Ashley; Roufas, Athena; Goldberg, Ivan; Zamir, Ehud; White, Andrew; Skalicky, Simon E

    2017-07-01

    Non-penetrating ocular injuries from badminton shuttlecocks can result in severe damage and life-long complications. This case series highlights the morbidity of such injuries, particularly in regard to post-traumatic glaucoma. This is a retrospective case series of 12 patients with shuttlecock-related blunt eye injuries sustained during badminton play without eye protection. By approaching colleagues through conference presentations and networking, the authors have attempted to gather all known cases of shuttlecock ocular injury managed in tertiary ocular emergency departments or private ophthalmological clinics in Victoria and New South Wales, Australia in 2015. This is the first multicentre case series to describe badminton-related ocular injuries in Australia. Our case series demonstrates, in particular, long-term glaucoma-related morbidity for patients over a large age range (16 to 77 years), with one patient requiring ongoing management 26 years following their initial injury. The cases reported further add to the literature promoting awareness of badminton-related ocular injury. We encourage player education and advocacy on badminton-related eye injuries and appropriate use of eye protection to reduce associated morbidity. © 2016 Optometry Australia.

  19. New scoring system for intra-abdominal injury diagnosis after blunt trauma.

    Science.gov (United States)

    Shojaee, Majid; Faridaalaee, Gholamreza; Yousefifard, Mahmoud; Yaseri, Mehdi; Arhami Dolatabadi, Ali; Sabzghabaei, Anita; Malekirastekenari, Ali

    2014-01-01

    An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (scoretool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

  20. Pattern of visceral injuries following blunt abdominal trauma in motor vehicular accidents

    International Nuclear Information System (INIS)

    Khan, J.S.; Iqbal, N.; Gardezi, J.R.

    2006-01-01

    To determine the frequency of various visceral injuries following, high-speed motor vehicle crashes with special reference to frequency of liver injuries, severity and complications. The study included 100 consecutive patients of blunt abdominal trauma. Patients of either gender and age above 12 and below 70 were included in this study. Purposive non-probability sampling was done. Injuries were identified, graded and managed accordingly. The data was then entered into SPSS and descriptive statistical tests were applied. Liver was the most common organ injured (35%), followed by spleen (32 %) and small gut (30 %). In 23 patients, liver was the only organ injured. Most of the liver injuries fell under grade I (42.8%) followed by grade II (28.35%) and grade III (22.85%) and were treated by suture hepatorrhaphy alone in 71.42% cases. The operated cases were mostly complicated by wound infection (33.76%). Overall mortality remained high (12%) and was related to a combination of delays in arriving at a diagnosis due to nonavailability of CT scan and routine use of peritoneal lavage. (author)

  1. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

    1998-05-01

    Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

  2. More than just a urinary catheter — Haemorrhage control by using a Foley catheter in a penetrating aortic root injury

    Directory of Open Access Journals (Sweden)

    Adel Elmoghrabi

    2016-08-01

    Full Text Available The prevalence of great vessel injuries in thoracic trauma is reported at 0.3–10%, predominantly due to a penetrating mechanism. Thoracic aortic injuries, more specifically those within proximity of the aortic root are challenging to manage and unceasing bleeding hampers adequate visualisation for performing repair. We report a case of a 31-year-old male that presented to the emergency department 1 h after sustaining a stab wound injury within proximity of the left upper sternal border. Vital signs were stable on presentation. Physical examination revealed a 1.5 cm laceration in the 3rd intercostal space. Chest X-ray revealed a small left pneumothorax, FAST scan was negative, and CT of the chest revealed left sided haemopneumothorax and haemopericardium. The patient was emergently transferred to the operating room where median thoracotomy was performed. A significant amount of bleeding was observed originating from a 1 cm laceration of the aortic root. Bleeding was controlled using a Foley catheter after unsuccessful attempts of digital compression, and the laceration was repaired using pledgeted sutures. Postoperative echocardiography and CT scan of the chest revealed normal cardiac functions with resolution of haemopericardium and haemopneumothorax, and the patient was discharged in a stable condition. High index of suspicion should be maintained for injury to the great vessels in patients with penetrating chest injuries, despite apparent haemodynamic stability. In this case, balloon tamponade using a Foley catheter served as a quick and simple technique that resulted in an almost bloodless field, facilitating adequate visualisation for definitive repair. Although the use of this technique has been previously described, this report serves as a reminder that a Foley catheter can be successfully used for balloon catheter tamponade in injuries to the aortic root. Keywords: Aortic root, Injury, Foley's catheter, Balloon catheter, Aorta

  3. Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT

    International Nuclear Information System (INIS)

    McKinney, Alexander; Ott, Frederick; Short, James; McKinney, Zeke; Truwit, Charles

    2007-01-01

    Purpose: Blunt carotid injuries (BCI's) and blunt vertebral artery injuries (BVI's), known jointly as BCVI's, are common in 'high risk' patients. The purpose is to evaluate the rate of occurrence of BCI/BVI in patients screened purely by the radiologic criteria of fracture through the carotid canal or vertebral transverse foramina, or significant cervical subluxation, noted by multidetector CT. Methods: Seventy-one patients with 108 catheterized vessels were included over a 13-month interval. The angiographic examinations were prompted by current hospital protocol, solely by the presence of fractures involving/adjacent to the carotid canal, cervical fractures involving/adjacent to the foramen transversarium, or cervical fractures with significant subluxation. The incidence of each grade of blunt injury was calculated after review of the CT scans and catheter angiograms by two neuroradiologists. Results: Two thousand and seventy-three total blunt trauma admissions occurred during the time period, with a BCVI rate of 0.92-1.0% (depending on the reviewer), similar to previous studies. Mean time to catheter angiography was 16.6 h. Of the 71 included patients, there were 11-12 BCI's and 10-12 BVI's, an overall rate of 27-30% of BCVI in the patients with foraminal fractures. Interobserver agreement in reviewing the catheter angiograms was excellent (Kappa 0.795). Of note, three internal carotid pseudoaneurysms resolved spontaneously after anticoagulation or aspirin. Conclusion: This study confirms that there is a high rate of BCVI in the presence of carotid canal or vertebral foramen fractures that are noted by multidetector CT. Utilization of purely radiologic criteria of foraminal involvement may be a significant screening tool in the decision of whether to evaluate these patients acutely by catheter or CT angiography, and for early detection of patients at risk for symptomatology, to initiate prompt, prophylactic treatment

  4. Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, Alexander [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States)]. E-mail: mckin022@umn.edu; Ott, Frederick [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); Short, James [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); McKinney, Zeke [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); Truwit, Charles [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States)

    2007-06-15

    Purpose: Blunt carotid injuries (BCI's) and blunt vertebral artery injuries (BVI's), known jointly as BCVI's, are common in 'high risk' patients. The purpose is to evaluate the rate of occurrence of BCI/BVI in patients screened purely by the radiologic criteria of fracture through the carotid canal or vertebral transverse foramina, or significant cervical subluxation, noted by multidetector CT. Methods: Seventy-one patients with 108 catheterized vessels were included over a 13-month interval. The angiographic examinations were prompted by current hospital protocol, solely by the presence of fractures involving/adjacent to the carotid canal, cervical fractures involving/adjacent to the foramen transversarium, or cervical fractures with significant subluxation. The incidence of each grade of blunt injury was calculated after review of the CT scans and catheter angiograms by two neuroradiologists. Results: Two thousand and seventy-three total blunt trauma admissions occurred during the time period, with a BCVI rate of 0.92-1.0% (depending on the reviewer), similar to previous studies. Mean time to catheter angiography was 16.6 h. Of the 71 included patients, there were 11-12 BCI's and 10-12 BVI's, an overall rate of 27-30% of BCVI in the patients with foraminal fractures. Interobserver agreement in reviewing the catheter angiograms was excellent (Kappa 0.795). Of note, three internal carotid pseudoaneurysms resolved spontaneously after anticoagulation or aspirin. Conclusion: This study confirms that there is a high rate of BCVI in the presence of carotid canal or vertebral foramen fractures that are noted by multidetector CT. Utilization of purely radiologic criteria of foraminal involvement may be a significant screening tool in the decision of whether to evaluate these patients acutely by catheter or CT angiography, and for early detection of patients at risk for symptomatology, to initiate prompt, prophylactic treatment.

  5. Weapon Use in Korean Homicide: Differences Between Homicides Involving Sharp and Blunt Instruments.

    Science.gov (United States)

    Park, Jisun; Son, Hyeonseo

    2017-10-23

    On the basis of information regarding 276 homicides committed in South Korea between 1987 and 2008, we compared offenders' and victims' characteristics, injury locations, weapon-related behavior, and offending behavior between homicides involving sharp and blunt instruments. The victims of sharp-force homicide were much younger relative to those of blunt-force homicide. In addition, homicides involving blunt instruments were more likely to be committed by offenders who lived with the victims. Most sharp-force homicides involved injuries to the torso, while blunt-force homicides involved mainly head injuries. Furthermore, perpetrators of sharp-force homicides tended to preselect their weapons, while those of blunt-force homicides were likely to use weapons of opportunity. Logistic regression analysis identified a number of factors, including injury location and body transportation, which significantly predicted weapon type. As this was the first South Korean study to compare sharp- and blunt-force homicides, the results have practical implications for homicide investigations. © 2017 American Academy of Forensic Sciences.

  6. FEASIBILITY OF THE CONSERVATIVE TREATMENT OF SPLENIC INJURIES IN BLUNT ABDOMINAL TRAUMA

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    M. M. Abakumov

    2013-01-01

    Full Text Available ABSTRACT. In blunt trauma, the structural features of the splenic parenchyma usually predispose to a significant intra-abdominal bleeding, so the excision of the damaged spleen is considered a main treatment technique in a majority of cases. However, a number of recent clinical studies have proved the necessity of a differentiated approach to making the treatment decisions and demonstrated the possibility of spleen salvage in certain cases.The most debatable issue is the management tactics in splenic injury associated with the formation of subcapsular hematoma. It is necessary to emphasize that the conservative treatment of such splenic injury implies a persisting risk of double-stage splenic rupture with following intra-abdominal bleeding.The Sklifosovsky Research Institute traditionally deals with injury management in all aspects and has gained a wide experience in splenic injury treatment that makes possible to demonstrate the choice of treatment tactics with regard to the splenic injury severity, and patient’s condition. A conservative management of spleen injury is reasonable only in stable patients and requires an additional use of instrumental diagnostic techniques. Morphological studies suggest that reparation processes around the splenic hematoma arise early enough and proceed, as a rule, with no signs of a purulent inflammation. 

  7. The effects of contrast media volume on acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis.

    Science.gov (United States)

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Podboy, Alexander J; Gillaspie, Erin A; Greason, Kevin L; Kashani, Kianoush B

    2016-11-01

    The goal of this systematic review was to assess the effects of contrast media volume on transcatheter aortic valve replacement-related acute kidney injury. A literature search was performed using Medline, EMbase, the Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of these databases through December 2015. Studies that reported relative risk, odds ratio, or hazard ratio comparing the risks of acute kidney injury following transcatheter aortic valve replacement in patients who received high contrast media volume were included. Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated using a random-effect, generic inverse variance method. Four cohort studies composed of 891 patients were included in the analyses to assess the risk of acute kidney injury after transcatheter aortic valve replacement in patients who received high contrast media volume. The pooled RR of acute kidney injury after transcatheter aortic valve replacement in patients who received a large volume of contrast media was 1.41 (95% CI, 0.87 to 2.28) compared with low contrast media volume. The meta-analysis was limited to studies using standard acute kidney injury definitions, and the pooled RR of acute kidney injury in patients who received high contrast media volume is 1.12 (95% CI, 0.78 to 1.62). Our meta-analysis shows no significant association between contrast media volume and risk of acute kidney injury after transcatheter aortic valve replacement. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

  8. Vascular geometry as a risk factor for non-penetrating traumatic injuries of the aortic arch.

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    Andreas Schicho

    Full Text Available To assess biomechanical factors in aortic arch geometry contributing to the development of non-penetrating aortic arch injury (NAAI in multiply injured patients with an Injury Severity Score (ISS ≥ 16.230 consecutive multiply injured trauma patients with an ISS ≥ 16 admitted to our Level-I trauma center during a consecutive 24-month period were prospectively included of whom 13 presented with NAAI (5.7%. Standardized whole-body CT in a 2x128-detector-row scanner included a head-and-neck CTA. Aortic arch diameters, width, height, angles and thoracic width and height were measured in individuals with NAAI and ISS-, sex-, age-, and trauma mechanism-matched controls.There was no difference between groups regarding sex, age, ISS, and aortic diameters. The aortic arch angle in individuals with NAAI (71.3° ± 14.9° was larger than in healthy control (60.7° ± 8.6°; p*<0.05. In patients with NAAI, the distance between ascendent and descendent aorta was larger (5.2 cm ± 1.9 cm than in control (2.8 ± 0.5 cm; ***p<0.001. The aortic arch is higher above tracheal bifurcation in NAAI (3.6 cm ± 0.6 cm than in matched control (2.4 cm ± 0.3 cm; ***p<0.001. Accordingly, the area under the aortic arch, calculated as half of an eliptic shape, is significantly larger in patients with NAAI (15.0 cm2 ± 6.5 cm2 when compared to age- and sex-matched controls without NAAI (5.5 cm2 ± 1.3 cm2; ***p<0.001.Besides the magnitude of deceleration and direction of impact, width and height of the aortic arch are the 3rd and 4th factor directly contributing to the risk of developing traumatic NAAI in severely injured patients.

  9. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

    Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

  10. Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report.

    Science.gov (United States)

    Watanabe, Kei; Yamazaki, Akiyoshi; Hirano, Toru; Izumi, Tomohiro; Sano, Atsuki; Morita, Osamu; Kikuchi, Ren; Ito, Takui

    2010-09-15

    Case report. To describe an iatrogenic aortic injury by pedicle screw instrumentation during posterior reconstructive surgery of spinal deformity. Iatrogenic major vascular injuries during anterior instrumentation procedures have been reported by several authors, but there have been few reports regarding iatrogenic major vascular injuries during posterior instrumentation procedures. A 57-year-old woman with thoracolumbar kyphosis due to osteoporotic T12 vertebral fracture underwent posterior correction and fusion (T10-L2), using segmental pedicle screw construct concomitant with T12 pedicle subtraction osteotomy. Postoperative routine plain radiographs and computed tomography myelography demonstrated a misplaced left T10 pedicle screw, which was in contact with the posteromedial aspect of the thoracic aorta, and suspected penetration of the aortic wall. The patient underwent removal of the pedicle screw, and repair of the penetrated aortic wall through a simultaneous anterior-posterior approach. The patient tolerated the procedure well without neurologic sequelae, and was discharged several days after removal of a left tube thoracostomy. Plain radiographs demonstrated solid fusion at the osteotomy site and no loosening of hardware. Preoperative neurologic symptoms improved completely at 18-months follow-up. Use of pedicle screw instrumentation has the potential to cause major vascular injury during posterior spinal surgery, and measures to prevent this complication must be taken. Timely diagnosis and treatment are essential to prevent both early and delayed complications and death.

  11. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A.

    2000-01-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  12. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma: A Single-Institution Experience.

    Science.gov (United States)

    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-03-01

    To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI.

  13. CT of blunt pancreatic trauma-A pictorial essay

    International Nuclear Information System (INIS)

    Venkatesh, Sudhakar Kundapur; Wan, John Mun Chin

    2008-01-01

    Blunt trauma to pancreas is uncommon and clinical features are often non-specific and unreliable leading to possible delays in diagnosis and therefore increased morbidity. CT has been established as the imaging modality of choice for the diagnosis of abdominal solid-organ injury in the blunt trauma patient. The introduction of multidetector-row CT allows for high resolution scans and multiplanar reformations that improve diagnosis. Detection of pancreatic injuries on CT requires knowledge of the subtle changes produced by pancreatic injury. The CT appearance of pancreatic injury ranges from a normal initial appearance of the pancreas to active pancreatic bleeding. Knowledge of CT signs of pancreatic trauma and a high index of suspicion is required in diagnosing pancreatic injury

  14. Blunt splenic injury in a child with situs inversus totalis treated with transcatheter arterial embolization

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    Naoki Hashizume

    2016-10-01

    Full Text Available We report the first case of blunt splenic rupture in a child with situs inversus totalis treated with transcatheter arterial embolization (TAE. A 12-year-old girl fell roughly 4 feet onto the pavement while riding her bicycle. Contrast-enhanced computed tomography revealed situs inversus totalis, a massive hemorrhage in the abdominal cavity, and a ruptured spleen with extravasation. Arteriography showed that the internal organs were located opposite their normal positioning. TAE was carried out with gelfoam and a micro coils at the branch of the upper lobe of the splenic artery. TAE is effective for blunt splenic injury with extravasation in a child with situs inversus. In TAE, there is no technical difference about situs inversus excepted mirror image of abdominal vascular formation.

  15. Blunt trauma to the spleen: ultrasonographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Doody, O. [Department of Radiology, Tallaght Hospital, Dublin (Ireland); Lyburn, D. [Department of Radiology, Cheltenham General Hospital (United Kingdom); Geoghegan, T. [Department of Radiology, Tallaght Hospital, Dublin (Ireland); Govender, P. [Department of Radiology, Tallaght Hospital, Dublin (Ireland); Monk, P.M. [Department of Radiology, Vancouver Hospital (Canada); Torreggiani, W.C. [Department of Radiology, Tallaght Hospital, Dublin (Ireland)]. E-mail: william.torreggiani@amnch.ie

    2005-09-01

    The spleen is the most frequently injured organ in adults who sustain blunt abdominal trauma. Splenic trauma accounts for approximately 25% to 30% of all intra-abdominal injuries. The management of splenic injury has undergone rapid change over the last decade, with increasing emphasis on splenic salvage and non-operative management. Identifying the presence and degree of splenic injury is critical in triaging the management of patients. Imaging is integral in the identification of splenic injuries, both at the time of injury and during follow-up. Although CT remains the gold standard in blunt abdominal trauma, US continues to play an important role in assessing the traumatized spleen. This pictorial review illustrates the various ultrasonographic appearances of the traumatized spleen. Correlation with other imaging is presented and complications that occur during follow-up are described.

  16.  Ischemic Stroke Secondary to Aortic Dissection Following Rifle Butt Recoil Chest Injury: A Case Report

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    John Valiath

    2011-11-01

    Full Text Available  Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.

  17. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison.

    Science.gov (United States)

    Bailitz, John; Starr, Frederic; Beecroft, Matthew; Bankoff, Jon; Roberts, Roxanne; Bokhari, Faran; Joseph, Kimberly; Wiley, Dorian; Dennis, Andrew; Gilkey, Susan; Erickson, Paul; Raksin, Patricia; Nagy, Kimberly

    2009-06-01

    An estimated 10,000 Americans suffer cervical spine injuries each year. More than 800,000 cervical spine radiographs (CSR) are ordered annually. The human and healthcare costs associated with these injuries are enormous especially when diagnosis is delayed. Controversy exists in the literature concerning the diagnostic accuracy of CSR, with reported sensitivity ranging from 32% to 89%. We sought to compare prospectively the sensitivity of cervical CT (CCT) to CSR in the initial diagnosis of blunt cervical spine injury for patients meeting one or more of the NEXUS criteria. The study prospectively compared the diagnostic accuracy of CSR to CCT in consecutive patients evaluated for blunt trauma during 23 months at an urban, public teaching hospital and Level I Trauma Center. Inclusion criteria were adult patient, evaluated for blunt cervical spine injury, meeting one or more of the NEXUS criteria. All patients received both three-view CSR and CCT as part of a standard diagnostic protocol. Each CSR and CCT study was interpreted independently by a different radiology attending who was blinded to the results of the other study. Clinically significant injuries were defined as those requiring one or more of the following interventions: operative procedure, halo application, and/or rigid cervical collar. Of 1,583 consecutive patients evaluated for blunt cervical spine trauma, 78 (4.9%) patients received only CCT or CSR and were excluded from the study. Of the remaining 1,505 patients, 78 (4.9%) had evidence of a radiographic injury by CSR or CCT. Of these 78 patients with radiographic injury, 50 (3.3%) patients had clinically significant injuries. CCT detected all patients with clinically significant injuries (100% sensitive), whereas CSR detected only 18 (36% sensitive). Of the 50 patients, 15 were at high risk, 19 at moderate risk, and 16 at low risk for cervical spine injury according to previously published risk stratification. CSR detected clinically significant

  18. Ventricular septal necrosis after blunt chest trauma

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    Alireza Ahmadi

    2012-07-01

    Full Text Available Ventricular Septal Defect (VSD after blunt chest trauma is a very rare traumatic affection.We report here a case of blunt chest injury-related VSD and pseudoaneurysm.A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edemaand echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely theintracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue somehidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinicalsequelae.

  19. OUR EXPERIENCE WITH BLUNT ABDOMINAL TRAUMA

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    Ankareddi Vijaya Lakshmi

    2016-12-01

    Full Text Available BACKGROUND Blunt abdominal trauma is an emergency and is associated with significant morbidity and mortality. The aim of the study is to study incidence, demographic profile, epidemiological factors, mechanism of trauma, treatment modalities, associated injuries, postoperative complications and morbidity and mortality. MATERIALS AND METHODS A retrospective analysis of 72 patients of blunt abdominal trauma who were admitted in government general hospital between May 2013 to April 2015 in Department of General Surgery, Government General Hospital, Guntur, with in a span of 24 months were studied. Demographic data, mechanism of trauma, management and outcome were studied. RESULTS Most of the patients in our study were in the age group of 21-30 years. Spleen was the commonest organ involved and most common procedure performed was splenectomy. Most common extra-abdominal injury was rib fractures. Wound infection was the commonest complication. CONCLUSION Initial resuscitative measures, thorough clinical examination and correct diagnosis forms the vital part of the management. FAST is more useful in blunt abdominal trauma patients who are unstable. X-ray revealed 100% accuracy in hollow viscous perforation in blunt abdominal trauma patients. CT abdomen is more useful in stable patients. Definitive indication for laparotomy was haemodynamic instability and peritonitis. Associated injuries influenced morbidity and mortality. Early diagnosis and prompt treatment can save many lives.

  20. Blunt thoracic trauma and cardiac injury in the athlete: contemporary management.

    Science.gov (United States)

    DE Gregorio, Cesare; Magaudda, Ludovico

    2017-09-29

    Commotion cordis and cardiac injuries are rare events usually following a chest blunt trauma during sports activities. Various aetiologies have been identified to cause electrical (commotion cordis) and/or structural (contusion and further injuries) damage, but high-velocity tools such as baseballs or hockey pucks (also called projectiles) have been chiefly identified. Clinical consequences are challenging, varying from uncomplicated supraventricular arrhythmias to cardiac wall rupture. Ventricular fibrillation is the most remarkable outcome leading to cardiac arrest in some individuals. In this article, up-to-date epidemiological and pathophysiological issues are discussed, along with the most suitable assistance protocols of the injured athlete in the sports arena. Current knowledge about traumatic sports injuries and ensuing cardiovascular sequelae made significant steps forwards than in the past. The majority of athletes (especially the youngest ones) wearing chest protectors are usually preserved from serious outcomes and sudden cardiac death, but further technical effort is encouraged to attain more satisfactory barriers against projectile's impact. Educational campaigns among students, closer team surveillance, implementation of the sports arenas with adequate rescue devices and medical assistance remain mandatory in every sports activity.

  1. Lap-belt syndrome: management of aortic intimal dissection in a 7-year-old child with a constellation of injuries

    International Nuclear Information System (INIS)

    Khanna, Paritosh C.; Bulas, Dorothy I.; Rothenbach, Patricia; Guzzetta, Philip C.

    2007-01-01

    We present a case of lap-belt motor vehicle injury in a 7-year-old male who was admitted with abdominal ecchymoses and pain with associated aortic intimal flap, bowel injury, hemoperitoneum, and retroperitoneal hematoma at initial imaging with CT. Most of these findings were confirmed at subsequent laparotomy, and the patient underwent operative repair of bowel injuries. His aortic intimal flap was followed with US and color Doppler imaging during which time he was treated conservatively until there was sonographic evidence of intimal healing. This patient illustrates a multimodality approach to imaging and conservative management. (orig.)

  2. The role of non-operative management (NOM in blunt hepatic trauma

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    Ayman Zaki Azzam

    2013-09-01

    Full Text Available Background: NOM in blunt hepatic trauma is the preferred treatment in otherwise stable patients. Aim: To evaluate the role of NOM in blunt hepatic trauma, avoiding unnecessary surgery. Methods and patients: Forty-four patients who presented with blunt hepatic trauma were admitted to the Emergency Unit. The patients were evaluated clinically. Abdominal computerized tomography was done to all hemodynamically stable patients and who were stabilized by the initial resuscitation. Staging of liver injury was done according to the scoring of the American Association for the Surgery of Trauma (AAST. Initially, all patients were treated conservatively and the patients who needed laparotomy later were considered as failure of NOM. Liver injuries due to penetrating causes were excluded. An informed consent was taken from each patient. Results: Blunt trauma was the mechanism of injury in 44 patients (60.2% including road traffic accidents in 42.5%. The peak age was between 20 and 30 years. The male to female ratio was 10:1. The majority of patients have multiple injuries with 10% having isolated liver injury. Thirty-six patients (82% had one or more associated extra-abdominal injuries. Surgery was indicated in 14 patients (32%. The mean admission systolic pressure was lower in the NOM failure group (90 vs. 122 mmHg with p < 0.04. Complications occurred more in the operative group, chest infection occurred in 21.4% with a p value of 0.001, hyperpyrexia occurred in 21.4% with a p value of 0.001, and wound infection in 14.2% with a p value of 0.025. Mortality occurred in 7 patients. The cause of death in patients with blunt hepatic trauma was liver related in 2 patients due to hemorrhage and DIC. Conclusion: NOM in blunt hepatic trauma is the preferred treatment in otherwise stable patients. The factors that can suspect failure of NOM were the development of hemodynamic instability or the presence of associated injury that mandates immediate exploration

  3. Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved.

    Science.gov (United States)

    Miller, Preston R; Chang, Michael C; Hoth, J Jason; Mowery, Nathan T; Hildreth, Amy N; Martin, R Shayn; Holmes, James H; Meredith, J Wayne; Requarth, Jay A

    2014-04-01

    Nonoperative management (NOM) of blunt splenic injury is well accepted. Substantial failure rates in higher injury grades remain common, with one large study reporting rates of 19.6%, 33.3%, and 75% for grades III, IV, and V, respectively. Retrospective data show angiography and embolization can increase salvage rates in these severe injuries. We developed a protocol requiring referral of all blunt splenic injuries, grades III to V, without indication for immediate operation for angiography and embolization. We hypothesized that angiography and embolization of high-grade blunt splenic injury would reduce NOM failure rates in this population. This was a prospective study at our Level I trauma center as part of a performance-improvement project. Demographics, injury characteristics, and outcomes were compared with historic controls. The protocol required all stable patients with grade III to V splenic injuries be referred for angiography and embolization. In historic controls, referral was based on surgeon preference. From January 1, 2010 to December 31, 2012, there were 168 patients with grades III to V spleen injuries admitted; NOM was undertaken in 113 (67%) patients. The protocol was followed in 97 patients, with a failure rate of 5%. Failure rate in the 16 protocol deviations was 25% (p = 0.02). Historic controls from January 1, 2007 to December 31, 2009 were compared with the protocol group. One hundred and fifty-three patients with grade III to V injuries were admitted during this period, 80 (52%) patients underwent attempted NOM. Failure rate was significantly higher than for the protocol group (15%, p = 0.04). Use of a protocol requiring angiography and embolization for all high-grade spleen injuries slated for NOM leads to a significantly decreased failure rate. We recommend angiography and embolization as an adjunct to NOM for all grade III to V splenic injuries. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Backer, A. de; Schepper, A. de [Department of Radiology, University Hospital of Antwerp (Belgium); Fierens, H.; Pelckmans, P. [Department of Gastroenterology, University Hospital of Antwerp (Belgium); Jorens, P.G. [Intensive Care Unit, University Hospital of Antwerp (Belgium); Vaneerdeweg, W. [Department of Surgery, University Hospital of Antwerp (Belgium)

    1998-12-01

    We report on two patients with biliary tract injury and associated biloma following blunt abdominal trauma. Both patients underwent emergency surgery because of hemodynamic instability and bloody peritoneal aspiration. Computed tomography in the postoperative days showed severe hepatic parenchymal injury and the presence of hypodense collections with intraparenchymal and subcapsular extension, suggestive for biloma, but otherwise failed to demonstrate the exact location of the bile duct injury. One of them underwent temporary percutaneous drainage. Bile duct injury was well demonstrated on endoscopic retrograde cholangiography (ERCP) and treated by endobiliary stent placement. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma. (orig.) With 2 figs., 9 refs.

  5. Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases

    International Nuclear Information System (INIS)

    Backer, A. de; Schepper, A. de; Fierens, H.; Pelckmans, P.; Jorens, P.G.; Vaneerdeweg, W.

    1998-01-01

    We report on two patients with biliary tract injury and associated biloma following blunt abdominal trauma. Both patients underwent emergency surgery because of hemodynamic instability and bloody peritoneal aspiration. Computed tomography in the postoperative days showed severe hepatic parenchymal injury and the presence of hypodense collections with intraparenchymal and subcapsular extension, suggestive for biloma, but otherwise failed to demonstrate the exact location of the bile duct injury. One of them underwent temporary percutaneous drainage. Bile duct injury was well demonstrated on endoscopic retrograde cholangiography (ERCP) and treated by endobiliary stent placement. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma. (orig.)

  6. Variation of Blunt Traumatic Injury with Age in Older Adults: Statewide Analysis 2011-14

    Directory of Open Access Journals (Sweden)

    Emily Earl-Royal

    2016-11-01

    Full Text Available Introduction: Traumatic injury is a leading cause of death and disability in adults ≥ 65 years old, but there are few epidemiological studies addressing this issue. The aim of this study was to assess how characteristics of blunt traumatic injuries in adults ≥ 65 vary by age. Methods: Using data from the a single-state trauma registry, this retrospective cohort study examined injured patients ≥ 65 admitted to all Level I and Level II trauma centers in Pennsylvania between 2011 and 2014 (n=38,562. Patients were stratified by age into three subgroups (age 65-74; 75-84; ≥85. We compared demographics, injury, and system-level across groups. Results: We found significant increases in the proportion of female gender, (48.6% vs. 58.7% vs. 67.7%, white race (89.1% vs. 92.6% vs. 94.6%, and non-Hispanic ethnicity (97.5% vs. 98.6% vs. 99.4% across advancing age across age groups, respectively. As age increased, the proportion of falls (69.9% vs. 82.1% vs. 90.3%, in-hospital mortality (4.6% vs. 6.2% vs. 6.8%, and proportion of patients arriving to the hospital via ambulance also increased (73.6% vs. 75.8% vs. 81.1%, while median injury severity plateaued (9.0% all groups and the proportion of Level I trauma alerts (10.6% vs. 8.2% vs. 6.7% decreased. We found no trend between age and patient transfer status. The five most common diagnoses were vertebral fracture, rib fracture, head contusion, open head wound, and intracranial hemorrhage, with vertebral fracture and head contusion increasing with age, and rib fracture decreasing with age. Conclusion: In a large cohort of older adults with trauma (n= 38,000, we found, with advancing age, a decrease in trauma alert level, despite an increase in mortality and a decrease in demographic diversity. This descriptive study provides a framework for future research on the relationship between age and blunt traumatic injury in older adults.

  7. Appendicitis following blunt abdominal trauma.

    Science.gov (United States)

    Cobb, Travis

    2017-09-01

    Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. The Role of Computed Tomography in Blunt Abdominal Trauma.

    Science.gov (United States)

    Karki, O B

    2015-01-01

    Blunt injury trauma is regularly encountered in the emergency department. Diagnostic tools that help in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma scan, Diagnostic peritoneal lavage and Computed Tomography scan. The aim of this study is to determine the validity of CT scan as an accurate diagnostic tool and its role in management of patients with blunt abdominal trauma. A prospective analysis of 80 patients of blunt abdomen trauma who were admitted in Manipal Teaching Hospital, Pokhara, Nepal within a span of 15 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Organ injuries were graded using the Organ Injury Scale guidelines. Most of the patients in our study were in the age group of 21-40 years with an M: F ratio of 2.3:1. Road traffic accident (47.5%) was the most common mechanism of injury. Spleen (27.5%) was the commonest organ injured. CT scan was superior to FAST scan and had sensitivity of 97.3% specificity 75% positive predictive value 98.6%. FAST scan had sensitivity of 78.9%, specificity 50%, positive predictive value 96% with p- value of 0.0034. 81% of patients were conservatively managed. In conjunction with close clinical monitoring, CT scan is reliable in the evaluation and management of blunt abdominal trauma patients. Our study also shows CT as a superior diagnostic modality compared to FAST scan.

  9. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation

    International Nuclear Information System (INIS)

    Bilos, Linda; Pirouzram, Artai; Toivola, Asko; Vidlund, Mårten; Cha, Soon Ok; Hörer, Tal

    2017-01-01

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  10. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation

    Energy Technology Data Exchange (ETDEWEB)

    Bilos, Linda, E-mail: linda.bilos@regionorebrolan.se; Pirouzram, Artai; Toivola, Asko; Vidlund, Mårten; Cha, Soon Ok; Hörer, Tal [Örebro University Hospital and Örebro University, Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health (Sweden)

    2017-01-15

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  11. Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic Hepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms

    Directory of Open Access Journals (Sweden)

    Nikhil P. Jaik

    2008-01-01

    Full Text Available Extrahepatic hepatic ductal injuries (EHDIs due to blunt abdominal trauma are rare. Given the rarity of these injuries and the insidious onset of symptoms, EHDI are commonly missed during the initial trauma evaluation, making their diagnosis difficult and frequently delayed. Diagnostic modalities useful in the setting of EHDI include computed tomography (CT, abdominal ultrasonography (AUS, nuclear imaging (HIDA scan, and cholangiography. Traditional options in management of EHDI include primary ductal repair with or without a T-tube, biliary-enteric anastomosis, ductal ligation, stenting, and drainage. Simple drainage and biliary decompression is often the most appropriate treatment in unstable patients. More recently, endoscopic retrograde cholangiopancreatography (ERCP allowed for diagnosis and potential treatment of these injuries via stenting and/or papillotomy. Our review of 53 cases of EHDI reported in the English-language literature has focused on the evolving role of ERCP in diagnosis and treatment of these injuries. Diagnostic and treatment algorithms incorporating ERCP have been designed to help systematize and simplify the management of EHDI. An illustrative case is reported of blunt traumatic injury involving both the extrahepatic portion of the left hepatic duct and its confluence with the right hepatic duct. This injury was successfully diagnosed and treated using ERCP.

  12. [Surgical Repair for Blunt Cardiac Rupture].

    Science.gov (United States)

    Yashiki, Noriyoshi; Yachi, Tsuyoshi; Takahashi, Tomohiko

    2017-07-01

    Blunt cardiac injury is a life-threatening condition. We report 3 successful cases in which we performed surgery for blunt cardiac injury. Three individuals were injured, 2 in traffic accidents and the other being caught between a crane and a steel frame. Echocardiograms and computed tomography scans revealed pooling of bloody pericardial fluid in all 3 patients, who underwent emergency surgery. Two patients needed sutures to control persistent bleeding. Although a heart-lung machine was prepared at the start of surgery in all 3 cases, we did not need to use it for any patient. Thus, prior to performing such surgery, it is necessary to ascertain its need.

  13. Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study.

    Science.gov (United States)

    Margari, Sergio; Garozzo Velloni, Fernanda; Tonolini, Massimo; Colombo, Ettore; Artioli, Diana; Allievi, Niccolò Ettore; Sammartano, Fabrizio; Chiara, Osvaldo; Vanzulli, Angelo

    2018-05-12

    To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student's t, chi-squared, and Cohen's kappa tests. Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (p splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.

  14. Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management.

    Science.gov (United States)

    Perdonck, P; de Schoutheets, J C; Monsieurs, K G; Van Laer, C; Vander Poorten, V; Vanderveken, O

    Penetrating and blunt trauma to the neck: clinical presentation, assessment ana emergency management. In Belgium, and even in Western Europe, penetrating and blunt injury to the neck is relatively uncommon in both the civilian and military populations. Pre-hospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this specific type of injury remains low. Historically, the neck has been divided into three anatomical zones with specific landmarks to guide the diagnostic and therapeutic approach to penetrating neck injuries. Most penetrating injuries need to be explored surgically, although with the advent of multi-detector computed tomographic angiography (MDCTA), which yields high diagnostic sensitivity, this inflexible approach has recently changed to a more targeted management, based on clinical, radiographic and, if deemed necessary, endoscopic findings. However, some authors have addressed their concern about this novel, 'no-zone' approach, since the risk of missing less apparent aerodigestive tract injuries may increase. It is recommended, therefore, that all patients with penetrating neck injuries be closely observed, irrespective of the initial findings. The incidence of blunt neck injury is much lower, and this makes risk assessment and management even more difficult in comparison with penetrating injuries. Again, MDCTA is most often the first diagnostic tool if a blunt neck injury is suspected, due to its good sensitivity for blunt cerebrovascular injuries (BCVI) as well as for aerodigestive tract injuries. Specific patterns of injury and unexpected neurological and neuro-radiological findings in trauma patients should always warrant further investigation. Despite ongoing debate, systemic anticoagulation is recommended for most BCVI, sometimes combined with endovascular treatment. Aerodigestive tract injuries may present dramatically, but are often more subtle, making the diagnosis more difficult

  15. Occult pneumomediastinum in blunt chest trauma: clinical significance.

    Science.gov (United States)

    Rezende-Neto, J B; Hoffmann, J; Al Mahroos, M; Tien, H; Hsee, L C; Spencer Netto, F; Speers, V; Rizoli, S B

    2010-01-01

    Thoracic injuries are potentially responsible for 25% of all trauma deaths. Chest X-ray is commonly used to screen patients with chest injury. However, the use of computed tomography (CT) scan for primary screening is increasing, particularly for blunt trauma. CT scans are more sensitive than chest X-ray in detecting intra-thoracic abnormalities such as pneumothoraces and pneumomediastinums. Pneumomediastinum detected by chest X-ray or "overt pneumomediastinum", raises the concern of possible aerodigestive tract injuries. In contrast, there is scarce information on the clinical significance of pneumomediastinum diagnosed by CT scan only or "occult pneumomediastinum". Therefore we investigated the clinical consequences of occult pneumomediastinum in our blunt trauma population. A 2-year retrospective chart review of all blunt chest trauma patients with initial chest CT scan admitted to a level I trauma centre. Data extracted from the medical records include; demographics, occult, overt, or no pneumomediastinum, the presence of intra-thoracic aerodigestive tract injuries (trachea, bronchus, and/or esophagus), mechanism and severity of injury, endotracheal intubation, chest thoracostomy, operations and radiological reports by an attending radiologist. All patients with intra-thoracic aerodigestive tract injuries from 1994 to 2004 were also investigated. Of 897 patients who met the inclusion criteria 839 (93.5%) had no pneumomediastinum. Five patients (0.6%) had overt pneumomediastinum and 53 patients (5.9%) had occult pneumomediastinum. Patients with occult pneumomediastinum had significantly higher ISS and AIS chest (pchest thoracostomy tube was more common (ppneumothorax. None of the patients with occult pneumomediastinum had aerodigestive tract injuries (95%CI 0-0.06). Follow up CT scan of patients with occult pneumomediastinum showed complete resolution in all cases, in average 3 h after the initial exam. Occult pneumomediastinum occurred in approximately 6% of

  16. The spleen not taken: Differences in management and outcomes of blunt splenic injuries in teenagers cared for by adult and pediatric trauma teams in a single institution.

    Science.gov (United States)

    OʼConnor, Sean C; Doud, Andrea N; Sieren, Leah M; Miller, Preston R; Zeller, Kristen A

    2017-09-01

    Nonoperative management (NOM) of blunt splenic injury, initially touted for the care of pediatric patients, has become the standard of care for stable trauma patients of all ages. In our institution, trauma patients younger than 16 years are managed by the pediatric surgery service and patients 16 years or older are managed by the adult trauma service. Angioembolization is routinely used for adults with blunt splenic injury but rarely used for pediatric patients. A retrospective chart review was performed to determine if more liberal use of angioembolization increases the success rate of NOM of blunt splenic injury in adolescents. Using our institutional trauma registry, we performed a retrospective chart review of 13- to 18-year-olds admitted with blunt splenic injury from 2007 to 2015. One hundred thirty-three patients were identified; 59 were 13- to 15-year-olds and cared for by the Pediatric Trauma service, whereas 74 were 16- to 18-year-olds and cared for by the Adult Trauma service. The cohorts were compared with respect to imaging performed, grade of injury, Injury Severity Score, presence of active extravasation or pseudoaneurysm, interventions performed, blood transfused, intensive care unit days, length of stay, complications, and 30-day mortality rates. There were no significant differences in Injury Severity Score, incidence of active extravasation or pseudoaneurysm identified on computed tomography, or grade of injury between the two cohorts. More patients underwent angioembolization in the "adult" group (p = 0.001) with no difference in the success rate of NOM (p = 0.117). The overall failure rate of NOM of high-grade injuries was only 4.1%. Failure of NOM in high-grade injuries is rare; as a result, the number needed to treat with prophylactic angioembolization would be around 37 patients, resulting in undue risk to many patients with no therapeutic benefit. No improvement in failure rate was seen with aggressive angioembolization, though a larger

  17. Blunt traumatic cardiac rupture: therapeutic options and outcomes.

    Science.gov (United States)

    Nan, Yu-Yun; Lu, Ming-Shian; Liu, Kuo-Sheng; Huang, Yao-Kuang; Tsai, Feng-Chun; Chu, Jaw-Ji; Lin, Pyng Jing

    2009-09-01

    Cardiac rupture following blunt thoracic trauma is rarely encountered by clinicians, since it commonly causes death at the scene. With advances in traumatology, blunt cardiac rupture had been increasingly disclosed in various ways. This study reviews our experience of patients with suspected blunt traumatic cardiac rupture and proposes treatment protocols for the same. This is a 5-year retrospective study of trauma patients confirmed with blunt traumatic cardiac rupture admitted to a university-affiliated tertiary trauma referral centre. The following information was collected from the patients: age, sex, mechanism of injury, initial effective diagnostic tool used for diagnosing blunt cardiac rupture, location and size of the cardiac injury, associated injury and injury severity score (ISS), reversed trauma score (RTS), survival probability of trauma and injury severity scoring (TRISS), vital signs and biochemical lab data on arrival at the trauma centre, time elapsed from injury to diagnosis and surgery, surgical details, hospital course and final outcome. The study comprised 8 men and 3 women with a median age of 39 years (range: 24-73 years) and the median follow-up was 5.5 months (range: 1-35 months). The ISS, RTS, and TRISS scores of the patients were 32.18+/-5.7 (range: 25-43), 6.267+/-1.684 (range: 2.628-7.841), and 72.4+/-25.6% (range: 28.6-95.5%), respectively. Cardiac injuries were first detected using focused assessment with sonography for trauma (FAST) in 4 (36.3%) patients, using transthoracic echocardiography in 3 (27.3%) patients, chest CT in 1 (9%) patient, and intra-operatively in 3 (27.3%) patients. The sites of cardiac injury comprised the superior vena cava/right atrium junction (n=4), right atrial auricle (n=1), right ventricle (n=4), left ventricular contusion (n=1), and diffuse endomyocardial dissection over the right and left ventricles (n=1). Notably, 2 had pericardial lacerations presenting as a massive haemothorax, which initially masked

  18. Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma.

    Science.gov (United States)

    Nummela, Mari T; Bensch, Frank V; Pyhältö, Tuomo T; Koskinen, Seppo K

    2018-02-01

    Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ 2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion

  19. Hepatic enzyme decline after pediatric blunt trauma: a tool for timing child abuse?

    Science.gov (United States)

    Baxter, Amy L; Lindberg, Daniel M; Burke, Bonnie L; Shults, Justine; Holmes, James F

    2008-09-01

    Previous research in adult patients with blunt hepatic injuries has suggested a pattern of serum hepatic transaminase concentration decline. Evaluating this decline after pediatric blunt hepatic trauma could establish parameters for estimating the time of inflicted injuries. Deviation from a consistent transaminase resolution pattern could indicate a developing complication. Retrospective review of pediatric patients with injuries including blunt liver trauma admitted to one of four urban level 1 trauma centers from 1990 to 2000. Cases were excluded for shock, death within 48 h, complications, or inability to determine injury time. Transaminase concentration decline was modeled by individual patients, by injury grade, and as a ratio with regard to injury time. One hundred and seventy-six patients met inclusion criteria. The rate of aspartate aminotransferase (AST) clearance changed significantly over time. Alanine aminotransferase (ALT) fell more slowly. Of the 118 patients who had multiple measurements of AST, for 112 (95%) the first concentration obtained was the highest. When ALT was greater than AST, the injury was older than 12h (97% specificity (95% CI, 95-99%), sensitivity 42% (95% CI, 33-50%)). Patients with enzymes that rose after 14 h post-injury were more likely to develop complications (RR=24, 95% CI 10-58). Hepatic transaminases rise rapidly after uncomplicated blunt liver injury, then fall predictably. Persistently stable or increasing concentrations may indicate complications. ALT>AST indicates subacute injury.

  20. Hepatic Enzyme Decline after Pediatric Blunt Trauma: A Tool for Timing Child Abuse?

    Science.gov (United States)

    Baxter, Amy L.; Lindberg, Daniel M.; Burke, Bonnie L.; Shults, Justine; Holmes, James F.

    2008-01-01

    Objectives: Previous research in adult patients with blunt hepatic injuries has suggested a pattern of serum hepatic transaminase concentration decline. Evaluating this decline after pediatric blunt hepatic trauma could establish parameters for estimating the time of inflicted injuries. Deviation from a consistent transaminase resolution pattern…

  1. Successful management of threatened aortic rupture late after rib fracture caused by blunt chest trauma.

    Science.gov (United States)

    Morimoto, Yoshihisa; Sugimoto, Takaki; Sakahira, Hideki; Matsuoka, Hidehito; Yoshioka, Yuki; Arase, Hiroki

    2014-05-01

    A 62-year-old man was crushed in a car accident and diagnosed with a fractured left ninth rib, pulmonary and heart contusion, hemopneumothorax, and descending aortic injury based on a computed tomography scan. He underwent chest tube drainage and was intubated for mechanical ventilation because a bone fragment of the ninth rib threatened to penetrate the descending aorta. On the second posttrauma day, computed tomography showed the bone fragment of the ninth rib approaching the descending aorta. He underwent graft replacement of the injured portion of the descending thoracic aorta, and we removed the fractured left ninth rib. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre.

    Science.gov (United States)

    Lin, Being-Chuan; Fang, Jen-Feng; Chen, Ray-Jade; Wong, Yon-Cheong; Hsu, Yu-Pao

    2014-01-01

    This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann-Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if phepatic artery ligation (n=11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p=0.019), prolonged initial prothrombin time (PT) (p=0.004), active partial thromboplastin time (APTT) (p<0.0001) and decreased platelet count (p=0.005). The mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Computed tomography and nonoperative treatment for blunt abdominal trauma

    International Nuclear Information System (INIS)

    Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro; Takahashi, Toshio.

    1990-01-01

    Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author)

  4. Computed tomography and nonoperative treatment for blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro [Saiseikai Shiga Hospital, Shiga (Japan); Takahashi, Toshio

    1990-01-01

    Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author).

  5. Pectus excavatum in blunt chest trauma: a case report

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    Liodakis Emmanouil

    2013-01-01

    Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

  6. Diagnostic imaging of blunt abdominal trauma in pediatric patients.

    Science.gov (United States)

    Miele, Vittorio; Piccolo, Claudia Lucia; Trinci, Margherita; Galluzzo, Michele; Ianniello, Stefania; Brunese, Luca

    2016-05-01

    Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 80-90 % of abdominal injuries. The mechanism of trauma is quite similar to that of the adults, but there are important physiologic differences between children and adults in this field, such as the smaller blood vessels and the high vasoconstrictive response, leading to the spreading of a non-operative management. The early imaging of children undergoing a low-energy trauma can be performed by CEUS, a valuable diagnostic tool to demonstrate solid organ injuries with almost the same sensitivity of CT scans; nevertheless, as for as urinary tract injuries, MDCT remains still the technique of choice, because of its high sensitivity and accuracy, helping to discriminate between an intra-peritoneal form a retroperitoneal urinary leakage, requiring two different managements. The liver is the most common organ injured in blunt abdominal trauma followed by the spleen. Renal, pancreatic, and bowel injuries are quite rare. In this review we present various imaging findings of blunt abdominal trauma in children.

  7. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

    Science.gov (United States)

    Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

    2015-01-01

    We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

  8. Blunt bilateral diaphragmatic rupture—A right side can be easily missed

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    Maria Michailidou

    2015-12-01

    Full Text Available Blunt diaphragmatic rupture (BDR is uncommon with a reported incidence range of 1%–2%. The true incidence is not known. Bilateral BDR is particularly rare. We presented a case of bilateral BDR and we think that the incidence is under-recognised thanks to an easily missed and difficult to diagnose right sided injury. Keywords: Blunt, Diaphragm, Bilateral, Injury

  9. Comparison of whole-body post mortem 3D CT and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification.

    Science.gov (United States)

    Daly, Barry; Abboud, Samir; Ali, Zabiullah; Sliker, Clint; Fowler, David

    2013-02-10

    Although 3D CT imaging data are available on survivors of accidental blunt trauma, little similar data has been collected and classified on major injuries in victims of fatal injuries. This study compared the sensitivity of post mortem computed tomography (PMCT) with that of conventional autopsy for major trauma findings classified according to the trauma Abbreviated Injury Scale (AIS). Whole-body 3D PMCT imaging data and full autopsy findings were analyzed on 21 victims of accidental blunt force trauma death. All major injuries were classified on the AIS scale with ratings from 3 (serious) to 6 (unsurvivable). Agreement between sensitivity of autopsy and PMCT for major injuries was determined. A total of 195 major injuries were detected (mean per fatality, 9.3; range, 1-14). Skeletal injuries by AIS grade included 37 grade 3, 45 grade 4, 12 grade 5, and 2 grade 6 major findings. Soft tissue injuries included 10 grade 3, 68 grade 4, 16 grade 5, and 5 grade 6 major findings. Of these, PMCT detected 165 (88 skeletal, 77 soft tissue), and autopsy detected 127 (59 skeletal, 68 soft tissue). PMCT agreed with autopsy in 86% and 76% of skeletal and soft tissue injuries, respectively. PMCT detected an additional 37 skeletal and 31 soft tissue injuries that were not identified at autopsy. Autopsy detected 8 skeletal and 22 soft tissue injuries that were not detected by PMCT. PMCT was more sensitive for skeletal (P=0.05) and head and neck region injury (P=0.043) detection. PMCT showed a trend for greater sensitivity than autopsy, but this did not reach statistical significance (P=0.083). 3D PMCT detected significantly more skeletal injuries than autopsy and a similar number of soft tissue injuries to autopsy and promises to be a sensitive tool for detection and classification of skeletal injuries in fatal blunt force accidental trauma. Use of the AIS scale allows standardized categorization and quantification of injuries that contribute to death in such cases and allows more

  10. Hyphema as a Complication of Blunt Ocular Trauma and Additional Ocular Findings

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    Mehmet Giray Ersöz

    2014-01-01

    Full Text Available Objectives: To investigate the frequency of angle recession, commotio retinae, and other ocular findings in patients with hyphema due to blunt ocular trauma. Materials and Methods: The medical records of 66 patients hospitalized between July 2010 and May 2012 with a diagnosis of traumatic hyphema were retrospectively reviewed. The age, gender, period between injury and the first examination, visual acuity at presentation, intraocular pressure (IOP, time of disappearance of hyphema, cause of blunt injury, additional ocular findings, medical and/or surgical treatment, follow-up time, and visual outcome were noted. Results: The mean age of the patients was 23.8±19.2 years. Males constituted the 83.3% of the whole group. Game-related injury (43.9% and work-related injury (22.7% were the most common causes of blunt trauma. The bead gun was the most common tool involved in injury. Angle recession was detected in 36 patients (54.5%. Development of secondary glaucoma was higher in the patients with angle recession (chi-square test, p<0.05. Commotio retinae was observed in 47% of patients. The mean visual acuity at presentation was 0.4±0.3, while at the last visit, it was 0.8±0.3. There was a statistically significant difference between baseline and final visual acuity (paired-samples t-test, p<0.001. Conclusion: Hyphema due to blunt ocular trauma is observed mostly in young men and children. The most common blunt ocular injuries are game-and work-related. Angle recession and commotio retinae are the main complications of blunt ocular trauma causing hyphema. In cases with blunt ocular trauma, the presence of hyphema makes it difficult to examine the anterior chamber angle and the fundus. It is important to perform these investigations at the earliest stage to manage the complications since commotio retinae and angle recession accompany many cases with hyphema. (Turk J Ophthalmol 2014; 44: 19-22

  11. The presence of nonthoracic distracting injuries does not affect the initial clinical examination of the cervical spine in evaluable blunt trauma patients: a prospective observational study.

    Science.gov (United States)

    Konstantinidis, Agathoklis; Plurad, David; Barmparas, Galinos; Inaba, Kenji; Lam, Lydia; Bukur, Marko; Branco, Bernardino C; Demetriades, Demetrios

    2011-09-01

    A distracting injury mandates cervical spine (c-spine) imaging in the evaluable blunt trauma patient who demonstrates no pain or tenderness over the c-spine. The purpose of this study was to examine which distracting injuries can negatively affect the sensitivity of the standard clinical examination of the c-spine. This is a prospective observational study conducted at a Level I Trauma Center from January 1, 2008, to December 31, 2009. After institutional review board approval, all evaluable (Glasgow Coma Scale score ≥13) blunt trauma patients older than 16 years sustaining a c-spine injury were enrolled. A distracting injury was defined as any immediately evident bony or soft tissue injury or a complaint of non-c-spine pain whether or not an actual injury was subsequently diagnosed. Information regarding the initial clinical examination and the presence of a distracting injury was collected from the senior resident or attending trauma surgeon involved in the initial management. During the study period, 101 evaluable patients sustained a c-spine injury. Distracting injuries were present in 88 patients (87.1%). The most common was rib fracture (21.6%), followed by lower extremity fracture (20.5%) and upper extremity fracture (12.5%). Only four (4.0%) patients had no pain or tenderness on the initial examination of the c-spine. All four patients had bruising and tenderness to the upper anterior chest. None of these four patients developed neurologic sequelae or required a surgical stabilization or immobilization. C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. Further definition of distracting injuries is mandated to avoid unnecessary utilization of resources and to reduce the imaging burden associated with the evaluation of the c-spine.

  12. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

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    Luo S

    2017-08-01

    Full Text Available Songyuan Luo,* Huanyu Ding,* Jianfang Luo, Wei Li, Bing Ning, Yuan Liu, Wenhui Huang, Ling Xue, Ruixin Fan, Jiyan Chen Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China *These authors contributed equally to this work Background: Thoracic endovascular aortic repair (TEVAR has become an emerging treatment modality for acute type B aortic dissection (TBAD patients in recent years. The risk factors and impacts of acute kidney injury (AKI after percutaneous TEVAR, however, have not been widely established.Methods: We retrospectively studied the clinical records of 305 consecutive patients who admitted to our institution and had TEVAR for TBAD between December 2009 and June 2013. The patients were routinely monitored for their renal functions preoperatively until 7 days after TEVAR. The Kidney Disease Improving Global Guidelines (KDIGO criteria were used for AKI.Results: Of the total 305 consecutive patients, 84 (27.5% developed AKI after TEVAR, comprising 66 (21.6% patients in KDIGO stage 1, 6 (2.0% patients in stage 2 and 12 (3.9% patients in stage 3. From the logistic regression analysis, systolic blood pressure (SBP on admission >140 mmHg (odds ratio [OR], 2.288; 95% CI, 1.319–3.969 and supra-aortic branches graft bypass hybrid surgery (OR, 3.228; 95% CI, 1.526–6.831 were independent risk factors for AKI after TEVAR. Local anesthesia tended to be a protective factor (OR, 0.563; 95% CI, 0.316–1.001. The preoperative renal function, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or statin administration, volume of contrast agent, range of TBAD and false lumen involving renal artery were not associated with post-operation AKI. The in-hospital mortality and major adverse events were markedly increased with the occurrence of AKI (7.1% vs 0.9%, P=0

  13. Traumatic thoracic injury: the role of Multidetector-row CT

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    Park, Kyung Joo; Kang, Doo Kyung; Kim, Tae Hee [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2006-05-15

    The introduction of Multidetector-row CT (MDCT) has revolutionized the diagnostic strategy of multitrauma patients. The rapid acquisition of a large scanning volume with a thin slice collimation allows for motion-free images of high spatial resolution, and this enables the application of the multiplanar reformat (MPR) and 3D volume-rendering (VR) images. The MPR images more accurately demonstrate aortic rupture or dissection, diaphragmatic injuries and fracture of vertebrae, sternum and costal cartilages. Diagnosing vascular injuries can be aided by using the MIP images. Rib fracture, trachea and bronchial laceration are more easily detected by the 3D images, while airway and vascular injuries can be detected from performing virtual endoscopy. We introduce our current CT imaging protocol and we present our clinical experience with using MDCT in the assessment of patients with blunt thoracic trauma.

  14. Blunt abdominal trauma in children.

    Science.gov (United States)

    Schonfeld, Deborah; Lee, Lois K

    2012-06-01

    This review will examine the current evidence regarding pediatric blunt abdominal trauma and the physical exam findings, laboratory values, and radiographic imaging associated with the diagnosis of intra-abdominal injuries (IAI), as well as review the current literature on pediatric hollow viscus injuries and emergency department disposition after diagnosis. The importance of the seat belt sign on physical examination and screening laboratory data remains controversial, although screening hepatic enzymes are recommended in the evaluation of nonaccidental trauma to identify occult abdominal organ injuries. Focused Assessment with Sonography for Trauma (FAST) has modest sensitivity for hemoperitoneum and IAI in the pediatric trauma patient. Patients with concern for undiagnosed IAI, including bowel injury, may be considered for hospital admission and serial abdominal exams without an increased risk of complications, if an exploratory laparotomy is not performed emergently. Although the FAST exam is not recommended as the sole screening tool to rule out IAI in hemodynamically stable trauma patients, it may be used in conjunction with the physical exam and laboratory findings to identify children at risk for IAI. Children with a normal physical exam and normal abdominal CT may not require routine hospitalization after blunt abdominal trauma.

  15. Increased incidence of adrenal gland injury in blunt abdominal trauma: a computed tomography-based study from Pakistan

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    Aziz Muhammad Usman

    2014-02-01

    Full Text Available 【Abstract】Objective: To determine the frequency of adrenal injuries in patients presenting with blunt abdominal trauma by computed tomography (CT. Methods: During a 6 month period from January 1, 2011 to June 30, 2011, 82 emergency CT examinations were performed in the setting of major abdominal trauma and retrospectively reviewed for adrenal gland injuries. Results: A total of 7 patients were identified as having adrenal gland injuries (6 males and 1 female. Two patients had isolated adrenal gland injuries. In the other 5 patients with nonisolated injuries, injuries to the liver (1 case, spleen (1 case, retroperitoneum (2 cases and mesentery (4 cases were identified. Overall 24 cases with liver injuries (29 %, 11 cases with splenic injuries (13%, 54 cases with mesenteric injuries (65%, 14 cases (17% with retroperitoneal injuries and 9 cases with renal injuries were identified. Conclusion: Adrenal gland injury is identified in 7 patients (11.7% out of a total of 82 patients who underwent CT after major abdominal trauma. Most of these cases were nonisolated injuries. Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports. The rise in incidence of adrenal injuries could be attributed to the mode of injury.

  16. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature.

    NARCIS (Netherlands)

    Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

    2009-01-01

    AIM: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. METHODS: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers

  17. Nonoperative management of blunt hepatic trauma: A systematic review.

    Science.gov (United States)

    Boese, Christoph Kolja; Hackl, Michael; Müller, Lars Peter; Ruchholtz, Steffen; Frink, Michael; Lechler, Philipp

    2015-10-01

    Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma. Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials. We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 patients, were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p hepatic injuries. Systematic review, level III.

  18. The Use of Chest Computed Tomographic Angiography in Blunt Trauma Pediatric Population.

    Science.gov (United States)

    Hasadia, Rabea; DuBose, Joseph; Peleg, Kobi; Stephenson, Jacob; Givon, Adi; Kessel, Boris

    2018-02-05

    Blunt chest trauma in children is common. Although rare, associated major thoracic vascular injuries (TVIs) are lethal potential sequelae of these mechanisms. The preferred study for definitive diagnosis of TVI in stable patients is computed tomographic angiography imaging of the chest. This imaging modality is, however, associated with high doses of ionizing radiation that represent significant carcinogenic risk for pediatric patients. The aim of the present investigation was to define the incidence of TVI among blunt pediatric trauma patients in an effort to better elucidate the usefulness of computed tomographic angiography use in this population. A retrospective cohort study was conducted including all blunt pediatric (age blunt trauma victims, 119,821patients were younger than 14 years. Twelve (0.0001%, 12/119821) of these children were diagnosed with TVI. The most common mechanism in this group was pedestrian hit by a car. Mortality was 41.7% (5/12). Thoracic vascular injury is exceptionally rare among pediatric blunt trauma victims but does contribute to the high morbidity and mortality seen with blunt chest trauma. Computed tomographic angiography, with its associated radiation exposure risk, should not be used as a standard tool after trauma in injured children. Clinical protocols are needed in this population to minimize radiation risk while allowing prompt identification of life-threatening injuries.

  19. Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT.

    Science.gov (United States)

    Malhotra, Ajay; Durand, David; Wu, Xiao; Geng, Bertie; Abbed, Khalid; Nunez, Diego B; Sanelli, Pina

    2018-07-01

    To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT. A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome. A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management. MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination. • MRI has limited utility after negative cervical CT in blunt trauma. • MRI is frequently positive for non-specific soft-tissue injury. • Unstable injury missed on CT is infrequent.

  20. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Malhotra, Ajay; Wu, Xiao; Kalra, Vivek B.; Liu, Renu; Forman, Howard P. [Yale School of Medicine, Department of Radiology and Biomedical Imaging, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT (United States); Nardini, Holly K.G. [Yale University, Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT (United States); Abbed, Khalid M. [Yale School of Medicine, Minimally Invasive Spine Surgery and Spine Tumor Surgery, New Haven, CT (United States)

    2017-03-15

    To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance. We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported. Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable. There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study. (orig.)

  1. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis

    International Nuclear Information System (INIS)

    Malhotra, Ajay; Wu, Xiao; Kalra, Vivek B.; Liu, Renu; Forman, Howard P.; Nardini, Holly K.G.; Abbed, Khalid M.

    2017-01-01

    To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance. We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported. Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable. There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study. (orig.)

  2. Management of pediatric blunt splenic injury at a rural trauma center.

    Science.gov (United States)

    Bird, Julio J; Patel, Nirav Y; Mathiason, Michelle A; Schroeppel, Thomas J; D'huyvetter, Cecile J; Cogbill, Thomas H

    2012-10-01

    Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear. A retrospective review of all patients younger than 16 years with BSI managed at a rural American College of Surgeons-verified adult Level II trauma center from January 1995 to December 2008 was completed. Patients were identified from the trauma registry by DRG International Classification of Diseases-9th Rev. (865.00-865.09) and management codes (41.5, 41.43, and 41.95). Variables reviewed included demographics, mechanism of injury, Injury Severity Score, grade of splenic injury, degree of hemoperitoneum, presence of arterial phase contrast blush on computed tomography at admission, admission and nadir hemoglobin level, blood transfused, length of stay, disposition, outpatient clinical and radiographic follow-up, interval of return to unrestricted activity, and clinical outcomes. During the 13-year study period, 38 children with BSI were identified. Thirty-seven (97%) were successfully managed nonoperatively. Median grade of splenic injury was 3 (range, 1-5); 73% had moderate-to-large hemoperitoneum. Median Injury Severity Score was 10 (range, 4-34). Three patients with isolated contrast blush on initial computed tomography were successfully managed nonoperatively with no angiographic intervention. One patient failed nonoperative management and underwent successful splenorrhaphy. All patients were discharged home. Thirty-day mortality was zero. Median follow-up duration was 5.5 years, with no late complications identified. Of the patients successfully managed nonoperatively, 92% had their follow-up at our institution; 74% underwent subsequent imaging, and none resulted in intervention or alteration of management plan. Pediatric BSI can be managed in adult

  3. CT evaluation of pulmonary parenchymal injury due to blunt chest trauma and its clinical significance

    International Nuclear Information System (INIS)

    Niimi, Hiroshi

    1990-01-01

    The CT findings of pulmonary parenchymal injury due to blunt chest trauma in 73 patients and their clinical significance were analyzed. CT was obtained within 6 hours after trauma. Findings were analyzed according to the number of injured segments and severity which was classified into three grades. A correlation was also made with arterial blood PaO 2 and thoracic complications. Pulmonary parenchymal injury was identified in multisegmental portions bilaterally in most cases. It was most frequently observed in the posterior portion of the lung such as segment 6. More than 50% of lesions were classified as Grade 1. Pulmonary laceration, defined as patchy density with the cavitary lesion (Grade 3), was noted in 9.2%. There was a good correlation between extent of pulmonary injury and degree of hypoxia. The correlation of pneumothorax was also found with extensive lesion and frequency of Grade 3 lesion. Cases with pulmonary laceration tend to have extensive injury, and be related to the degree of hypoxia. In conclusion, CT evaluation of pulmonary parenchymal injury is valuable not only for morphological evaluation but also for estimation of hypoxia. (author)

  4. CT evaluation of pulmonary parenchymal injury due to blunt chest trauma and its clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Niimi, Hiroshi (St. Marianna University School of Medicine, Kawasaki, Kanagawa (Japan))

    1990-10-01

    The CT findings of pulmonary parenchymal injury due to blunt chest trauma in 73 patients and their clinical significance were analyzed. CT was obtained within 6 hours after trauma. Findings were analyzed according to the number of injured segments and severity which was classified into three grades. A correlation was also made with arterial blood PaO{sub 2} and thoracic complications. Pulmonary parenchymal injury was identified in multisegmental portions bilaterally in most cases. It was most frequently observed in the posterior portion of the lung such as segment 6. More than 50% of lesions were classified as Grade 1. Pulmonary laceration, defined as patchy density with the cavitary lesion (Grade 3), was noted in 9.2%. There was a good correlation between extent of pulmonary injury and degree of hypoxia. The correlation of pneumothorax was also found with extensive lesion and frequency of Grade 3 lesion. Cases with pulmonary laceration tend to have extensive injury, and be related to the degree of hypoxia. In conclusion, CT evaluation of pulmonary parenchymal injury is valuable not only for morphological evaluation but also for estimation of hypoxia. (author).

  5. Cardiogenic shock following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  6. Multi-detector row computed tomography and blunt chest trauma

    International Nuclear Information System (INIS)

    Scaglione, Mariano; Pinto, Antonio; Pedrosa, Ivan; Sparano, Amelia; Romano, Luigia

    2008-01-01

    Blunt chest trauma is a significant source of morbidity and mortality in industrialized countries. The clinical presentation of trauma patients varies widely from one individual to another and ranges from minor reports of pain to shock. Knowledge of the mechanism of injury, the time of injury, estimates of motor vehicle accident velocity and deceleration, and evidence of associated injury to other systems are all salient features to provide for an adequate assessment of chest trauma. Multi-detector row computed tomography (MDCT) scanning and MDCT-angiography are being used more frequently in the diagnosis of patients with chest trauma. The high sensitivity of MDCT has increased the recognized spectrum of injuries. This new technology can be regarded as an extremely valuable adjunct to physical examination to recognize suspected and unsuspected blunt chest trauma

  7. CT findings in children with blunt trauma in the spleen

    International Nuclear Information System (INIS)

    Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori; Watanabe, Shinsuke.

    1991-01-01

    We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author)

  8. CT findings in children with blunt trauma in the spleen

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    Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori (Kyoto Second Red Cross Hospital (Japan)); Watanabe, Shinsuke

    1991-09-01

    We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author).

  9. New scoring system for intra-abdominal injury diagnosis after blunt trauma

    Directory of Open Access Journals (Sweden)

    Shojaee Majid

    2014-02-01

    Full Text Available 【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT admitted to the emergency department (ED of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male were enrolled (48 cases of IAI. A 24-point blunt abdominal trauma scoring system (BATSS was developed. Patients were divided into three groups including low (score<8, moderate (8≤score<12 and high risk (score≥12. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%. Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%. Conclusion: The present scoring system furnishes a

  10. Computed Tomographic Findings and Mortality in Patients With Pneumomediastinum From Blunt Trauma.

    Science.gov (United States)

    Lee, Wayne S; Chong, Vincent E; Victorino, Gregory P

    2015-08-01

    The care of most patients with pneumomediastinum (PNM) due to trauma can be managed conservatively; however, owing to aerodigestive tract injury and other associated injuries, there is a subset of patients with PNM who are at higher risk of mortality but can be difficult to identify. To characterize computed tomographic (CT) findings associated with mortality in patients with PNM due to blunt trauma. A retrospective review of medical records from January 1, 2002, to December 31, 2011, was conducted at a university-based urban trauma center. The patients evaluated were those injured by blunt trauma and found to have PNM on initial chest CT scanning. Data analysis was performed July 2, 2013, to June 18, 2014. In-hospital mortality. During the study period, 3327 patients with blunt trauma underwent chest CT. Of these, 72 patients (2.2%) had PNM. Patients with PNM had higher Injury Severity Scores (P blunt trauma; however, CT findings of posterior PNM, air in all mediastinal compartments, and concurrent hemothorax are associated with increased mortality. These CT findings could be used as a triage tool to alert the trauma surgeon to a potentially lethal injury.

  11. Rare Case of Large Bowel Injury due to Direct Blunt Trauma to a Preexisting Femoral Hernia

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    C. Tinner

    2017-01-01

    Full Text Available We report a case of an 85-year-old man with a known asymptomatic left femoral hernia who was admitted to the emergency ward a few hours after falling from a bicycle and suffering from blunt trauma of the handlebar to the left inguinal region. The clinical findings and a computed tomography (CT scan detecting free air in the femoral hernia sac suggested bowel perforation. Emergency laparotomy 6 hours after the incident confirmed a tear of the sigmoid colon accompanied by free blood and faeces in the left inguinal region of the abdomen. A segmental sigmoid resection and a primary end-to-end colorectal anastomosis were performed. The postoperative course was complicated by delayed oral feeding, a local infection, and a partial left testicle necrosis that led to secondary resection. The patient was discharged after 32 days of in-hospital care. Three months post trauma, we recorded a restitutio ad integrum. The case exemplifies that blunt trauma to preexisting femoral hernias may cause potentially lethal bowel perforation and that the time interval between time of injury and surgical treatment may be a prognostic factor. CT scans seem most suitable for ruling out bowel perforation. The scarce literature for blunt trauma to hernias is reviewed.

  12. Non-operative management of blunt trauma in abdominal solid organ injuries: a prospective study to evaluate the success rate and predictive factors of failure.

    Science.gov (United States)

    Hashemzadeh, S H; Hashemzadeh, K H; Dehdilani, M; Rezaei, S

    2010-06-01

    Over the past several years, non-operative management (NOM) has increasingly been recommended for the care of selected blunt abdominal solid organ injuries. No prospective study has evaluated the rate of NOM of blunt abdominal trauma in the northwest of Iran. The objective of our study was to evaluate the success rate of this kind of management in patients who do not require emergency surgery. This prospective study was carried out in Imam Khomeini Hospital (as a referral center of trauma) at Tabriz University of Medical Sciences, Iran, between 20 March 2004 and 20 March 2007. All trauma patients who had suffered an injury to a solid abdominal organ (kidney, liver, or spleen) were selected for initial analysis, using the Student's t test or the c2 test. During the three years of the study, 98 patients (83 males and 15 females) with blunt trauma were selected to NOM for renal, hepatic and splenic injuries. Mean age was 26.1+/-17.7 years (range, 2 to 89) and mean injury severity score (ISS) was 14.5+/-7.4. The success rate of NOM was 93.8%. Fifty-one patients (43 males, 8 females; mean ISS, 14.2+/-5.8) underwent NOM of splenic trauma; 38 patients (33 males, 5 females; mean ISS, 12.9+/-8.2) hepatic trauma, and nine patients (7 males, 2 females; mean ISS, 22.2+/-7.6) renal trauma. Six patients underwent laparotomy due to the failure of NOM. The success rates of this treatment were 94.1%, 94.7% and 88.8% for the spleen, liver and kidney injuries, respectively. Age, female gender and ISS were significant predictors of the failure of NOM (Ptrauma. The study indicates that the rates of NOM vary in relation to the severity of the organ injury. This suggests trauma centers should use this approach.

  13. Denver screening protocol for blunt cerebrovascular injury reduces the use of multi-detector computed tomography angiography.

    Science.gov (United States)

    Beliaev, Andrei M; Barber, P Alan; Marshall, Roger J; Civil, Ian

    2014-06-01

    Blunt cerebrovascular injury (BCVI) occurs in 0.2-2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi-detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen-positive patients would reduce the unnecessary use of CTA as a pre-emptive screening tool. This is a registry-based study of blunt trauma patients admitted to Auckland City Hospital from 1998 to 2012. The diagnosis of BCVI was confirmed or excluded with CTA, magnetic resonance angiography and, if these imaging were non-conclusive, four-vessel digital subtraction angiography. Thirty (61%) BCVI and 19 (39%) non-BCVI patients met eligibility criteria. The Denver protocol applied to our cohort of patients had a sensitivity of 97% (95% confidence interval (CI): 83-100%) and a specificity of 42% (95% CI: 20-67%). With a prevalence of BCVI in blunt trauma patients of 0.2% and 2.7%, post-test odds of a screen-positive test were 0.03 (95% CI: 0.002-0.005) and 0.046 (95% CI: 0.314-0.068), respectively. Application of the CTA to the Denver protocol screen-positive trauma patients can decrease the use of CTA as a pre-emptive screening tool by 95-97% and reduces its hazards. © 2013 Royal Australasian College of Surgeons.

  14. Blunt Head Trauma and Headache

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    Ana B Chelse

    2015-04-01

    Full Text Available Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI among a large cohort of children 2-18 years of age.

  15. [Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma].

    Science.gov (United States)

    Kruppa, C; Goericke, S L; Matheney, T; Ozokyay, L; Schildhauer, T A; Muhr, G; Dudda, M

    2010-10-01

    Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

  16. Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients

    Energy Technology Data Exchange (ETDEWEB)

    Peters, S., E-mail: soeren.peters@rub.d [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany); Nicolas, V.; Heyer, C.M. [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany)

    2010-04-15

    Accidental injuries are the leading cause of death in the 15 to 44-year-old age group. Blunt chest trauma is often encountered in these patients and is associated with a mortality of up to 25%. Although conventional radiography still plays an important role in the initial emergency room setting, for follow-up in the intensive care unit, multidetector computed tomography has established itself as the standard imaging method for the evaluation of chest trauma patients. The following review presents salient radiological findings of the chest wall and shoulder girdle, thoracic spine, pleural space, and lung in polytraumatized patients.

  17. Radiological assessment of paediatric cervical spine injury in blunt trauma: the potential impact of new NICE guidelines on the use of CT

    International Nuclear Information System (INIS)

    Davies, J.; Cross, S.; Evanson, J.

    2016-01-01

    Aim: To determine the potential effect of changes to the National Institute for Health and Care Excellence (NICE) guidelines to the use of computed tomography (CT) in the assessment of suspected paediatric cervical spine (c-spine) injury. Material and methods: A 5 year retrospective study was conducted of c-spine imaging in paediatric (<10 years) patients presenting following blunt trauma at a Level 1 trauma centre in London. All patients under the age of 10 years who underwent any imaging of the c-spine following blunt trauma were included. Clinical data relating to the presenting signs and symptoms were obtained from the retrospective review of electronic records and paper notes. This was then applied to the previous NICE guideline (CG56) and to the new NICE guideline (CG176). Patients with incomplete data were excluded. Results: Two hundred and seventy-eight patients <10 years underwent imaging of the c-spine following blunt trauma. Two hundred and seventy (97.12%) examinations had complete data and were included in further analysis. One hundred and forty-nine (55.19%) met the criteria for a CT of the c-spine under NICE CG56, whereas 252 (93.33%) met the updated NICE CG176 criteria for c-spine CT. Five (1.85%) patients had a c-spine injury and met the criteria under both CG56 and CG176 NICE guidelines. Conclusion: Recent changes to NICE Head Injury Guidelines relating to radiological assessment of paediatric c-spine following blunt trauma are likely to result in an increased usage of CT as the initial radiological investigation over plain radiographs, without an apparent increase in specificity in the present series. - Highlights: • Paediatric CSI is a rare but serious consequence of blunt trauma. • New NICE 176 criteria broadened the criteria for c-spine CT following trauma. • 69% more patients may be eligible for assessment with CT under new guidelines. • 5 cases of CSI occurred in this series of 278 paediatric trauma cases. • All 5 cases met CG176

  18. Murine P-glycoprotein deficiency alters intestinal injury repair and blunts lipopolysaccharide-induced radioprotection.

    Science.gov (United States)

    Staley, Elizabeth M; Yarbrough, Vanisha R; Schoeb, Trenton R; Daft, Joseph G; Tanner, Scott M; Steverson, Dennis; Lorenz, Robin G

    2012-09-01

    P-glycoprotein (P-gp) has been reported to increase stem cell proliferation and regulate apoptosis. Absence of P-gp results in decreased repair of intestinal epithelial cells after chemical injury. To further explore the mechanisms involved in the effects of P-gp on intestinal injury and repair, we used the well-characterized radiation injury model. In this model, injury repair is mediated by production of prostaglandins (PGE(2)) and lipopolysaccharide (LPS) has been shown to confer radioprotection. B6.mdr1a(-/-) mice and wild-type controls were subjected to 12 Gy total body X-ray irradiation and surviving crypts in the proximal jejunum and distal colon were evaluated 3.5 days after irradiation. B6.mdr1a(-/-) mice exhibited normal baseline stem cell proliferation and COX dependent crypt regeneration after irradiation. However, radiation induced apoptosis was increased and LPS-induced radioprotection was blunted in the C57BL6.mdr1a(-/-) distal colon, compared to B6 wild-type controls. The LPS treatment induced gene expression of the radioprotective cytokine IL-1α, in B6 wild-type controls but not in B6.mdr1a(-/-) animals. Lipopolysaccharid-induced radioprotection was absent in IL-1R1(-/-) animals, indicating a role for IL-1α in radioprotection, and demonstrating that P-gp deficiency interferes with IL-1α gene expression in response to systemic exposure to LPS.

  19. Is the Grading of Liver Injuries a Useful Clinical Tool in the Initial Management of Blunt Trauma Patients?

    Science.gov (United States)

    Helling, Thomas S; Ward, Michael R; Balon, Jennifer

    2009-04-01

    Computed tomography (CT) has become the preferred method for evaluation of the abdomen for victims of blunt trauma. Grading of liver injuries, primarily by CT, has been advocated as a measure of severity and, by implication, the likelihood for intervention or complications. We have sought to determine if grading of liver injuries, as a clinical tool, affects immediate or extended management of patients. We have retrospectively reviewed all patients sustaining blunt liver injuries as diagnosed by CT over a five-year period at a Level I trauma center to determine if grading of injury influenced management. The AAST organ scaling system was utilized (major grade 4-5, minor grade 1-3), as well as the ISS, AIS, mortality, morbidity, and treatment. There were 133 patients available for review. The patients were grouped into major (n = 20) and minor (n = 113) liver injuries and operative (n = 12) and nonoperative (n = 121) management. Major liver injuries had a higher ISS (39 + 13 vs. 27 + 15, p = 0.001) and were more likely to require operative intervention (5/20 vs. 7/113, p = 0.02). Mortality in this group was not different (major vs. minor), and there were no differences in the incidence of complications. Twelve patients (9%) required operation, all for hemodynamic instability, all within 24 h, and 11/12 within 6 h. At operation 8/12 patients had other sources of bleeding beside the liver injury, and 7/12 had minor hepatic injuries. The operative patients had higher ISS and AIS scores (head/neck, chest, abdomen, extremities) than those managed nonoperatively. More patients died in the operative group (6/12 vs. 8/121, p = 0.0003). There were more pulmonary (6/12 vs. 16/121, p = 0.005), cardiovascular (6/12 vs. 19/121, p = 0.01), and infectious (5/12 vs. 20/121, p = 0.049) complications in the operative group. There were 14 deaths overall; 13/14 were due to traumatic brain injury, and 8/14 required urgent operation for hemorrhage. In conclusion, grading of liver

  20. [Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma].

    Science.gov (United States)

    Carvalho, Fábio Henrique de; Romeiro, Paula Christina Marra; Collaço, Iwan Augusto; Baretta, Giorgio Alfredo Pedroso; Freitas, Alexandre Coutinho Teixeira de; Matias, Jorge Eduardo Fouto

    2009-04-01

    Identify prognostic factors related to treatment failure of blunt splenic injuries managed by non surgical treatment (NST). Fifty six adult patients submitted to NST were prospectively studied. The injuries were diagnosed by computed axial tomography scan and classified according to AAST (American Association for Surgery of Trauma) criteria. Patients were divided in success and failure groups. NST failure was defined as the need for laparotomy for any reason. NST failures (19.6%) were due to: abdominal pain (45.4%), hemodinamic instability (36.4%), splenic haematoma associated to a fall in hematocrit (9.1%) and splenic abscess (9.1%). There were no failures in grade I and II of the splenic injuries; failure rate was 17.5% in grade III and IV injuries grouped, and 80% in grade V injuries (p = 0,0008). In the success group, 31.3% patients received red cell transfusions, versus 63.6% patients in the failure group (p = 0,05). Failure rate in patients with ISS = 8 was zero; 15.9% in patients with ISS 9 to 25; and 50% in patients with ISS = 26 (p = 0,05). There were no deaths or missed bowel injuries. ISS and splenic injury grade were related to failure of NST.

  1. Behind armour blunt trauma--an emerging problem.

    Science.gov (United States)

    Cannon, L

    2001-02-01

    Behind Armour Blunt Trauma (BABT) is the non-penetrating injury resulting from the rapid deformation of armours covering the body. The deformation of the surface of an armour in contact with the body wall arises from the impact of a bullet or other projectile on its front face. The deformation is part of the retardation and energy absorbing process that captures the projectile. In extreme circumstances, the BABT may result in death, even though the projectile has not perforated the armour. An escalation of the available energy of bullets and the desire of armour designers to minimise the weight and bulk of personal armour systems will increase the risk of BABT in military and security forces personnel. In order to develop materials that can be interposed between the armour and the body wall to attenuate the transfer of energy into the body, it is essential that the mechanism of BABT is known. There is a great deal of activity within UK and NATO to unravel the interactions; the mechanism is likely to be a combination of stress (pressure) waves generated by the rapid initial motion of the rear of the armour, and shear deformation to viscera produced by gross deflection of the body wall. Physical and computer model systems are under development to characterise the biophysical processes and provide performance targets for materials to be placed between armours and the body wall in order to attenuate the injuries (trauma attenuating backings-TABs). The patho-physiological consequences of BABT are being clarified by research, but the injuries will have some of the features of blunt chest trauma observed in road traffic accidents and other forms of civilian blunt impact injury. The injuries also have characteristics of primary blast injury. An overview diagnosis and treatment is described.

  2. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

    Science.gov (United States)

    Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed; Al-Sadek, Lina

    2016-01-01

    AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries. MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed. RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema. CONCLUSIONS: The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients. PMID:28028415

  3. The Role of Computed Tomography in Blunt Abdominal Trauma

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    Om Bahadur Karki

    2016-10-01

    aim of this study is to determine the validity of CT scan as an accurate diagnostic tool and its role in management of patients with blunt abdominal trauma. Methods: A prospective analysis of 80 patients of blunt abdomen trauma who were admitted in Manipal Teaching Hospital, Pokhara, Nepal within a span of 15 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Organ injuries were graded using the Organ Injury Scale guidelines. Results: Most of the patients in our study were in the age group of 21-40 years with an M: F ratio of 2.3:1. Road traf c accident (47.5% was the most common mechanism of injury. Spleen (27.5% was the commonest organ injured. CT scan was superior to FAST scan and had sensitivity of 97.3% speci city 75% positive predictive value 98.6%. FAST scan had sensitivity of 78.9%, speci city 50%, positive predictive value 96% with p- value of 0.0034. 81% of patients were conservatively managed. Conclusion: In conjunction with close clinical monitoring, CT scan is reliable in the evaluation and management of blunt abdominal trauma patients. Our study also shows CT as a superior diagnostic modality compared to FAST scan. Keywords: blunt abdominal trauma; CT scan; FAST scan; road traf c accident.

  4. Emergency CT in blunt abdominal trauma of multiple injury patients

    International Nuclear Information System (INIS)

    Kinnunen, J.; Kivioja, A.; Poussa, K.; Laasonen, E.M.

    1994-01-01

    Multiple injury patients with blunt abdominal trauma (n = 110) were examined by abdominal CT. An i.v., but not peroral, contrast medium was used, thereby eliminating the delay caused by administering peroral contrast medium and any subsequent delay in making the diagnoses and beginning operative treatment. Eighteen patients underwent emergency laparotomy after the initial CT examination. The preoperative CT findings were compared to the laparotomy findings. CT revealed all but one of the severe parenchymal organ lesions requiring surgery. The one liver laceration that went undetected had caused hemoperitoneum, which was diagnosed by CT. The bowel and mesenteric lesions presented as intra-abdominal blood, and the hemoperitoneum was discovered in every patient with these lesions. Fourteen patients also initially had positive abdominal CT findings; 10 of them underwent an additional abdominal CT within 3 days, but the repeat studies did not reveal any lesions in need of surgery. Omission of the oral contrast medium did not jeopardize making the essential diagnoses, but it did save time. (orig.)

  5. PERFORATION OF THE COLON AS A RESULT OF BLUNT ABDOMINAL TRAUMA: A CASE REPORTS

    Directory of Open Access Journals (Sweden)

    Arpad Ivanecz

    2002-06-01

    Full Text Available Background. Blunt trauma to the abdomen is more likely to damage solid organs. Blunt injuries to the colon are uncommon and usually they follows a direct blow to the abdomen. Physical findings suggesting peritoneal iritation can be present early in the postinjury period but there is usually a delay in the manifestation of colonic injury. If the colonic perforation is present as a solitary injury, signs of peritoneal iritation are easier to recognize and they lead to further evaluation and operation. Because of the force required to injure the colon, associated injuries often coexist, consequently physical findings may be masked, diagnosis delayed, and outcome compromised.Conclusions. Additionaly, the recent trend for conservative management of blunt abdominal trauma may lead to delay in diagnosis. Perioperative antibiotics and early laparotomy with complete intra-abdominal exploration and primary repair of the colon injury usually provide excellent results.

  6. [Non-surgical management after blunt traumatic liver injuries: A review article].

    Science.gov (United States)

    Noyola-Villalobos, Héctor Faustino; Loera-Torres, Marco Antonio; Jiménez-Chavarría, Enrique; Núñez-Cantú, Olliver; García-Núñez, Luis Manuel; Arcaute-Velázquez, Fernando Federico

    2016-01-01

    Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in haemodynamically stable patients with a success rate of around 85 to 98%. This haemodynamic stability is the most important factor in selecting the appropriate patient. Adjuncts in non-surgical management are angioembolisation, image-guided drainage and endoscopic retrograde cholangiopancreatography. Failure in non-surgical management is relatively rare but potentially fatal, and needs to be recognised and aggressively treated as early as possible. The main cause of failure in non-surgical management is persistent haemorrhage. The aim of this paper is to describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma. Copyright © 2016 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  7. Do we really rely on fast for decision-making in the management of blunt abdominal trauma?

    Science.gov (United States)

    Carter, Jeffrey W; Falco, Mark H; Chopko, Michael S; Flynn, William J; Wiles Iii, Charles E; Guo, Weidun Alan

    2015-05-01

    The Focused Assessment with Sonography in Trauma examination (FAST) is currently taught and recommended in the ATLS(®), often as an addendum to the primary survey for patients with blunt abdominal trauma. Although it is non-invasive and rapidly performed at bedside, the utility of FAST in blunt abdominal trauma has been questioned. We designed this study to examine our hypothesis that FAST is not an efficacious screening tool for identifying intra-abdominal injuries. We performed a retrospective chart review of all patients with confirmatory diagnosis of blunt abdominal injuries with CT and/or laparotomy for a period of 1.5 years (from 7/2009 to 11/2010). FAST was performed by ED residents and considered positive when free intra-abdominal fluid was visualized. Abdominal CT, or exploratory laparotomy findings were used as confirmation of intra-abdominal injury. A total of 1671 blunt trauma patients were admitted to and evaluated in the Emergency Department during a 1½ year period and 146 patients were confirmed intra-abdominal injuries by CT and/or laparotomy. Intraoperative findings include injuries to the liver, spleen, kidneys, and bowels. In 114 hemodynamically stable patients, FAST was positive in 25 patients, with a sensitivity of 22%. In 32 hemodynamically unstable patients, FAST was positive in 9 patients, with a sensitivity of 28%. A free peritoneal fluid and splenic injury are associated with a positive FAST on univariate analysis, and are the independent predictors for a positive FAST on multiple logistic regression. FAST has a very low sensitivity in detecting blunt intraabdominal injury. In hemodynamically stable patients, a negative FAST without a CT may result in missed intra-abdominal injuries. In hemodynamically unstable blunt trauma patients, with clear physical findings on examination, the decision for exploratory laparotomy should not be distracted by a negative FAST. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. How Does the Severity of Injury Vary between Motorcycle and Automobile Accident Victims Who Sustain High-Grade Blunt Hepatic and/or Splenic Injuries? Results of a Retrospective Analysis.

    Science.gov (United States)

    Hsieh, Ting-Min; Tsai, Tsung-Cheng; Liu, Yueh-Wei; Hsieh, Ching-Hua

    2016-07-21

    High-grade blunt hepatic and/or splenic injuries (BHSI) remain a great challenge for trauma surgeons. The main aim of this study was to investigate the characteristics, mortality rates, and outcomes of high-grade BHSI in motorcyclists and car occupants hospitalized for treatment of traumatic injuries in a Level I trauma center in southern Taiwan. High-grade BHSI are defined as grade III-VI blunt hepatic injuries and grade III-V blunt splenic injuries. This retrospective study reviewed the data of 101 motorcyclists and 32 car occupants who experienced a high-grade BHSI from 1 January 2011 to 31 December 2013. Two-sided Fisher's exact or Pearson's chi-square tests were used to compare categorical data, unpaired Student's t-test was used to analyze normally distributed continuous data, and Mann-Whitney's U test was used to compare non-normally distributed data. In this study, the majority (76%, 101/133) of high-grade BHSI were due to motorcycle crashes. Car occupants had a significantly higher injury severity score (ISS; 26.8 ± 10.9 vs. 20.7 ± 10.4, respectively, p = 0.005) and organ injured score (OIS; 3.8 ± 1.0 vs. 3.4 ± 0.6, respectively, p = 0.033), as well as a significantly longer hospital length of stay (LOS; 21.2 days vs. 14.6 days, respectively, p = 0.038) than did motorcyclists. Car occupants with high-grade BHSI also had worse clinical presentations than their motorcyclist counterparts, including a significantly higher incidence of hypotension, hyperpnea, tube thoracostomy, blood transfusion >4 units, LOS in intensive care unit >5 days, and complications. However, there were no differences in the percentage of angiography or laparotomy performed or mortality rate between these two groups of patients. This study demonstrated that car occupants with high-grade BHSI were injured more severely, had a higher incidence of worse clinical presentation, had a longer hospital LOS, and had a higher incidence of complications than motorcyclists. The results also

  9. How Does the Severity of Injury Vary between Motorcycle and Automobile Accident Victims Who Sustain High-Grade Blunt Hepatic and/or Splenic Injuries? Results of a Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Ting-Min Hsieh

    2016-07-01

    Full Text Available Background: High-grade blunt hepatic and/or splenic injuries (BHSI remain a great challenge for trauma surgeons. The main aim of this study was to investigate the characteristics, mortality rates, and outcomes of high-grade BHSI in motorcyclists and car occupants hospitalized for treatment of traumatic injuries in a Level I trauma center in southern Taiwan. Methods: High-grade BHSI are defined as grade III-VI blunt hepatic injuries and grade III-V blunt splenic injuries. This retrospective study reviewed the data of 101 motorcyclists and 32 car occupants who experienced a high-grade BHSI from 1 January 2011 to 31 December 2013. Two-sided Fisher’s exact or Pearson’s chi-square tests were used to compare categorical data, unpaired Student’s t-test was used to analyze normally distributed continuous data, and Mann–Whitney’s U test was used to compare non-normally distributed data. Results: In this study, the majority (76%, 101/133 of high-grade BHSI were due to motorcycle crashes. Car occupants had a significantly higher injury severity score (ISS; 26.8 ± 10.9 vs. 20.7 ± 10.4, respectively, p = 0.005 and organ injured score (OIS; 3.8 ± 1.0 vs. 3.4 ± 0.6, respectively, p = 0.033, as well as a significantly longer hospital length of stay (LOS; 21.2 days vs. 14.6 days, respectively, p = 0.038 than did motorcyclists. Car occupants with high-grade BHSI also had worse clinical presentations than their motorcyclist counterparts, including a significantly higher incidence of hypotension, hyperpnea, tube thoracostomy, blood transfusion >4 units, LOS in intensive care unit >5 days, and complications. However, there were no differences in the percentage of angiography or laparotomy performed or mortality rate between these two groups of patients. Conclusions: This study demonstrated that car occupants with high-grade BHSI were injured more severely, had a higher incidence of worse clinical presentation, had a longer hospital LOS, and had a

  10. Blunt splenic trauma: Assessment, management and outcomes.

    Science.gov (United States)

    El-Matbouly, Moamena; Jabbour, Gaby; El-Menyar, Ayman; Peralta, Ruben; Abdelrahman, Husham; Zarour, Ahmad; Al-Hassani, Ammar; Al-Thani, Hassan

    2016-02-01

    The approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI. A traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords "Traumatic Splenic injury", "Blunt splenic trauma", "management" between December 1954 and November 2014. Most of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeon's experience in addition to radiographic findings. About one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  11. Non-Operative Management of Isolated Pneumoperitoneum Due to Severe Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Murat Kilic

    2016-02-01

    Full Text Available Nonoperative management of blunt abdominal trauma is the treatment of choice for hemodynamically stable patients. The results of nonoperative management are more successful in isolated solid organ injuries such as the liver and spleen than hollow viscus injury. In this approach, both the clinical course of the patient and the computed tomography findings play an important role. Isolated pneumoperitoneum in blunt abdominal trauma may be a surgical challenge for clinicians because it is usually a significant radiological sign for hallow viscus perforations. Here, we report a case of isolated pneumoperitoneum detected on computed tomography and managed non-surgically, in a young man suffered from a severe blunt abdominal trauma. Our aim is to attract the attention of surgeons to the management problems of the presence of pneumoperitoneum in the absence of other radiological findings in blunt abdominal trauma.

  12. About Usefulness of Kalemia Monitoring after Blunt Liver Trauma

    Directory of Open Access Journals (Sweden)

    Francesco Meriggi

    2012-01-01

    Full Text Available Background. The aim of this study is to investigate the evidence of hypokalemia as a suitable parameter for therapeutic decision making after severe blunt liver trauma. Methods. We reviewed the medical records of 11 patients (9 M, 2 F, mean age 32 years admitted to San Matteo Hospital of Pavia between 2007–2009. All of them were victims of road accidents hospitalized for blunt liver injury and submitted to surgery. Results. Hypokalemia was observed in 7/11 (63.6% patients during the preoperative period (mean value 2.91 mEq/L. Serum potassium concentration normalized in all patients at the 7th postoperative day only (<0.01. Conclusions. According to literature results, our study confirms that after blunt hepatic injury serum potassium levels may decrease significantly. Therefore, kalemia must be carefully monitored in order to establish appropriate treatment and avoid any complications.

  13. [Treatment practice in patients with isolated blunt splenic injuries. A survey of Swiss traumatologists].

    Science.gov (United States)

    Schnüriger, B; Martens, F; Eberle, B M; Renzulli, P; Seiler, C A; Candinas, D

    2013-01-01

    The non-operative management (NOM) of blunt splenic injuries has gained widespread acceptance. However, there are still many controversies regarding follow-up of these patients. The purpose of this study was to survey active members of the Swiss Society of General and Trauma Surgery (SGAUC) to determine their practices regarding the NOM of isolated splenic injuries. A survey of active SGAUC members with a written questionnaire was carried out. The questionnaire was designed to elicit information about personal and facility demographics, diagnostic practices, in-hospital management, preferred follow-up imaging and return to activity. Out of 165 SGAUC members 52 (31.5%) completed the survey and 62.8% of all main trauma facilities in Switzerland were covered by the sample. Of the respondents 14 (26.9%) have a protocol in place for treating patients with splenic injuries. For initial imaging in hemodynamically stable patients 82.7% of respondents preferred ultrasonography (US). In cases of suspected splenic injury 19.2% of respondents would abstain from further imaging. In cases of contrast extravasation from the spleen half of the respondents would take no specific action. For low-grade injuries 86.5% chose to admit patients for an average of 1.6 days (range 0-4 days) with a continuously monitored bed. No differences in post-discharge activity restrictions between moderate and high-grade splenic injuries were found. The present survey showed considerable practice variation in several important aspects of the NOM of splenic injuries. Not performing further CT scans in patients with suspected splenic injuries and not intervening in cases of a contrast extravasation were the most important discrepancies to the current literature. Standardization of the NOM of splenic injuries may be of great benefit for both surgeons and patients.

  14. Acquired ventricular septal defect: A rare sequel of blunt chest ...

    African Journals Online (AJOL)

    Ventricular septal defect (VSD) is the most common congenital cardiac lesion encountered worldwide. Only very rarely is it acquired, and causation through blunt injury in a child is extremely rare. A previously healthy 7‑year‑old boy suffered blunt chest trauma while at play. He presented 11 days later with features of acute ...

  15. Schematic X-ray diagnostic examination for the acute phase after a blunt thoraco-abdominal injury

    International Nuclear Information System (INIS)

    Kingma, L.M.

    1981-01-01

    The radiodiagnostic examination in the acute phase after a blunt thoracoabdominal injury can be made more reliable by repeating the examination after half an hour. The classical radiodiagnostic examination of the thorax and the abdomen is completed by a detail view of the upper abdomen. This X-ray plays a decisive part in the diagnosis of lesions of the liver, the spleen and both hemi-diafragms. The intravenous urogram is not only important because of the information gained about the condition of the urinary tract, but is also of great value to the management of shock and to regulate the infusion of fluids in the acute phase. One of the most important conclusions from this investigation is that the exclusion of pathology in trauma-patients is just as important as the demonstration of it. By ignoring the indications for urography and the significance of possible haematuria unnecessary loss of time can be avoided. The statistical relevance of the observations is shown in many examples, with the exception of the time-limits imposed in the selection of the patients. It could not be proved that the X-ray scheme is only of more value in the early post traumatic period. There was no correlation found between the passage of time since trauma and the significance of the results of the radiodiagnostic examination. Finally, advice is given about a scheme for the radiodiagnostic examination of patients with a blunt thoraco-abdominal injury, based upon the observations and conclusions in this dissertation. (Auth.)

  16. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

    Science.gov (United States)

    Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

    2015-01-01

    PURPOSE We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. METHODS Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTS The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSION Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury. PMID:26081719

  17. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT

    Directory of Open Access Journals (Sweden)

    Iyore AO James

    2014-01-01

    Full Text Available Clearance of cervical spine injury (CSI in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT, magnetic resonance imaging of the cervical spine (CS-MRI is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI website (www.ncbi.nlm.nih.gov for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%. The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%. Eleven patients (0.7% had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

  18. Localized fluid collection of hepatic bare area in children with blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myung Gi; Kim, Ji Hyung; Kim, Ok Hwa [School of Medicine, Ajou University, Suwon (Korea, Republic of)

    2000-06-01

    To investigate the incidence and significance of localized fluid collection in the hepatic bare area resulting from blunt abdominal trauma in children. We retrospectively reviewed the CT scans and medical records of eighty children with blunt abdominal trauma and evaluated the incidence of fluid collection in the hepatic bare area. The findings were correlated with the presence of injury to adjacent organs. Fluid collection in the hepatic bare area was noted in 23 of 80 patients (28.7%). Associated organ injuries included liver laceration (17/23), contusion of the right hemidiaphragm (7/23), right adrenal injury (5/23), and right renal injury (5/23). In one patient, organic injury was not detected in spite of fluid collection in the hepatic bare area. Eight of 23 patients (34.8%) showed fluid collection in this area, but not intraperitoneally. Fluid collection in the hepatic bare area after blunt abdominal trauma was noted in about 30% of patients and was frequently accompanied by injury to adjacent organs. Since right hemidiaphragmatic contusion associated with fluid collection in the bare area was not a uncommon CT finding, close observation of the condition is warranted. (author)

  19. Localized fluid collection of hepatic bare area in children with blunt abdominal trauma

    International Nuclear Information System (INIS)

    Kim, Myung Gi; Kim, Ji Hyung; Kim, Ok Hwa

    2000-01-01

    To investigate the incidence and significance of localized fluid collection in the hepatic bare area resulting from blunt abdominal trauma in children. We retrospectively reviewed the CT scans and medical records of eighty children with blunt abdominal trauma and evaluated the incidence of fluid collection in the hepatic bare area. The findings were correlated with the presence of injury to adjacent organs. Fluid collection in the hepatic bare area was noted in 23 of 80 patients (28.7%). Associated organ injuries included liver laceration (17/23), contusion of the right hemidiaphragm (7/23), right adrenal injury (5/23), and right renal injury (5/23). In one patient, organic injury was not detected in spite of fluid collection in the hepatic bare area. Eight of 23 patients (34.8%) showed fluid collection in this area, but not intraperitoneally. Fluid collection in the hepatic bare area after blunt abdominal trauma was noted in about 30% of patients and was frequently accompanied by injury to adjacent organs. Since right hemidiaphragmatic contusion associated with fluid collection in the bare area was not a uncommon CT finding, close observation of the condition is warranted. (author)

  20. Abdominal computed tomography scan as a screening tool in blunt trauma

    International Nuclear Information System (INIS)

    Brasel, K.J.; Borgstrom, D.C.; Kolewe, K.A.

    1997-01-01

    Background. One of the most difficult problems in blunt trauma is evaluation for potential intraabdominal injury. Admission for serial abdominal exams remains the standard of care after intraabdominal injury has been initially excluded. We hypothesized a normal abdominal computed tomography (CT) scan in a subgroup of minimally injured patients would obviate admission for serial abdominal examinations, allowing safe discharge from the emergency department (ED). Methods. We reviewed our blunt trauma experience with patients admitted solely for serial abdominal examinations after a normal CT. Patients were identified from the trauma registry at a Level 1 trauma center from July 1991 through June 1995. Patients with abnormal CTs, extra-abdominal injuries necessitating admission, hemodynamic abnormalities, a Glasgow Coma Scale less than 13, or injury severity scores (ISSs) greater than 15 were excluded. Records of 238 patients remained; we reviewed them to determine the presence of missed abdominal injury. Results. None of the 238 patients had a missed abdominal injury. Average ISS of these patients was 3.2 (range, 0 to 10). Discharging these patients from the ED would result in a yearly cost savings of $32,874 to our medical system. Conclusions. Abdominal CT scan is a safe and cost-effective screening tool in patients with blunt trauma. A normal CT scan in minimally injured patients allows safe discharge from the ED. (authors)

  1. CT of blunt hepatic trauma in children

    International Nuclear Information System (INIS)

    Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Omura, Makoto; Nishio, Yoshinori; Watanabe, Shinsuke.

    1991-01-01

    CT findings of blunt hepatic trauma were studied in 27 children. Liver injury was classified into 3 types from mild to severe. Liver contusion was observed in 1, liver laceration in 21, and liver rupture in 5. Only 2 patients (7.4%) required surgery, and the others could be managed by conservative therapy. CT, which accurately reveals not only the severity of liver injury but also injuries of other abdominal organs and intraperitoneal bleeding, is important for the diagnosis of liver injury and determination of its treatment. (author)

  2. Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Daniel H. Wolbrom

    2016-01-01

    Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

  3. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis.

    Science.gov (United States)

    Duchesne, Juan C; Simmons, Jon D; Schmieg, Robert E; McSwain, Norman E; Bellows, Charles F

    2008-12-01

    Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy. A retrospective cohort analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years. The cohorts were defined by two separate 30 month periods and included 78 patients seen before (group I) and 76 patients seen after (group II) the introduction of an institutional SAE protocol. Demographics, splenic injury grade, and outcomes of the two groups were compared using Student's t test, or chi2 test. Analysis was by intention-to-treat. Six hundred eighty-two patients with blunt splenic injury were identified; 154 patients (29%) were HDS with CT evidence of active contrast extravasation. Group I (n = 78) was treated with splenectomy and group II (n = 76) was treated with proximal SAE. There was no difference in age (33 +/- 14 vs. 37 +/- 17 years), Injury Severity Score (31 +/- 13 vs. 29 +/- 11), or mortality (18% vs. 15%) between the two groups. However, the incidence of Adult Respiratory Distress Syndrome (ARDS) was 4-fold higher in those patients that underwent proximal SAE compared with those that underwent splenectomy (22% vs. 5%, p = 0.002). Twenty two patients failed nonoperative management (NOM) after SAE. This failure appeared to be directly related to the grade of splenic organ injury (grade I and II: 0%; grade III: 24%; grade IV: 53%; and grade V: 100%). Introduction of proximal SAE in NOM of HDS splenic trauma patients with active extravasation did not alter mortality rates at a Level 1 Trauma Center. Increased incidence of ARDS and association of

  4. Transient electrocardiographic abnormalities following blunt chest trauma in a child

    NARCIS (Netherlands)

    Udink ten Cate, Floris; Heerde, van Marc; Rammeloo, Lukas; Hruda, Jaroslav

    2008-01-01

    Blunt cardiac injury may occur in patients after suffering nonpenetrating trauma of the chest. It encompasses a wide spectrum of cardiac injury with varied severity and clinical presentation. Electrocardiographic abnormalities are frequently encountered. This article presents a case of a child

  5. The usefulness of physical examination and laboratory data in pediatric patients with blunt abdominal trauma

    International Nuclear Information System (INIS)

    Muramori, Katsumi; Kondo, Tsuyoshi; Zaizen, Yoshio; Tsuno, Shinsuke

    2007-01-01

    To evaluate the usefulness of clinical and laboratory data in pediatric patients with abdominal blunt trauma, the case records of 43 pediatric cases with blunt trauma who were admitted to our hospital were reviewed retrospectively. Among these patients, 23 were determined to have intraabdominal injury. Abdominal physical examination was not statistically identified to be a predictor of intraabdominal injury, however, the hematocrit and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were significantly aberrant in these cases. Furthermore, the mean AST and ALT values in the non-hepatic injury cases were also apt to be higher than those in the no-injury group. These findings suggested that the serum AST and ALT may be possible predictors of intraabdominal injury, not only that restricted to the liver. Additionally, in our cases, abdominal CT examination was more diagnostic than ultrasound examination. Accordingly, in cases of pediatric abdominal blunt trauma with aberrant serum values of the liver transaminases, CT san should be performed electively. (author)

  6. CT-based injury classification

    International Nuclear Information System (INIS)

    Mirvis, S.E.; Whitley, N.O.; Vainright, J.; Gens, D.

    1988-01-01

    Review of preoperative abdominal CT scans obtained in adults after blunt trauma during a 2.5-year period demonstrated isolated or predominant liver injury in 35 patients and splenic injury in 33 patients. CT-based injury scores, consisting of five levels of hepatic injury and four levels of splenic injury, were correlated with clinical outcome and surgical findings. Hepatic injury grades I-III, present in 33 of 35 patients, were associated with successful nonsurgical management in 27 (82%) or with findings at celiotomy not requiring surgical intervention in four (12%). Higher grades of splenic injury generally required early operative intervention, but eight (36%) of 22 patients with initial grade III or IV injury were managed without surgery, while four (36%) of 11 patients with grade I or II injury required delayed celiotomy and splenectomy (three patients) or emergent rehospitalization (one patient). CT-based injury classification is useful in guiding the nonoperative management of blunt hepatic injury in hemodynamically stable adults but appears to be less reliable in predicting the outcome of blunt splenic injury

  7. Development of a murine model of blunt hepatic trauma.

    Science.gov (United States)

    Nemzek-Hamlin, Jean A; Hwang, Haejin; Hampel, Joseph A; Yu, Bi; Raghavendran, Krishnan

    2013-10-01

    Despite the prevalence of blunt hepatic trauma in humans, there are few rodent models of blunt trauma that can be used to study the associated inflammatory responses. We present a mouse model of blunt hepatic trauma that was created by using a cortical contusion device. Male mice were anesthetized with ketamine-xylazine-buprenorphine and placed in left lateral recumbency. A position of 2 mm ventral to the posterior axillary line and 5 mm caudal to the costal margin on the right side was targeted for impact. An impact velocity of 6 m/s and a piston depth of 12 mm produced a consistent pattern of hepatic injury with low mortality. All mice that recovered from anesthesia survived without complication for the length of the study. Mice were euthanized at various time points (n = 5 per group) until 7 d after injury for gross examination and collection of blood and peritoneal lavage fluids. Some mice were reanesthetized for serial monitoring of hepatic lesions via MRI. At 2 h after trauma, mice consistently displayed laceration, hematoma, and discoloration of the right lateral and caudate liver lobes, with intraabdominal hemorrhage but no other gross injuries. Blood and peritoneal lavage fluid were collected from all mice for cytokine analysis. At 2 h after trauma, there were significant increases in plasma IL10 as well as peritoneal lavage fluid IL6 and CXCL1/KC; however, these levels decreased within 24 h. At 7 d after trauma, the mice had regained body weight, and the hepatic lesions, which initially had increased in size during the first 48 h, had returned to their original size. In summary, this technique produced a reliable, low mortality, murine model that recreates features of blunt abdominal liver injury in human subjects with similar acute inflammatory response.

  8. Isolated jejunal perforation following blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Ahmet Pergel

    2012-09-01

    Full Text Available Isolated perforation of the jejunum, following blunt abdominaltrauma, is extremely rare. These injuries aredifficult to diagnose because initial clinical signs are frequentlynonspecific and a delay in treatment increasesmortality and morbidity of the patients. Conventional radiogramsare often inadequate for diagnosing this subsetof trauma. For an accurate and timely diagnosis, thepossibility of bowel perforation and the need for repeatedexaminations should be kept in mind. Herein, we presenta 28-year-old man with isolated jejunal perforation followingblunt abdominal trauma.Key words: Blunt abdominal trauma, isolated jejunal perforation,early diagnosis

  9. Treatment of air leak in polytrauma patients with blunt chest injury.

    Science.gov (United States)

    Halat, Gabriel; Negrin, Lukas L; Chrysou, Konstantina; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

    2017-09-01

    Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern. Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak. An evaluation of injury pattern, chest wall injuries in particular, duration of air leak, reason for drainage maintenance in place, hospital length of stay, ICU stay, ventilator duration, type of treatment, and the delay to surgical intervention was performed. Whereas 4 patients showed severe air leak and were subsequently scheduled for timely surgical intervention, the remaining 50 patients only showed minor air leak. Only 7 patients with minor air leak suffered from prolonged air leak (>5days), which spontaneously resolved in all of them after a mean duration of 7.7days (range 6-12days). Absence of a prolonged air leak resulted in a shorter length of stay and a shorter duration of mechanical ventilation, although no statistical significance was observed. Early spontaneous cessation of most minor air leaks as well as early surgical intervention for severe air leak lead to very satisfactory patient outcomes with a relatively short hospital stay in our patients. We therefore advocate early surgery for lacerations of the pulmonary parenchyma resulting in severe air leak, whereas minor air leaks can usually be treated conservatively. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Primary hepatic artery embolization in pediatric blunt hepatic trauma.

    Science.gov (United States)

    Ong, Caroline C P; Toh, Luke; Lo, Richard H G; Yap, Te-Lu; Narasimhan, Kannan

    2012-12-01

    Non-operative management of isolated blunt hepatic trauma is recommended except when hemodynamic instability requires immediate laparotomy. Hepatic artery angioembolization is increasingly used for hepatic injuries with ongoing bleeding as demonstrated by contrast extravasation on the CT scan. It is used primarily or after laparotomy to control ongoing hemorrhage. Hepatic angioembolization as part of multimodality management of hepatic trauma is reported mainly in adults, with few pediatric case reports. We describe our institution experience with primary pediatric hepatic angioembolization and review the literature with regard to indications and complications. Two cases (3 and 8 years old), with high-grade blunt hepatic injuries with contrast extravasation on the CT scan were successfully managed by emergency primary hepatic angioembolization with minimal morbidity and avoided laparotomy. To date, the only reports of pediatric hepatic angioembolization for trauma are 5 cases for acute bleeding and 15 delayed cases for pseudoaneurysm. The role of hepatic angioembolization in the presence of an arterial blush on CT in adults is accepted, but contested in a pediatric series, despite higher transfusion rate and mortality rate. We propose that hepatic angioembolization should be considered adjunct treatment, in lieu of, or in addition to emergency laparotomy for hemostasis in pediatric blunt hepatic injury. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Multidetector CT findings of bowel Transection in blunt abdominal trauma

    International Nuclear Information System (INIS)

    Cho, Hyun Suk; Woo, Ji Young; Hong, Hye Suk; Park, Mee Hyun; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji Young; Ha, Hong Il

    2013-01-01

    Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

  12. Nonoperative management for major blunt hepatic trauma. A case report.

    Science.gov (United States)

    Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania

    2015-03-16

    Over the past 20 years the management of blunt liver trauma has evolved from a primary operative approach to a nonoperative one, for both low and high grade injuries, only on the basis of hemodynamic stability. However, in spite of a high success rate of non operative management, it is frequently observed, also in our country, an old fashioned way to approach these patients, based on habit more than observation and evidence based medicine. We present a case of successful nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) in a 34-year-old woman. Nowadays more than 85% of liver injuries are managed without operative intervention, irrespective of the injury grade. Success rate of the conservative approach ranges from 82% to 100% and almost all complications (14% in high grade injuries) can be managed with interventional radiology procedures, still avoiding major surgery. Today, in the absence of other abdominal injuries requiring surgical exploration, hemodynamic instability from ongoing hemorrhage after primary evaluation and resuscitative treatment, is the only indication to an operative management of traumatic liver injuries.

  13. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    Energy Technology Data Exchange (ETDEWEB)

    Buch, Karen; Nguyen, Thanh; Norbash, Alex; Mian, Asim [Boston University School of Medicine, Department of Radiology, Boston Medical Center, Boston, MA (United States); Mahoney, Eric; Burke, Peter [Boston University School of Medicine, Department of Surgery, Boston Medical Center, Boston, MA (United States); Libby, Brandon; Calner, Paul [Boston University School of Medicine, Department of Emergency Medicine, Boston Medical Center, Boston, MA (United States)

    2016-02-15

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  14. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    International Nuclear Information System (INIS)

    Palas, J.; Matos, A.P.; Ramalho, M.; Mascarenhas, V.; Heredia, V.

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  15. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  16. Isolated Multiple Fragmented Cricoid Fracture Associated with External Blunt Neck Trauma: A Case Report

    International Nuclear Information System (INIS)

    Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Yong Hoon; Seo, Jung Wook; Cho, Hyeon Je; Kim, Yeon Soo

    2010-01-01

    Blunt laryngeal trauma is a relatively uncommon but possibly life-threatening injury. An isolated cricoid fracture associated with blunt trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that developed in a 20-year-old man after a blunt neck trauma that occurred during a baseball game and was diagnosed by 64-slice multidetector computed tomography (MDCT)

  17. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

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    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  18. Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

    International Nuclear Information System (INIS)

    Vlies, C. H. van der; Hoekstra, J.; Ponsen, K. J.; Reekers, J. A.; Delden, O. M. van; Goslings, J. C.

    2012-01-01

    Introduction: Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods: An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results: A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions: SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United States.

  19. Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures.

    Science.gov (United States)

    Ekpe, Eyo Effiong; Eyo, Catherine

    2017-01-01

    Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study. This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury. There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as "okada") and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates> 30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2of 96%. This improved after 1 h of administration of analgesics to SpO2of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2of 100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%-100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values> 100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%-100% predicted. Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through

  20. Unrecognized blunt tracheal trauma with massive pneumomediastinum and tension pneumothorax

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    Nanda Shetty

    2011-01-01

    Full Text Available Blunt neck trauma with an associated laryngotracheal injury is rare. We report a patient with blunt neck trauma who came to the emergency room and was sent to ward without realizing the seriousness of the situation. He presented later with respiratory distress and an anesthesiologist was called in for emergency airway management. Airway management in such a situation is described in this report.

  1. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

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    Galloway Robert

    2009-12-01

    Full Text Available Abstract Background Blunt Traumatic Pericardial Rupture (BTPR with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

  2. Delayed Stroke following Blunt Neck Trauma: A Case Illustration with Recommendations for Diagnosis and Treatment

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    Best Anyama

    2017-01-01

    Full Text Available Blunt cerebrovascular injury (BCVI to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of BCVI. In an effort to highlight this issue, we report the case of a 31-year-old male patient who presented with left-sided weakness consistent with transient ischemic attack (TIA and concussion. The patient’s symptoms occurred within 24 hours of a blunt neck injury sustained by a knee strike during a basketball game. An initial computerized tomography (CT scan of the brain was normal; a CT angiogram (CTA of the neck and carotids did not reveal obstruction, dissection, stenosis, or abnormalities of the carotid or vertebral vessels and the patient was subsequently discharged. A magnetic resonance imaging (MRI of the brain obtained four days after the initial injury demonstrated an acute infarct in the right middle cerebral artery (MCA territory. Thus, despite initial negative imaging, neurological deficits must be aggressively pursued in order to prevent stroke in BCVI cases.

  3. Studying morbidity and predicting mortality in patients with blunt chest trauma using a novel clinical score

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    Priyadarshini Manay

    2017-01-01

    Full Text Available Background: A departmental audit in March 2015 revealed significant mortality rate of 40% in blunt chest trauma patients (much greater than the global 25%. A study was thus planned to study morbidity and predictors of mortality in blunt chest trauma patients admitted to our hospital. Methods: This study was a prospective observational study of 139 patients with a history of blunt chest trauma between June 2015 and November 2015 after the Institutional Ethics Committee approval in April 2015. The sample size was calculated from the prevalence rate in our institute from the past medical records. Results: The morbidity factors following blunt chest injuries apart from pain were need for Intensive Care Unit stay, mechanical ventilation, and pneumonia/acute respiratory distress syndrome. Significant predictors of mortality in our study were SpO2 16, and need for mechanical ventilation. By calculating the likelihood ratios of each respiratory sign, a clinical score was devised. Conclusion: The modifiable factors affecting morbidity and mortality were identified. Mild to moderate chest injury due to blunt trauma is difficult to diagnose. The restoration of respiratory physiology has not only significant implications on recovery from chest injury but also all other injuries. It is our sincere hope that the score we have formulated will help reduce mortality and morbidity after further trials.

  4. Transection of the inferior vena cava from blunt thoracic trauma: case reports.

    Science.gov (United States)

    Peitzman, A B; Udekwu, A O; Pevec, W; Albrink, M

    1989-04-01

    Blunt thoracic trauma is a frequent cause of death in multiple trauma victims. Myocardial rupture may occur in up to 65% of patients who die with thoracic injuries. Two cases are presented with intrapericardial transection of the inferior vena cava, pericardial rupture, and myocardial rupture from blunt thoracic trauma. Both patients died.

  5. Retrospective Review of Pediatric Blunt Renal Trauma: A Single Institution's Five Year Experience.

    Science.gov (United States)

    Richards, Carly R; Clark, Margaret E; Sutherland, Ronald S; Woo, Russell K

    2017-05-01

    Children are at higher risk of renal injury from blunt trauma than adults due to a variety of anatomic factors such as decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. Non-operative management is gaining in popularity for even major injuries, although there are no universally accepted guidelines. We present a retrospective review of pediatric major blunt renal injuries (grade 3 or higher) at a children's hospital in Hawai'i over a 5-year period. Medical records were examined between January 2009 and September 2014 from Kapi'olani Medical Center for Women and Children in Honolulu, Hawai'i. Inclusion criteria were a diagnosis of renal trauma, or the diagnosis of blunt abdominal trauma with hematuria. Exclusion criteria were grade I or II renal injury or death due to an additional traumatic injury. Mechanism of injury, clinical characteristics on admission, blood product requirements, surgical interventions performed, and hospital length of stay were retrospectively analyzed. Eleven total patient records were examined, nine of which fit inclusion criteria. Uniquely, 33% of patients sustained their renal injury while surfing. No patients required laparotomy or nephrectomy, though 22% of patients received a blood transfusion and 44% of patients underwent ureteral stent placement. Non-operative management of major renal injuries in children is feasible and allows for preservation of renal tissue. A novel mechanism of surfing as a cause of major renal trauma is seen in the state of Hawai'i.

  6. Retrospective Review of Pediatric Blunt Renal Trauma: A Single Institution's Five Year Experience

    Science.gov (United States)

    Clark, Margaret E; Sutherland, Ronald S; Woo, Russell K

    2017-01-01

    Children are at higher risk of renal injury from blunt trauma than adults due to a variety of anatomic factors such as decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. Non-operative management is gaining in popularity for even major injuries, although there are no universally accepted guidelines. We present a retrospective review of pediatric major blunt renal injuries (grade 3 or higher) at a children's hospital in Hawai‘i over a 5-year period. Medical records were examined between January 2009 and September 2014 from Kapi‘olani Medical Center for Women and Children in Honolulu, Hawai‘i. Inclusion criteria were a diagnosis of renal trauma, or the diagnosis of blunt abdominal trauma with hematuria. Exclusion criteria were grade I or II renal injury or death due to an additional traumatic injury. Mechanism of injury, clinical characteristics on admission, blood product requirements, surgical interventions performed, and hospital length of stay were retrospectively analyzed. Eleven total patient records were examined, nine of which fit inclusion criteria. Uniquely, 33% of patients sustained their renal injury while surfing. No patients required laparotomy or nephrectomy, though 22% of patients received a blood transfusion and 44% of patients underwent ureteral stent placement. Non-operative management of major renal injuries in children is feasible and allows for preservation of renal tissue. A novel mechanism of surfing as a cause of major renal trauma is seen in the state of Hawai‘i. PMID:28484665

  7. Development of a computer model to predict aortic rupture due to impact loading.

    Science.gov (United States)

    Shah, C S; Yang, K H; Hardy, W; Wang, H K; King, A I

    2001-11-01

    Aortic injuries during blunt thoracic impacts can lead to life threatening hemorrhagic shock and potential exsanguination. Experimental approaches designed to study the mechanism of aortic rupture such as the testing of cadavers is not only expensive and time consuming, but has also been relatively unsuccessful. The objective of this study was to develop a computer model and to use it to predict modes of loading that are most likely to produce aortic ruptures. Previously, a 3D finite element model of the human thorax was developed and validated against data obtained from lateral pendulum tests. The model included a detailed description of the heart, lungs, rib cage, sternum, spine, diaphragm, major blood vessels and intercostal muscles. However, the aorta was modeled as a hollow tube using shell elements with no fluid within, and its material properties were assumed to be linear and isotropic. In this study fluid elements representing blood have been incorporated into the model in order to simulate pressure changes inside the aorta due to impact. The current model was globally validated against experimental data published in the literature for both frontal and lateral pendulum impact tests. Simulations of the validated model for thoracic impacts from a number of directions indicate that the ligamentum arteriosum, subclavian artery, parietal pleura and pressure changes within the aorta are factors that could influence aortic rupture. The model suggests that a right-sided impact to the chest is potentially more hazardous with respect to aortic rupture than any other impact direction simulated in this study. The aortic isthmus was the most likely site of aortic rupture regardless of impact direction. The reader is cautioned that this model could only be validated on a global scale. Validation of the kinematics and dynamics of the aorta at the local level could not be done due to a lack of experimental data. It is hoped that this model will be used to design

  8. Clinical value of different detection methods in blunt ocular trauma

    Directory of Open Access Journals (Sweden)

    Yang Li

    2018-02-01

    Full Text Available Blunt ocular can cause persistent change of eye structure and function, the method of detection which is closely related to eye injury including B-can ultrasonography, UBM, OCT, FFA, scanning laser polarimetry, fundus autofluorescence, each examination with particular emphasis. This paper aims to review the advantages and disadvantages of different inspection methods in order to provide reference for clinical diagnosis and treatment of blunt ocular trauma.

  9. Infrarenal Abdominal Aortic Pseudoaneurysm: Is It a Real Emergency?

    Science.gov (United States)

    Massara, Mafalda; Prunella, Roberto; Gerardi, Pasquale; Lillo, Antonio; De Caridi, Giovanni; Serra, Raffaele; Notarstefano, Stefano; Impedovo, Giovanni

    2017-01-01

    Abdominal aortic pseudoaneurysm is a rare but life-threatening condition that occurs due to penetrating or blunt trauma. Clinical manifestations are variable, and the time interval from the initial trauma to diagnosis is variable. A prompt diagnosis and an aggressive management approach are required to avoid catastrophic complications. Possible treatment options are open surgical repair, endovascular repair, pseudoanerysmal sac thrombosis induction through direct thrombin injection, and coil embolization. Here, we present the case of a 75-year-old man affected by an infrarenal abdominal aortic pseudoaneurysm presenting with abdominal and lumbar pain for 3 days, who was successfully treated with an endograft. PMID:29515707

  10. Screening ultrasonography of 2,204 patients with blunt abdominal trauma in the Wenchuan earthquake.

    Science.gov (United States)

    Zhou, Jixiang; Huang, Jiwei; Wu, Hong; Jiang, Hui; Zhang, Heqing; Prasoon, Pankaj; Xu, Yinglong; Bai, Yannan; Qiu, Jianguo; Zeng, Yong

    2012-10-01

    Abdominal injuries constitute a small proportion of all earthquake-related traumas; however, it often resulted in fatal hemorrhage. Ultrasonography has been described as an effective triage tool in the evaluation of blunt abdominal trauma. We aimed to present an overview of the diagnostic accuracy of screening ultrasonography for patients with blunt abdominal trauma admitted to various hospitals during the Wenchuan earthquake in China. We retrospectively analyzed the patients with blunt abdominal trauma who underwent ultrasonography after admission to various hospitals. Ultrasonography findings were considered positive if evidence of free fluid or a parenchymal injury was identified. Ultrasonography findings were compared with the findings of computed tomography, diagnostic peritoneal lavage, repeated ultrasonography, cystography, operation, and/or the clinical course. Findings from 2,204 ultrasonographic examinations were evaluated. Findings of 199 ultrasonographic examinations (9.0%) were considered positive. Of the patients, 12 (0.5%) had a false-negative ultrasonographic findings; of this group, 3 (25%) required exploratory laparotomy. Ultrasonography had a sensitivity of 91.9%, specificity of 96.9%, and an accuracy of 96.6% for detection of abdominal injuries. Positive predictive value was 68.3%, and negative predictive value was 99.4%. Screening ultrasonography is highly reliable in the setting of blunt abdominal trauma after earthquake. It should be used as an initial diagnostic modality in the evaluation of most blunt abdominal trauma. Diagnostic study, level III.

  11. CT diagnosis of blunt laryngeal trauma

    International Nuclear Information System (INIS)

    Kong Fanbin; Xia Ruigan; Hu Libin

    2000-01-01

    Objective: To analyze CT findings of blunt laryngeal trauma (BLT) and evaluate the value of CT in the diagnosis of BLT. Methods: CT diagnosis and treatment of 16 patients with BLT were reviewed. Results: Soft-tissue injuries were detected in five cases including swelling of the aryepiglottic folds, the false or true vocal cords and airway narrowing in four, and left cricoarytenoid dislocation and card paralysis in one. Supraglottic injuries in two cases including c fractures of the epiglottis in 2 and associated with a laceration of the aryepiglottic folds and the hypopharynx. Glottic injuries in four cases including ventricle fracture of the right thyroid ala in one and midline ventricle or comminute fractures of the thyroid cartilage in three, a square segment of cartilage was depressed into the larynx, and the true vocal cords and the anterior commissure were disrupted in one of this series. Subglottic injuries in five cases including cricoid ring fracture on the opposite side following a lateral force in one, with the fragment depressed into the larynx. Two showed marked comminution of the cricoid ring. Midline vertical fracture of the posterior cricoid plate associated with the laceration of the first tracheal ring in one, and one presented marked disruption of the right cricothyroid joint. Conclusion: CT clearly shows the extent of cartilaginous injury and displacement, related soft-tissue changes and the degree of resulting airway encroachment, and it may be successfully used to determine the need for open exploration and repair in selected cases of blunt trauma to the larynx

  12. Isolated Avulsion of the Common Hepatic Duct from Blunt Abdominal Trauma

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    Victor W. Wong

    2012-01-01

    Full Text Available Isolated extrahepatic biliary tract injury following blunt abdominal trauma is rare. The underlying pathogenic mechanisms remain obscure, but include shear and/or compression forces on the biliary system. Associated morbidity rates are high and largely the result of delays in diagnosis. Imaging modalities commonly employed for diagnosis include ultrasonography, computed tomography, nuclear medicine, and magnetic resonance imaging. Percutaneous and endoscopic techniques have been used both for diagnosis and treatment. Treatment options are dictated by the stability of the patient and the extent of bile duct and concomitant injuries. In this paper, we discuss a case of isolated avulsion of the hepatic duct confluence following blunt trauma that was successfully managed with Roux-en-Y hepaticojejunostomy. To our knowledge, this specific injury pattern has not been previously reported.

  13. Seatbelt sign in a case of blunt abdominal trauma; what lies beneath it?

    Science.gov (United States)

    Vailas, Michail G; Moris, Demetrios; Orfanos, Stamatios; Vergadis, Chrysovalantis; Papalampros, Alexandros

    2015-10-30

    The reported incidence of hollow viscus injuries (HVI) in blunt trauma patients is approximately 1%. The most common site of injury to the intestine in blunt abdominal trauma (BAT) is the small bowel followed by colon, with mesenteric injuries occurring three times more commonly than bowel injuries. Isolated colon injury is a rarely encountered condition. Clinical assessment alone in patients with suspected intestinal or mesenteric injury after blunt trauma is associated with unacceptable diagnostic delays. This is a case of a 31-year-old man, admitted to the emergency department after being the restrained driver, involved in a car accident. After initial resuscitation, focused assessment with sonography for trauma examination (FAST) was performed revealing a subhepatic mass, suspicious for intraperitoneal hematoma. A computed tomography scan (CT) that followed showed a hematoma of the mesocolon of the ascending colon with active extravasation of intravenous contrast material. An exploratory laparotomy was performed, hemoperitomeum was evacuated, and a subserosal hematoma of the cecum and ascending colon with areas of totally disrupted serosal wall was found. Hematoma of the adjacent mesocolon expanding to the root of mesenteric vessels was also noted. A right hemicolectomy along with primary ileocolonic anastomosis was performed. Patient's recovery progressed uneventfully. Identifying an isolated traumatic injury to the bowel or mesentery after BAT can be a clinical challenge because of its subtle and nonspecific clinical findings; meeting that challenge may eventually lead to a delay in diagnosis and treatment with subsequent increase in associated morbidity and mortality. Isolated colon injury is a rare finding after blunt trauma and usually accompanied by other intra-abdominal organ injuries. Abdominal 'seatbelt' sign, ecchymosis of the abdominal wall, increasing abdominal pain and distension are all associated with HVI. However, the accuracy of these findings

  14. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

    Science.gov (United States)

    Huang, Gregory S; Chance, Elisha A; Hileman, Barbara M; Emerick, Eric S; Gianetti, Emily A

    2017-01-01

    No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

  15. A patient education tool for nonoperative management of blunt abdominal trauma.

    Science.gov (United States)

    Budinger, Julie Marie

    2007-01-01

    Blunt trauma is the primary mechanism of injury seen at Charleston Area Medical Center, a rural level I trauma center. Blunt abdominal trauma occurs as a result of various mechanisms. It can be safely managed nonoperatively and is considered to be the standard of care in hemodynamically stable patients. Appropriate patient education before discharge will enable patients to identify complications early and seek appropriate medical care.

  16. Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury.

    Science.gov (United States)

    McBride, Cameron L; Dubose, Joseph J; Miller, Charles C; Perlick, Alexa P; Charlton-Ouw, Kristofer M; Estrera, Anthony L; Safi, Hazim J; Azizzadeh, Ali

    2015-01-01

    Thoracic endovascular aortic repair (TEVAR) is widely used for treatment of traumatic aortic injury (TAI). Stent graft coverage of the left subclavian artery (LSA) may be required in up to 40% of patients. We evaluated the long-term effects of intentional LSA coverage (LSAC) on symptoms and return to normal activity in TAI patients compared with a similarly treated group whose LSA was uncovered (LSAU). Patients were identified from a prospective institutional trauma registry between September 2005 and July 2012. TAI was confirmed using computed tomography angiography. The electronic medical records, angiograms, and computed tomography angiograms were reviewed in a retrospective fashion. In-person or telephone interviews were conducted using the SF-12v2 (Quality Metrics, Lincoln, RI) to assess quality of life. An additional questionnaire was used to assess specific LSA symptoms and the ability to return to normal activities. Data were analyzed by Spearman rank correlation and multiple linear and logistic regression analysis with appropriate transformations using SAS software (SAS Institute, Cary, NC). During the study period, 82 patients (57 men; mean age 40.5 ± 20 years, mean Injury Severity Score, 34 ± 10.0) underwent TEVAR for treatment of TAI. Among them, LSAC was used in 32 (39.5%) and LSAU in 50. A group of the LSAU patients (n = 22) served as matched controls in the analysis. We found no statistically significant difference in SF-12v2 physical health scores (ρ = -0.08; P = .62) between LSAC and LSAU patients. LSAC patients had slightly better mental health scores (ρ = 0.62; P = .037) than LSAU patients. LSAC patients did not have an increased likelihood of experiencing pain (ρ = -0.0056; P = .97), numbness (ρ = -0.12; P = .45), paresthesia (ρ = -0.11; P = .48), fatigue (ρ = -0.066; P = .69), or cramping (ρ = -0.12; P = .45). We found no difference between groups in the ability to return to activities. The mean follow-up time was 3.35 years. Six LSAC

  17. Conservative management of a grade V injury to an ectopic pelvic kidney following blunt trauma to the lower abdomen: a case report

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    Becker Adam M

    2010-07-01

    Full Text Available Abstract Introduction Ectopic pelvic kidneys represent an anatomic variant that remains clinically asymptomatic in most patients. While there is some literature to suggest that ectopic kidneys may be more predisposed to blunt trauma injuries, there are few examples to guide the management of these injuries. To our knowledge, we present the first case of a grade V renal injury to an ectopic pelvic kidney managed successfully with conservative measures. Case Presentation We present a case of grade V renal injury to an ectopic pelvic kidney in a 21 year-old African-American male. The clinical and radiographic findings are presented, along with the patient's conservative hospital course. Conclusion We suggest that management of grade V renal injuries to ectopic pelvic kidneys can be treated similarly to that of kidneys in normal anatomic position. Conservative measures may be considered in properly selected patients.

  18. Aortic ruptures in seat belt wearers.

    Science.gov (United States)

    Arajärvi, E; Santavirta, S; Tolonen, J

    1989-09-01

    Several investigations have indicated that rupture of the thoracic aorta is one of the leading causes of immediate death in victims of road traffic accidents. In Finland in 1983, 92% of front-seat passengers were seat belt wearers on highways and 82% in build-up areas. The mechanisms of rupture of the aorta have been intensively investigated, but the relationship between seat belt wearing and injury mechanisms leading to aortic rupture is still largely unknown. This study comprises 4169 fatally injured victims investigated by the Boards of Traffic Accident Investigation of Insurance Companies during the period 1972 to 1985. Chest injuries were recorded as the main cause of death in 1121 (26.9%) victims, 207 (5.0%) of those victims having worn a seat belt. Aortic ruptures were found at autopsy in 98 victims and the exact information of the location of the aortic tears was available in 68. For a control group, we analyzed 72 randomly chosen unbelted victims who had a fatal aortic rupture in similar accidents. The location of the aortic rupture in unbelted victims was more often in the ascending aorta, especially in drivers, whereas in seat belt wearers the distal descending aorta was statistically more often ruptured, especially in right-front passengers (p less than 0.05). The steering wheel predominated statistically as the part of the car estimated to have caused the injury in unbelted victims (37/72), and some interior part of the car was the most common cause of fatal thoracic impacts in seat belt wearers (48/68) (p less than 0.001). The mechanism of rupture of the aorta in the classic site just distal to the subclavian artery seems to be rapid deceleration, although complex body movements are also responsible in side impact collisions. The main mechanism leading to rupture of the ascending aorta seems to be severe blow to the bony thorax. This also often causes associated thoracic injuries, such as heart rupture and sternal fracture. Injuries in the ascending

  19. Partial Avulsion of Common Bile Duct and Duodenal Perforation in a Blunt Abdominal Trauma

    OpenAIRE

    Mirza, Bilal; Ijaz, Lubna; Iqbal, Shahid; Sheikh, Afzal

    2010-01-01

    Complete or partial avulsion of common bile duct is a very rare injury following blunt abdominal trauma in children. A 7-year old boy presented to ER following blunt abdominal trauma by a moving motorcycle. X ray abdomen revealed free air under diaphragm and CT scan showed pancreatic contusion injury. At operation anterior wall of common bile duct (CBD) along with a 2mm rim of duodenal tissue on either side of anterior wall of CBD were found avulsed from the duodenum. The avulsed portion of C...

  20. Non-operative management (NOM) of blunt hepatic trauma: 80 cases.

    Science.gov (United States)

    Özoğul, Bünyami; Kısaoğlu, Abdullah; Aydınlı, Bülent; Öztürk, Gürkan; Bayramoğlu, Atıf; Sarıtemur, Murat; Aköz, Ayhan; Bulut, Özgür Hakan; Atamanalp, Sabri Selçuk

    2014-03-01

    Liver is the most frequently injured organ upon abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention. A total of 80 patients with blunt liver injury who were hospitalized to the general surgery clinic or other clinics due to the concomitant injuries were followed non-operatively. The normally distributed numeric variables were evaluated by Student's t-test or one way analysis of variance, while non-normally distributed variables were analyzed by Mann-Whitney U-test or Kruskal-Wallis variance analysis. Chi-square test was also employed for the comparison of categorical variables. Statistical significance was assumed for phepatic trauma seems to be the gold standard.

  1. Pneumothorax and subcutaneous emphysema secondary to blunt chest injury

    OpenAIRE

    Porhomayon, Jahan; Doerr, Ralph

    2011-01-01

    This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process.

  2. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND

  3. Blunt Facial Trauma Causing Isolated Optic Nerve Hematoma

    Directory of Open Access Journals (Sweden)

    R. Parab

    2013-01-01

    Full Text Available Traumatic optic neuropathy is an uncommon, yet serious, result of facial trauma. The authors present a novel case of a 59-year-old gentleman who presented with an isolated blunt traumatic left optic nerve hematoma causing vision loss. There were no other injuries or fractures to report. This case highlights the importance of early recognition of this rare injury and reviews the current literature and management of traumatic optic neuropathy.

  4. Computed tomography of the chest in blunt thoracic trauma: results of a prospective study

    International Nuclear Information System (INIS)

    Blostein, P.; Hodgman, C.

    1998-01-01

    Blunt thoracic injuries detected by computed tomography of the chest infrequently require immediate therapy. If immediate therapy is needed, findings will be visible on plain roentgenograms or on clinical exam. Routine Computed Tomography of the chest in blunt trauma is not recommended but may be helpful in selected cases. (N.C.)

  5. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

    Science.gov (United States)

    Martínez-Pérez, R; Paredes, I; Cepeda, S; Ramos, A; Castaño-León, A M; García-Fuentes, C; Lobato, R D; Gómez, P A; Lagares, A

    2014-05-01

    In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies

  6. Criteria for the selective use of chest computed tomography in blunt trauma patients

    International Nuclear Information System (INIS)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G.; Deunk, Jaap; Edwards, Michael J.R.; Vugt, Arie B. van; Kuijk, Cornelis van

    2010-01-01

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  7. Criteria for the selective use of chest computed tomography in blunt trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G. [Radboud University Nijmegen, Medical Centre, Department of Radiology, Nijmegen (Netherlands); Deunk, Jaap; Edwards, Michael J.R. [Radboud University Nijmegen, Medical Centre, Department of Surgery, Nijmegen (Netherlands); Vugt, Arie B. van [Radboud University Nijmegen, Medical Centre Nijmegen, Department of Emergency Medicine, Nijmegen (Netherlands); Kuijk, Cornelis van [VU (Vrije Universiteit) University, Medical Center Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2010-04-15

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients ({>=}16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age {>=}55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with {>=}1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  8. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

    Science.gov (United States)

    Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

    2015-12-01

    patients with occult injury (of 1,454, 13.9%) had major interventions, 343 of 1,454 (23.6%) had minor interventions, and 909 (62.5%) had no intervention. Patients with occult injury included 514 with pulmonary contusions (of 682 total, 75.4% occult), 405 with pneumothorax (of 597 total, 67.8% occult), 184 with hemothorax (of 230 total, 80.0% occult), those with greater than 2 rib fractures (n=672/1,120, 60.0% occult) or sternal fracture (n=269/281, 95.7% occult), 12 with great vessel injury (of 18 total, 66.7% occult), 5 with diaphragm injury (of 6, 83.3% occult), and 537 with multiple occult injuries. Interventions for patients with occult injury included mechanical ventilation for 31 of 514 patients with pulmonary contusion (6.0%), chest tube for 118 of 405 patients with pneumothorax (29.1%), and 75 of 184 patients with hemothorax (40.8%). Inpatient pain control or observation greater than 24 hours was conducted for 183 of 672 patients with rib fractures (27.2%) and 79 of 269 with sternal fractures (29.4%). Three of 12 (25%) patients with occult great vessel injuries had surgery. Repeated imaging was conducted for 50.6% of patients with occult injury (88.1% chest radiography, 11.9% chest CT, 7.5% both). For patients with occult injury, 90.9% (1,321/1,454) were admitted, with 9.1% observed in the ED for median 6.9 hours. Forty-four percent of observed patients were then admitted (4.0% of patients with occult injury). In a more seriously injured subset of patients with blunt trauma who had both chest radiography and chest CT, occult injuries were found by chest CT in 71% of those with thoracic injuries and one fourth of all those with blunt chest trauma. More than one third of occult injury had intervention (37.5%). Chest tubes composed 76.2% of occult injury major interventions, with observation or inpatient pain control greater than 24 hours in 32.4% of occult fractures. Only 1 in 20 patients with occult injury was discharged home from the ED. For these patients with

  9. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center.

    Science.gov (United States)

    Garvey, Erin M; Haakinson, Danielle J; McOmber, Mark; Notrica, David M

    2015-02-01

    There is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma. A retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed. There were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days. Pediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it.

    Science.gov (United States)

    Paulus, Elena M; Fabian, Timothy C; Savage, Stephanie A; Zarzaur, Ben L; Botta, Vandana; Dutton, Wesley; Croce, Martin A

    2014-02-01

    Aggressive screening to diagnose blunt cerebrovascular injury (BCVI) results in early treatment, leading to improved outcomes and reduced stroke rates. While computed tomographic angiography (CTA) has been widely adopted for BCVI screening, evidence of its diagnostic sensitivity is marginal. Previous work from our institution using 32-channel multidetector CTA in 684 patients demonstrated an inadequate sensitivity of 51% (Ann Surg. 2011,253: 444-450). Digital subtraction angiography (DSA) continues to be the reference standard of diagnosis but has significant drawbacks of invasiveness and resource demands. There have been continued advances in CT technology, and this is the first report of an extensive experience with 64-channel multidetector CTA. Patients screened for BCVI using CTA and DSA (reference) at a Level 1 trauma center during the 12-month period ending in May 2012 were identified. Results of CTA and DSA, complications, and strokes were retrospectively reviewed and compared. A total of 594 patients met criteria for BCVI screening and underwent both CTA and DSA. One hundred twenty-eight patients (22% of those screened) had 163 injured vessels: 99 (61%) carotid artery injuries and 64 (39%) vertebral artery injuries. Sixty-four-channel CTA demonstrated an overall sensitivity per vessel of 68% and specificity of 92%. The 52 false-negative findings on CTA were composed of 34 carotid artery injuries and 18 vertebral artery injuries; 32 (62%) were Grade I injuries. Overall, positive predictive value was 36.2%, and negative predictive value was 97.5%. Six procedure-related complications (1%) occurred with DSA, including two iatrogenic dissections and one stroke. Sixty-four-channel CTA demonstrated a significantly improved sensitivity of 68% versus the 51% previously reported for the 32-channel CTA (p = 0.0075). Sixty-two percent of the false-negative findings occurred with low-grade injuries. Considering complications, cost, and resource demand associated with

  11. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem?

    Science.gov (United States)

    Chrysou, Konstantina; Halat, Gabriel; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

    2017-04-20

    Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included. A total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AIS thorax 3), 19.1% a severe chest injury (AIS thorax 4) and 15.5% a moderate chest injury (AIS thorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AIS thorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AIS thorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality. Although 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AIS

  12. Base Deficit as an Indicator of Significant Blunt Abdominal Trauma

    African Journals Online (AJOL)

    multiruka1

    important cause of morbidity and mortality among trauma patients. ... the use of BD as an indicator of significant BAT. Methods: ... Key words: Base deficit, Blunt abdominal trauma,. Predictor. ..... Delineate Risk for Torso Injury in Stable Patients.

  13. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

    International Nuclear Information System (INIS)

    Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

    2009-01-01

    Aim: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. Methods: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2 x 2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Results: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). Conclusion: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients

  14. Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the ''fallen lung'' sign

    International Nuclear Information System (INIS)

    Wintermark, M.; Schnyder, P.; Wicky, S.

    2001-01-01

    Tracheo-bronchial injuries occur in less than 1 % of blunt chest trauma patients. Indirect signs, such as pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, are revealed on admission plain films and chest CT survey. In most instances, however, tracheo-bronchoscopy is mandatory in assessing the definite diagnosis of tracheo-bronchial lesion. Occasionally, an abnormal course of a mainstem bronchus or a ''fallen lung'' sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury. (orig.)

  15. Factors Associated with ICU Admission following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Andrea Bellone

    2016-01-01

    Full Text Available Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1% were admitted to intensive care unit (ICU within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p=0.0018 and the severity of trauma score (p<0.0002 were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

  16. Surgical repair of right atrial wall rupture after blunt chest trauma.

    Science.gov (United States)

    Telich-Tarriba, Jose E; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.

  17. Pneumoperitoneum in a patient with pneumothorax and blunt neck trauma

    Directory of Open Access Journals (Sweden)

    Suhail Yaqoob Hakim

    2014-01-01

    CONCLUSION: Free air in the abdomen after blunt traumatic neck injury is very rare. If pneumoperitoneum is suspected in the presence of pneumothorax, exploratory laparotomy should be performed to rule out intraabdominal injury. As, there is no consensus for this plan yet, further prospective studies are warrant. Conservative management for pneumoperitoneum in the absence of viscus perforation is still a safe option in carefully selected cases.

  18. Radiology of blunt chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Shulman, H.S.; Samuels, T.H. (Sunnybrook Medical Centre, Toronto, Ontario (Canada))

    1983-09-01

    Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronhcial rupture and diaphragmatic rupture.

  19. Unusual blunt force wound produced by a gun muzzle.

    Science.gov (United States)

    Hanzlick, R; Zaki, S A

    1986-09-01

    Most blunt force injuries produced by guns are associated with gun butts, and patterned, muzzle/sight impressions are usually produced by discharging firearms. An unusual and distinct forehead laceration produced by a blow with the muzzle end of a .32 caliber revolver is presented.

  20. Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease.

    Science.gov (United States)

    Piffaretti, Gabriele; Bonardelli, Stefano; Bellosta, Raffaello; Mariscalco, Giovanni; Lomazzi, Chiara; Tolenaar, Jip L; Zanotti, Camilla; Guadrini, Cristina; Sarcina, Antonio; Castelli, Patrizio; Trimarchi, Santi

    2014-10-01

    The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease. We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair. Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P=.046); open surgical repair of the abdominal aortic disease was associated with a higher risk of spinal cord injury but did not reach statistical significance (odds ratio, 0.16; 95% confidence interval, 0.02-1.06; P=.057). Actuarial survival estimates at 1, 2, and 5 years after the procedure were 80%±5%, 68%±6%, and 63%±7%, respectively. Spinal cord injury did not impair survival (P=.885). In our experience, the risk of spinal cord injury is still substantial at 8% in patients with multilevel aortic disease. The distance of the distal landing zone from the celiac trunk is a significant predictor of spinal cord ischemia. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  1. Blunt Splenic Trauma in Children : Are We Too Careful?

    NARCIS (Netherlands)

    De Jong, W. J. J.; Nellensteijn, D. R.; ten Duis, H. J.; Albers, M. J. I. J.; El Moumni, M.; Hulscher, J. B. F.

    Introduction: There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT. Patients and Methods: The data

  2. Ocular Injury

    Science.gov (United States)

    ... trauma can happen at home, school, play or sports. Most common injuries are scratches to the cornea or blunt trauma. Approved and tested eye and face protection is essential to prevent injuries. Sports such as hockey, baseball, racquet ball, squash, and ...

  3. The radiology of blunt chest trauma

    International Nuclear Information System (INIS)

    Shulman, H.S.; Samuels, T.H.

    1983-01-01

    Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronhcial rupture and diaphragmatic rupture

  4. Initial screening test for blunt cerebrovascular injury: Validity assessment of whole-body computed tomography.

    Science.gov (United States)

    Laser, Adriana; Kufera, Joseph A; Bruns, Brandon R; Sliker, Clint W; Tesoriero, Ronald B; Scalea, Thomas M; Stein, Deborah M

    2015-09-01

    Our whole-body computed tomography protocol (WBCT), used to image patients with polytrauma, consists of a noncontrast head computed tomography (CT) followed by a multidetector computed tomography (40- or 64- slice) that includes an intravenous, contrast-enhanced scan from the face through the pelvis. WBCT is used to screen for blunt cerebrovascular injury (BCVI) during initial CT imaging of the patient with polytrauma and allows for early initiation of therapy with the goal of avoiding stroke. WBCT has not been directly compared with CT angiography (CTA) of the neck as a screening tool for BCVI. We hypothesize that WBCT is a valid modality to diagnose BCVI compared with neck CTA, thus screening patients with polytrauma for BCVI and limiting the need for subsequent CTA. A retrospective review of the trauma registry was conducted for all patients diagnosed with BCVI from June 2009 to June 2013 at our institution. All injuries, identified and graded on initial WBCT, were compared with neck CTA imaging performed within the first 72 hours. Sensitivity was calculated for WBCT by the use of CTA as the reference standard. Proportions of agreement also were calculated between the grades of injury for both imaging modalities. A total of 319 injured vessels were identified in 227 patients. On initial WBCT 80 (25%) of the injuries were grade I, 75 (24%) grade II, 45 (14%) grade III, 41 (13%) grade IV, and 58 (18%) were classified as indeterminate: 27 vertebral and 31 carotid lesions. Twenty (6%) of the 319 injuries were not detected on WBCT but identified on subsequent CTA (9 grade I, 7 grade II, 4 grade III); 6 vertebral and 14 carotid. For each vessel type and for all vessels combined, WBCT demonstrated sensitivity rates of over 90% to detect BCVI among the population of patients with at least one vessel injured. There was concordant grading of injuries between WBCT and initial diagnostic CTA in 154 (48% of all injuries). Lower grade injures were more discordant than higher

  5. Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Gregory Mansella

    2014-01-01

    Full Text Available Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

  6. Hemobilia as a late complication after blunt abdominal trauma: a case report and review of the literature.

    NARCIS (Netherlands)

    Schouten van der Velden, A.P.; Ruijter, W.M.J. de; Janssen, C.M.M.; Schultze Kool, L.J.; Tan, E.C.T.H.

    2010-01-01

    BACKGROUND: Bleeding within the biliary tree, called hemobilia, is a rare complication after blunt hepatic trauma. OBJECTIVES: To report on a patient who developed hemobilia 1 month after a blunt abdominal injury and to discuss the diagnosis and treatment of hemobilia. CASE REPORT: A 17-year-old boy

  7. Nonoperative management for patients with grade IV blunt hepatic trauma

    Directory of Open Access Journals (Sweden)

    Zago Thiago

    2012-08-01

    Full Text Available Abstract Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5% who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%; one patient developed a tracheal stenosis (secondary to tracheal intubation; one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  8. Nonoperative management for patients with grade IV blunt hepatic trauma.

    Science.gov (United States)

    Zago, Thiago Messias; Tavares Pereira, Bruno Monteiro; Araujo Calderan, Thiago Rodrigues; Godinho, Mauricio; Nascimento, Bartolomeu; Fraga, Gustavo Pereira

    2012-08-22

    The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  9. Risk factors for mortality in blunt abdominal trauma with surgical approach

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    SILVANIA KLUG PIMENTEL

    Full Text Available ABSTRACTObjective:identify risk factors for mortality in patients who underwent laparotomy after blunt abdominal trauma.Methods:retrospective study, case-control, which were reviewed medical records of blunt trauma victims patients undergoing laparotomy, from March 2013 to January 2015, and compared the result of the deaths group with the group healed.Results:of 86 patients, 63% were healed, 36% died, and one patient was excluded from the study. Both groups had similar epidemiology and trauma mechanism, predominantly young adults males, automobilistic accident. Most cases that evolved to death had hemodynamic instability as laparotomy indication - 61% against 38% in the other group (p=0.02. The presence of solid organ injury was larger in the group of deaths - 80% versus 48% (p=0.001 and 61% of them had other associated abdominal injury compared to 25% in the other group (p=0.01. Of the patients who died 96% had other serious injuries associated (p=0.0003. Patients requiring damage control surgery had a higher mortality rate (p=0.0099. Only one of 18 patients with isolated hollow organ lesion evolved to death (p=0.0001. The mean injury score of TRISS of cured (91.70% was significantly higher than that of deaths (46.3% (p=0.002.Conclusion:the risk factors for mortality were hemodynamic instability as an indication for laparotomy, presence of solid organ injury, multiple intra-abdominal injuries, need for damage control surgery, serious injury association and low index of trauma score.

  10. When Physics Meets Biology: Low and High Velocity Penetration, Blunt Trauma and Blast Injuries to the Brain

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    Leanne eYoung

    2015-05-01

    Full Text Available The incidence of TBI in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impact, and blast. Most generally, TBI is a condition in which physical loads exceed the capacity of brain tissues to absorb without injury. More specifically, TBI results when sufficient external force is applied to the head and is subsequently converted into stresses that must be absorbed or redirected by protective equipment. If the stresses are not sufficiently absorbed or redirected, they will lead to damage of extracranial soft tissue and the skull. Complex interactions and kinematics of the head, neck and jaw cause strains within the brain tissue, resulting in structural, anatomical damage that is characteristic of the inciting insult. This mechanical trauma then initiates a neuro-chemical cascade that leads to the functional consequences of TBI, such as cognitive impairment. To fully understand the mechanisms by which TBI occurs, it is critically important to understand the effects of the loading environments created by these threats. In the following, a review is made of the pertinent complex loading conditions and how these loads cause injury. Also discussed are injury thresholds and gaps in knowledge, both of which are needed to design improved protective systems.

  11. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

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    Tabet A. Al-Sadek

    2016-11-01

    CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries, but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.

  12. Hepatic hydrothorax after blunt chest trauma

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    Shang-Chiung Wang

    2012-08-01

    Full Text Available We report a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. This was a female patient with liver cirrhosis, Child–Turcotte–Pugh class A, without ascites before injury. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually. We inserted a chest tube to relieve the patient's symptoms, and the daily drainage amount remained consistent. Hepatic hydrothorax was confirmed by the intraperitoneal injection of radioisotope 99mTc-sulfur colloid that demonstrated one-way transdiaphragmatic flow of fluid from the peritoneal cavity to pleural cavities. Finally, the hydrothorax was treated successfully by minocycline-induced pleural symphysis. To the best of our knowledge, this is the first case of hepatic hydrothorax developed after thoracoabdominal trauma.

  13. Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma

    International Nuclear Information System (INIS)

    Krohmer, Steven J.; Hoffer, Eric K.; Burchard, Kenneth W.

    2010-01-01

    Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19-49 years) presented with acute onset of pain 5-70 days after blunt trauma to the left upper quadrant. Two had known splenic injuries that had been managed nonoperatively. All had computed axial tomography evidence of active splenic hemorrhage or false aneurysm on representation. All underwent successful SAE. Follow-up ranged from 28 to 370 days. These cases and a review of the literature indicate that SAE is safe and effective for NOM failure caused by delayed manifestations of splenic arterial injury.

  14. Gastric traumatic injuries: CT findings

    International Nuclear Information System (INIS)

    Lassandro, Francesco; Romano, Stefania; Rossi, Giovanni; Muto, Roberto; Cappabianca, Salvatore; Grassi, Roberto

    2006-01-01

    Objective: Gastric blunt traumatic injuries are uncommon and their radiological appearance has been infrequently reported in medical literature. These injuries are difficult to diagnose preoperatively, though they require immediate recognition to minimize their otherwise high mortality and morbidity. The aim of our study is to describe the radiological appearance of blunt gastric traumatic injuries. Materials and methods: Retrospective evaluation of a 25 patients series observed between January 1997 and May 2005. Results: We observed rupture of the stomach in 20% of cases, in 44% of cases a partial lesion of the stomach, in one case a necrotic post-traumatic volvulus, five patients (20%) had benign portal pneumatosis, in three patients the stomach was secondarily involved because of a diaphragmatic hernia. The fundus resulted to be the most frequently damaged part of the stomach (80%). Conclusions: Blunt traumatic injuries need a careful and systematic approach given their economical and social relevance. For these reasons uncommon lesions require attention and may be important to search for specific findings of gastric lesions

  15. Gastric traumatic injuries: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lassandro, Francesco [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, I-80131 Naples (Italy)]. E-mail: francesco.lassandro@fastwebnet.it; Romano, Stefania [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Rossi, Giovanni [Department of Radiology, V. Monaldi Hospital, Naples (Italy); Muto, Roberto [Department of Radiology, V. Monaldi Hospital, Naples (Italy); Cappabianca, Salvatore [Magrassi-Lanzara Department, Institute of Radiology, Second University of Naples (Italy); Grassi, Roberto [Magrassi-Lanzara Department, Institute of Radiology, Second University of Naples (Italy)

    2006-09-15

    Objective: Gastric blunt traumatic injuries are uncommon and their radiological appearance has been infrequently reported in medical literature. These injuries are difficult to diagnose preoperatively, though they require immediate recognition to minimize their otherwise high mortality and morbidity. The aim of our study is to describe the radiological appearance of blunt gastric traumatic injuries. Materials and methods: Retrospective evaluation of a 25 patients series observed between January 1997 and May 2005. Results: We observed rupture of the stomach in 20% of cases, in 44% of cases a partial lesion of the stomach, in one case a necrotic post-traumatic volvulus, five patients (20%) had benign portal pneumatosis, in three patients the stomach was secondarily involved because of a diaphragmatic hernia. The fundus resulted to be the most frequently damaged part of the stomach (80%). Conclusions: Blunt traumatic injuries need a careful and systematic approach given their economical and social relevance. For these reasons uncommon lesions require attention and may be important to search for specific findings of gastric lesions.

  16. Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

    Science.gov (United States)

    Bertens, K A; Vogt, K N; Hernandez-Alejandro, R; Gray, D K

    2015-02-01

    A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE). A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality. We identified 396 patients with a mean ISS of 33 (± 14). Sixty-two (18%) patients had severe liver injuries (≥ AAST grade IV). OM occurred in 109 (27%) patients. Logistic regression revealed high ISS (OR 1.07; 95% CI 1.05-1.10), and lower systolic blood pressure on arrival (OR 0.98; 95% CI 0.97-0.99) to be associated with OM. The overall mortality was 17%. Older patients (OR 1.05; 95% CI 1.03-1.07), those with high ISS (OR 1.11; 95% CI 1.08-1.14) and those requiring OM (OR 2.89; 95% CI 1.47-5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23%) and AE (29%) groups (p = 0.32). Only 3% of those with NOM experienced morbidity. The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.

  17. Paediatric Blunt Liver Trauma in a Dutch Level 1 Trauma Center

    NARCIS (Netherlands)

    Nellensteijn, D.; Porte, R. J.; van Zuuren, W.; ten Duis, H. J.; Hulscher, J. B. F.

    2009-01-01

    Introduction: Paediatric blunt hepatic trauma treatment is changing from operative treatment (OT) to non-operative treatment (NOT). In 2000 the American Pediatric Surgical Association has published guidelines for NOT of these injuries. Little is known about the treatment of paediatric liver trauma

  18. Outcomes of patients with blunt chest trauma encountered at emergency department and possible risk factors affecting mortality

    Directory of Open Access Journals (Sweden)

    Yuan-Ming Tsai

    2017-01-01

    Full Text Available Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries who underwent thoracic computed tomography on arrival in the emergency department (January 2010–December 2013. Patients with brain injuries were excluded from the study. The prognostic values of age, sex, trauma type, injury severity score, revised trauma score (RTS, ventilator requirement, days in Intensive Care Unit (ICU, associated thoracic injury, and laboratory examinations (including arterial blood gas [ABG] were evaluated. Results: Fifteen of 30 analyzed patients died during their ICU stays; accordingly, we classified patients as survivors and nonsurvivors. These groups differed significantly regarding the RTS (P = 0.002, mechanical ventilation requirement (P = 0.007, total stay length (P = 0.009, and the presence of hemothorax (P = 0.030. However, no significant differences in the pneumothorax, rib fractures, and blood tests (including ABG analysis were observed between the groups. Conclusion: Among hospitalized trauma patients with blunt thoracic injuries, RTS, mechanical ventilation requirement, and hemothorax were identified as risk factors for mortality. Patients with hemothorax should receive multidisciplinary care and be monitored closely to improve survival.

  19. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    International Nuclear Information System (INIS)

    Basile, K.E.; Sivit, C.J.; Sachs, P.B.; Stallion, A.

    1999-01-01

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.)

  20. Computed tomographic diagnosis of the blunt hepatic trauma

    International Nuclear Information System (INIS)

    Suzuki, Masayuki; Takashima, Tsutomu; Funaki, Hiromi; Kanno, Seiichi; Ushitani, Kenji; Tabuchi, Makoto.

    1982-01-01

    In this report, the CT appearances of three cases of the blunt hepatic trauma are presented. The hepatic hematomas are displayed as the poorly demarcated, uneven low density area on plain CT. Post-contrast study makes their margin more clearly. The intrapertioneal hemorrhage is shown as a fluid collection around the liver and/or spleen. As CT is non-invasively and quickly performed, it is useful for the evaluation of the hepatic injury in emergency. The concomitant other organ injuries may be accurately detected by CT. The follow-up study is useful for estimating the therapeutic effect and considering the treatment plan. (author)

  1. Evaluation of amylase and lipase levels in blunt trauma abdomen patients.

    Science.gov (United States)

    Kumar, Subodh; Sagar, Sushma; Subramanian, Arulselvi; Albert, Venencia; Pandey, Ravindra Mohan; Kapoor, Nitika

    2012-04-01

    There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA). To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged). Wilcoxon's Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. A total of 55 patients with median age 26 (range, 6-80) years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT) or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) on days 1, 3, and 5, were found to be significant. Day 1 serum amylase, AST, ALT, hemoglobin, and

  2. A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes?

    Science.gov (United States)

    Yiannoullou, P; Hall, C; Newton, K; Pearce, L; Bouamra, O; Jenks, T; Scrimshire, A B; Hughes, J; Lecky, F; Macdonald, Adh

    2017-01-01

    INTRODUCTION The spleen remains one of the most frequently injured organs following blunt abdominal trauma. In 2012, regional trauma networks were launched across England and Wales with the aim of improving outcomes following trauma. This retrospective cohort study investigated the management and outcomes of blunt splenic injuries before and after the establishment of regional trauma networks. METHODS A dataset was drawn from the Trauma Audit Research Network database of all splenic injuries admitted to English and Welsh hospitals from 1 April 2010 to 31 March 2014. Demographic data, injury severity, treatment modalities and outcomes were collected. Management and outcomes were compared before and after the launch of regional trauma networks. RESULTS There were 1457 blunt splenic injuries: 575 between 2010 and 2012 and 882 in 2012-14. Following the introduction of the regional trauma networks, use of splenic artery embolotherapy increased from 3.5% to 7.6% (P = 0.001) and splenectomy rates decreased from 20% to 14.85% (P = 0.012). Significantly more patients with polytrauma and blunt splenic injury were treated with splenic embolotherapy following 2012 (61.2% vs. 30%, P splenic artery embolotherapy since the introduction of the regional trauma networks. This may have resulted from improved access to specialist services and reduced practice variation since the establishment of these networks.

  3. Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention necessary?

    Science.gov (United States)

    Ingram, Martha-Conley E; Siddharthan, Ragavan V; Morris, Andrew D; Hill, Sarah J; Travers, Curtis D; McKracken, Courtney E; Heiss, Kurt F; Raval, Mehul V; Santore, Matthew T

    2016-08-01

    There are no widely accepted guidelines for management of pediatric patients who have evidence of solid organ contrast extravasation ("blush") on computed tomography (CT) scans following blunt abdominal trauma. We report our experience as a Level 1 pediatric trauma center in managing cases with hepatic and splenic blush. All pediatric blunt abdominal trauma cases resulting in liver or splenic injury were queried from 2008 to 2014. Patients were excluded if a CT was unavailable in the medical record. The presence of contrast blush was based on final reports from attending pediatric radiologists. Correlations between incidence of contrast blush and major outcomes of interest were determined using χ and Wilcoxon rank-sum tests for categorical and continuous variables, respectively, evaluating statistical significance at p splenic or liver injury after blunt abdominal trauma, we report on 30 patients (9%) with solid organ blush, resulting in 18 cases of hepatic blush and 16 cases of splenic blush (four patients had extravasation from both organs). Blush was not found to correlate significantly with age, gender, or type of injury (liver vs. splenic) but was found to associate with higher grades of solid organ injury (p = 0.002) and higher ISS overall (p splenic or liver injury is associated with higher grade of injury. These patients receive intensive medical management but do not uniformly require invasive intervention. From our data, we suggest that a blush can safely be managed nonoperatively and that treatment should be dictated by change in physiology. Therapeutic study, level IV.

  4. Criteria for nonoperative management of blunt splenic trauma

    Directory of Open Access Journals (Sweden)

    Sarmast Shoushtary MH

    2009-02-01

    Full Text Available "nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3% underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7% nonoperative management was successful. In 10 patients (9.9% This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.

  5. Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma.

    Science.gov (United States)

    Haraguchi, Yumiko; Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Nakashima, Ikue; Wada, Hiroshi; Sanui, Masamitsu; Momomura, Shin-Ichi; Fujita, Hideo

    2018-03-30

    Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.

  6. Endovascular repair of traumatic thoracic aortic tears.

    Science.gov (United States)

    Mansour, M Ashraf; Kirk, Jeffrey S; Cuff, Robert F; Banegas, Shonda L; Ambrosi, Gavin M; Liao, Timothy H; Chambers, Christopher M; Wong, Peter Y; Heiser, John C

    2012-03-01

    Patients with thoracic aorta injuries (TAI) present a unique challenge. The purpose of this study was to review the outcomes of thoracic endovascular aortic repair (TEVAR) in patients with TAI. A retrospective chart review of all patients admitted for TEVAR for trauma was performed. In a 5-year period, 19 patients (6 women and 13 men; average age, 42 y) were admitted to our trauma center with TAI. Mechanism of injury was a motor vehicle crash in 12 patients, motorcycle crash in 2 patients, automobile-pedestrian accident in 2 patients, 1 fall, 1 crush injury, and 1 stab wound to the back. A thoracic endograft was used in 6 patients and proximal aortic cuffs were used in 13 patients (68%). One patient (5%) died. There were no strokes, myocardial infarctions, paraplegia, or renal failure. TEVAR for TAI appears to be a safe option for patients with multiple injuries. TEVAR in young patients is still controversial because long-term endograft behavior is unknown. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  8. One Stage Emergency Pancreatoduodenectomy  for Isolated Injury to Pancreatic Head Following Blunt Abdominal Trauma: Case Report and Review of Literature.

    Science.gov (United States)

    Ghosh, Sumanta Kumar

    2013-07-01

    Major pancreatic injury following blunt abdominal trauma by itself is a relatively rare occurrence, and in vast majority of cases (95%) it is associated with injury to adjacent major vessels and organs; thus making isolated major pancreatic injury even rarer. While most pancreatic injuries are managed by simple measures like debridement and drainage, complex proximal injury poses surgical challenge regarding surgical skill and judgement. Disproportionate approach at any stage of management can contribute  to high mortality and morbidity. Emergency pancreatoduodenectomy plays a limited but important role in managing serious trauma to proximal pancreas and duodenum. Author presents a case where isolated injury to head of pancreas required emergency pancreatoduodenectomy. After a bizarre road accident, a middle aged male underwent emergency laparotomy for intraperitoneal bleeding and during exploration a deep transverse laceration with ampullary disruption was found in the head of the organ. Duodenum in all its part was intact and there was no other injury. The nature and site of injury made emergency pancreatoduodenectomy the only viable option. Leaking pancreatojejunostomy enhances infective complications that lead to late mortality. To circumvent this problem there is enthusiasm for staged surgery with resection and tube pancreatostomy in first stage, leaving the difficult anastomosis for a later date, However, if the patient is haemodynamically stable and operated reasonably early, one stage pancreatoduodenectomy gives good result and avoids repeating surgery with inherent problems and reduces hospital stay. For successful management of pancreatic trauma it is essential to make early diagnosis of duct disruption, with sound application of operative skill and judgement by treating surgeon.

  9. Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

    Science.gov (United States)

    Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

    2018-01-01

    Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

  10. Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?

    Science.gov (United States)

    Shiau, J-P; Chin, C-C; Yeh, C-N; Chen, J-F; Lee, S-T; Fang, J-F; Liao, C-C

    2013-06-01

    Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.

  11. Delayed recurrent nerve paralysis following post-traumatic aortic pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Mesolella Massimo

    2016-01-01

    Full Text Available Blunt trauma to the neck or to the chest are increasingly observed in the emergency clinical practice. They usually follow motor vehicle accidents or may be work or sports related. A wide pattern of clinical presentation can be potentially encountered. We report the uncommon case of a patient who was referred to our observation presenting with hoarseness and disphagia. Twenty days before he had sustained a car accident with trauma to the chest, neck and the mandible. Laryngoscopy showed a left recurrent laryngeal nerve palsy. Further otolaryngo-logical examination showed no other abnormality. At CT and MR imaging a post-traumatic aortic pseudoaneurysm was revealed. The aortic pseudoaneurysm was consequently repaired by implantation of an endovascular stent graft under local anesthesia. The patient was discharged 10 days later. At 30-days follow-up laryngoscopy the left vocal cord palsy was completely resolved.

  12. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Basile, K.E.; Sivit, C.J.; Sachs, P.B. [Department of Radiology, Rainbow Babies and Children`s Hospital of the University Hospitals of Cleveland, OH (United States); Stallion, A. [Department of Surgery, Rainbow Babies` and Children`s Hospital of the University Hospitals of Cleveland, OH (United States)

    1999-05-01

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.) With 3 figs., 8 refs.

  13. Ultrasonographic findings in blunt abdominal trauma among Yemeni patients in Sana'a

    International Nuclear Information System (INIS)

    Al Najjar, A. A. H.

    2004-09-01

    A hundred and thirty patients (104 males, and 26 females) with suspected blunt abdominal trauma were admitted to this prospective study at Althawra hospital, Sana'a, Yemen in the period between june and december 2003. Real-time ultrasonography of the abdomen was performed in all patients. Fifty-six patients showed U/S evidence of visceral injury. Fourteen injuries of spleen, 7 had evidence of liver and 8 had renal injuries. Only eight needed a laparatomy because of cardiovascular instability and the laparatomy confirmed the ultrasound findings. The remainder were treated conservatively with good results. It is of interest that there was one ultrasonic sign of fluid in one patient who progressed well on conservative therapy. Ultrasonic signs of visceral laceration or contusion were found in patients who had 2 up to 8 sonic findings. It appears that visceral injury always gives more than two sonic signs. The remaining 33 patients only had intraperitoneal fluid, only one of them had volvulus. It is not possible to state the nature of fluid, whether it is an exudate, transudate, blood or lymph. Diagnostic peritoneal lavage would have been helpful. Seven patients died, most of them due to associated injuries, mainly head injury and cardiovascular collapse, one patient died on table and had retroperitonieal haematoma extending from pelvis to the mesentery of transverse colon and had no abdominal organ injury. The sensitivity of ultrasonography for liver was 87.5% and for spleen 100%. Ultrasonography is sensitive, safe, cost effective and non invasive method for screening patients with blunt abdominal trauma.(Author)

  14. The value of routine follow-up imaging in pediatric blunt liver trauma

    Energy Technology Data Exchange (ETDEWEB)

    Navarro, O.; Babyn, P.S. [Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON (Canada); Pearl, R.H. [Division of General Surgery, Hospital for Sick Children, Toronto, ON (Canada)

    2000-08-01

    Purpose. To evaluate the utility of routine follow-up computed tomography (CT) and/or ultrasound (US) scans in children with blunt hepatic trauma initially managed non-operatively. Materials and methods. Review of the records of 66 children with proven blunt liver injury on initial CT scan, who were initially managed non-operatively during the period January 1991 to December 1996. Follow-up CT and US studies were analyzed and correlated with clinical outcome. Results. Of the 66 children, 30 were not followed with any imaging study, 26 were followed with US only, 7 with CT only and 3 with US and CT. Disappearance of the liver lesion(s) was seen in 25 patients (range: 6 days - 14 months) and decrease in size was noted in 10. In one patient, who developed abdominal and right shoulder pain 10 days after presentation with subsequent hemoglobin drop, CT showed contrast medium extravasation into a hepatic hematoma from portal vein injury that required surgery. Conclusion. Our series suggests that in asymptomatic patients, US and CT follow-up studies do not provide the additional information needed for patient management. Therefore, we believe that in asymptomatic children with blunt hepatic trauma who are clinically stable, routine follow-up imaging studies are of very limited value. (orig.)

  15. The value of routine follow-up imaging in pediatric blunt liver trauma

    International Nuclear Information System (INIS)

    Navarro, O.; Babyn, P.S.; Pearl, R.H.

    2000-01-01

    Purpose. To evaluate the utility of routine follow-up computed tomography (CT) and/or ultrasound (US) scans in children with blunt hepatic trauma initially managed non-operatively. Materials and methods. Review of the records of 66 children with proven blunt liver injury on initial CT scan, who were initially managed non-operatively during the period January 1991 to December 1996. Follow-up CT and US studies were analyzed and correlated with clinical outcome. Results. Of the 66 children, 30 were not followed with any imaging study, 26 were followed with US only, 7 with CT only and 3 with US and CT. Disappearance of the liver lesion(s) was seen in 25 patients (range: 6 days - 14 months) and decrease in size was noted in 10. In one patient, who developed abdominal and right shoulder pain 10 days after presentation with subsequent hemoglobin drop, CT showed contrast medium extravasation into a hepatic hematoma from portal vein injury that required surgery. Conclusion. Our series suggests that in asymptomatic patients, US and CT follow-up studies do not provide the additional information needed for patient management. Therefore, we believe that in asymptomatic children with blunt hepatic trauma who are clinically stable, routine follow-up imaging studies are of very limited value. (orig.)

  16. Molecular and cellular mechanisms of aortic stenosis.

    Science.gov (United States)

    Yetkin, Ertan; Waltenberger, Johannes

    2009-06-12

    Calcific aortic stenosis is the most common cause of aortic valve replacement in developed countries, and this condition increases in prevalence with advancing age. The fibrotic thickening and calcification are common eventual endpoint in both non-rheumatic calcific and rheumatic aortic stenoses. New observations in human aortic valves support the hypothesis that degenerative valvular aortic stenosis is the result of active bone formation in the aortic valve, which may be mediated through a process of osteoblast-like differentiation in these tissues. Additionally histopathologic evidence suggests that early lesions in aortic valves are not just a disease process secondary to aging, but an active cellular process that follows the classical "response to injury hypothesis" similar to the situation in atherosclerosis. Although there are similarities with the risk factor and as well as with the process of atherogenesis, not all the patients with coronary artery disease or atherosclerosis have calcific aortic stenosis. This review mainly focuses on the potential vascular and molecular mechanisms involved in the pathogenesis of aortic valve stenosis. Namely extracellular matrix remodeling, angiogenesis, inflammation, and eventually osteoblast-like differentiation resulting in bone formation have been shown to play a role in the pathogenesis of calcific aortic stenosis. Several mediators related to underlying mechanisms, including growth factors especially transforming growth factor-beta1 and vascular endothelial growth factors, angiogenesis, cathepsin enzymes, adhesion molecules, bone regulatory proteins and matrix metalloproteinases have been demonstrated, however the target to be attacked is not defined yet.

  17. Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization.

    Science.gov (United States)

    Bansal, Samiksha; Karrer, Frederick M; Hansen, Kristine; Partrick, David A

    2015-08-01

    Splenic artery embolization (SAE) in the presence of contrast blush (CB) has been recommended to reduce the failure rate of nonoperative management. We hypothesized that the presence of CB on computed tomography has minimal impact on patient outcomes. A retrospective review was conducted of all children (splenic trauma over a 10-year period at a level 1 pediatric trauma center. Data are presented as mean ± standard error of mean. Seven hundred forty children sustained blunt abdominal trauma, of which 549 had an identified solid organ injury. Blunt splenic injury was diagnosed in 270 of the 740 patients. All patients were managed nonoperatively without SAE. CB was seen on computed tomography in 47 patients (17.4%). There were no significant differences in the need for blood transfusion (12.5% vs 11.1%) or length of stay (3.1 vs 3.3 days) or need for splenectomy when compared in children with or without CB. Pediatric trauma patients with blunt splenic injuries can be safely managed without SAE and physiologic response and hemodynamic stability should be the primary determinants of appropriate management. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Biliary stricture due to neuroma after an innocent blunt abdominal trauma.

    Science.gov (United States)

    Katsinelos, P; Dimiropoulos, S; Galanis, I; Tsolkas, P; Paroutoglu, G; Arvaniti, M; Katsiba, D; Baltaglannis, S; Pilpilidis, I; Papagiannis, A; Vaslliadis, I

    2002-10-01

    A traumatic neuroma of the biliary tract is rarely associated with biliary obstruction. However, when it arises in the common bile duct (CBD) and is associated with obstructive jaundice, it is difficult to distinguish it from bile duct cancer. We describe a patient who developed obstructive jaundice and itching, due to CBD stricture, 8 years after innocent blunt abdominal trauma. The stricture was resected and hepatico-jejunal anastomosis was performed. Histological examination revealed a traumatic neuroma and a fibrous scar around the common bile duct. Symptoms disappeared following surgical removal of the lesion. Blunt abdominal injury may cause the late onset of a fibrous scar and traumatic neuroma in the common bile duct. To our knowledge, a traumatic neuroma of the biliary tract after blunt abdominal trauma has not been reported previously. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis and treatment.

  19. Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

    Science.gov (United States)

    Brillantino, A; Iacobellis, F; Robustelli, U; Villamaina, E; Maglione, F; Colletti, O; De Palma, M; Paladino, F; Noschese, G

    2016-10-01

    The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

  20. [Diagnostic management in paediatric blunt abdominal trauma - a systematic review with metaanalysis].

    Science.gov (United States)

    Schöneberg, C; Tampier, S; Hussmann, B; Lendemans, S; Waydhas, C

    2014-12-01

    The objective of this systematic review was to investigate the diagnostic management in paediatric blunt abdominal injuries. A literature research was performed using following sources: MEDLINE, Embase and Cochrane. Where it was possible a meta-analysis was performed. Furthermore the level of evidence for all publications was assigned. Indicators for intraabdominal injury (IAI) were elevated liver transaminases, abnormal abdominal examinations, low systolic blood pressure, reduced haematocrit and microhematuria. Detecting IAI with focused assessment with sonography for trauma (FAST) had an overall sensitivity of 56.5 %, a specificity of 94.68 %, a positive likelihood ratio of 10.63 and a negative likelihood ratio of 0.46. The accuracy was 84.02 %. Among haemodynamically unstable children the sensitivity and specificity were 100 %. The overall prevalence of IAI and negative CT was 0.19 %. The NPV of abdominal CT for diagnosing IAI was 99.8 %. The laparotomy rate in patients with isolated intraperitoneal fluid (IIF) in one location was 3.48 % and 56.52 % in patients with IIF in more than one location. FAST as an isolated tool in the diagnostics after blunt abdominal injury is very uncertain, because of the modest sensitivity. Discharging children after blunt abdominal trauma with a negative abdominal CT scan seems to be safe. When IIF is detected on CT scan, it depends on the number of locations involved. If IIF is found only in 1 location, IAI is uncommon, while IIF in two or more locations results in a high laparotomy rate. Georg Thieme Verlag KG Stuttgart · New York.

  1. Evaluation of amylase and lipase levels in blunt trauma abdomen patients

    Directory of Open Access Journals (Sweden)

    Subodh Kumar

    2012-01-01

    Full Text Available Background: There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA. Aim: To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. Materials and Methods: A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged. Wilcoxon′s Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. Results: A total of 55 patients with median age 26 (range, 6-80 years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST, alanine aminotransferase (ALT, and alkaline phosphatase (ALP on days 1, 3, and 5, were found to

  2. Embrella embolic deflection device for cerebral protection during transcatheter aortic valve replacement

    NARCIS (Netherlands)

    Samim, Mariam; Agostoni, Pierfrancesco; Hendrikse, Jeroen; Budde, Ricardo P J; Nijhoff, Freek; Kluin, Jolanda; Ramjankhan, Faiz; Doevendans, Pieter A.; Stella, Pieter R.

    2015-01-01

    AIMS: To compare the extent of cerebral ischemic injury after transcatheter aortic valve replacement (TAVR) with the use of an Embrella Embolic Deflector System versus unprotected TAVR. METHODS: Fifteen patients with severe symptomatic aortic stenosis underwent TAVR with use of the Embrella Embolic

  3. Embrella embolic deflection device for cerebral protection during transcatheter aortic valve replacement

    NARCIS (Netherlands)

    Samim, Mariam; Agostoni, Pierfrancesco; Hendrikse, Jeroen; Budde, Ricardo P. J.; Nijhoff, Freek; Kluin, Jolanda; Ramjankhan, Faiz; Doevendans, Pieter A.; Stella, Pieter R.

    2015-01-01

    Aims: To compare the extent of cerebral ischemic injury after transcatheter aortic valve replacement (TAVR) with the use of an Embrella Embolic Deflector System versus unprotected TAVR. Methods: Fifteen patients with severe symptomatic aortic stenosis underwent TAVR with use of the Embrella Embolic

  4. Proposal of a new preliminary scoring tool for early identification of significant blunt bowel and mesenteric injuries in patients at risk after road traffic crashes.

    Science.gov (United States)

    Raharimanantsoa, Mahery; Zingg, Tobias; Thiery, Alicia; Brigand, Cécile; Delhorme, Jean-Baptiste; Romain, Benoît

    2017-12-14

    Blunt bowel and mesenteric injuries (BBMI) are regularly missed by abdominal computed tomography (CT) scans. The aim of this study was to develop a risk assessment tool for BBMI to help clinicians in decision-making for blunt trauma after road traffic crashes (RTCs). Single-center retrospective study of trauma patients from January 2010 to April 2015. All patients admitted to our hospital after blunt trauma following RTCs and CT scan at admission were assessed. Of the 394 patients included, 78 (19.8%) required surgical exploration and 34 (43.6%) of these had a significant BBMI. A univariate and multivariate analysis were performed comparing patients with BBMI (n = 34) and patients without BBMI (n = 360). A score with a range from 0 to 13 was created. Scores from 8 to 9 were associated with 5-25% BBMI risk. The power of this new score ≥ 8 to predict a surgically significant BBMI had a sensitivity of 96%, specificity of 86.4%, positive predictive value (PPV) of 48% and negative predictive value (NPV) of 99.4%. This score could be a valuable tool for the management of blunt trauma patients after RTA without a clear indication for laparotomy but at risk for BBMI. The outcome of this study suggests selective diagnostic laparoscopy for a score ≥ 8 in obtunded patients and ≥ 10 in all other. To assess the value and accuracy of this new score, a prospective validation of these retrospective findings is due.

  5. Blunt hepatic trauma: comparison between surgical and nonoperative treatment.

    Science.gov (United States)

    Zago, Thiago Messias; Pereira, Bruno Monteiro; Calderan, Thiago Rodrigues Araujo; Hirano, Elcio Shiyoiti; Rizoli, Sandro; Fraga, Gustavo Pereira

    2012-01-01

    To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

  6. Delayed splenic rupture presenting 70 days following blunt abdominal trauma.

    Science.gov (United States)

    Resteghini, Nancy; Nielsen, Jonpaul; Hoimes, Matthew L; Karam, Adib R

    2014-01-01

    Delayed splenic rupture following conservative management of splenic injury is an extremely rare complication. We report a case of an adult patient who presented with delayed splenic rupture necessitating splenectomy, 2 months following blunt abdominal trauma. Imaging at the initial presentation demonstrated only minimal splenic contusion and the patient was discharge following 24 hours of observation. © 2014.

  7. Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the ''fallen lung'' sign

    Energy Technology Data Exchange (ETDEWEB)

    Wintermark, M.; Schnyder, P.; Wicky, S. [Dept. of Diagnostic and Interventional Radiology, University Hospital, Lausanne (Switzerland)

    2001-03-01

    Tracheo-bronchial injuries occur in less than 1 % of blunt chest trauma patients. Indirect signs, such as pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, are revealed on admission plain films and chest CT survey. In most instances, however, tracheo-bronchoscopy is mandatory in assessing the definite diagnosis of tracheo-bronchial lesion. Occasionally, an abnormal course of a mainstem bronchus or a ''fallen lung'' sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury. (orig.)

  8. Acute aortic syndromes: definition, prognosis and treatment options.

    Science.gov (United States)

    Carpenter, S W; Kodolitsch, Y V; Debus, E S; Wipper, S; Tsilimparis, N; Larena-Avellaneda, A; Diener, H; Kölbel, T

    2014-04-01

    Acute aortic syndromes (AAS) are life-threatening vascular conditions of the thoracic aorta presenting with acute pain as the leading symptom in most cases. The incidence is approximately 3-5/100,000 in western countries with increase during the past decades. Clinical suspicion for AAS requires immediate confirmation with advanced imaging modalities. Initial management of AAS addresses avoidance of progression by immediate medical therapy to reduce aortic shear stress. Proximal symptomatic lesions with involvement of the ascending aorta are surgically treated in the acute setting, whereas acute uncomplicated distal dissection should be treated by medical therapy in the acute period, followed by surveillance and repeated imaging studies. Acute complicated distal dissection requires urgent invasive treatment and thoracic endovascular aortic repair has become the treatment modality of choice because of favorable outcomes compared to open surgical repair. Intramural hematoma, penetrating aortic ulcers, and traumatic aortic injuries of the descending aorta harbor specific challenges compared to aortic dissection and treatment strategies are not as uniformly defined as in aortic dissection. Moreover these lesions have a different prognosis. Once the acute period of aortic syndrome has been survived, a lifelong medical treatment and close surveillance with repeated imaging studies is essential to detect impending complications which might need invasive treatment within the short-, mid- or long-term.

  9. Ear Injury

    Science.gov (United States)

    ... of different injuries can affect the outer ear. Cauliflower ear (subperichondrial hematoma) A blunt blow to the ... to a deformed ear. This deformity, called a cauliflower ear, is common among wrestlers, boxers, and rugby ...

  10. Criteria for the selective use of chest computed tomography in blunt trauma patients.

    NARCIS (Netherlands)

    Brink, M.; Deunk, J.; Dekker, H.M.; Edwards, M.J.R.; Kool, D.R.; Vugt, A.B. van; Kuijk, C. van; Blickman, J.G.

    2010-01-01

    PURPOSE: The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. METHODS: This observational study prospectively included consecutive patients (>or=16 years old) who underwent

  11. Blunt trauma induced splenic blushes are not created equal

    Directory of Open Access Journals (Sweden)

    Burlew Clay

    2012-03-01

    Full Text Available Abstract Background Currently, evidence of contrast extravasation on computed tomography (CT scan is regarded as an indication for intervention in splenic injuries. In our experience, patients transferred from other institutions for angioembolization have often resolved the blush upon repeat imaging at our hospital. We hypothesized that not all splenic blushes require intervention. Methods During a 10-year period, we reviewed all patients transferred with blunt splenic injuries and contrast extravasation on initial postinjury CT scan. Results During the study period, 241 patients were referred for splenic injuries, of whom 16 had a contrast blush on initial CT imaging (88% men, mean age 35 ± 5, mean ISS 26 ± 3. Eight (50% patients were managed without angioembolization or operation. Comparing patients with and without intervention, there was a significant difference in admission heart rate (106 ± 9 vs 83 ± 6 and decline in hematocrit following transfer (5.3 ± 2.0 vs 1.0 ± 0.3, but not in injury grade (3.9 ± 0.2 vs 3.5 ± 0.3, systolic blood pressure (125 ± 10 vs 115 ± 6, or age (38.5 ± 8.2 vs 30.9 ± 4.7. Of the 8 observed patients, 3 underwent repeat imaging immediately upon arrival with resolution of the blush. In the intervention group, 4 patients had ongoing extravasation on repeat imaging, 2 patients underwent empiric embolization, and 2 patients underwent splenectomy for physiologic indications. Conclusions For blunt splenic trauma, evidence of contrast extravasation on initial CT imaging is not an absolute indication for intervention. A period of observation with repeat imaging could avoid costly, invasive interventions and their associated sequelae.

  12. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

    Science.gov (United States)

    Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

    2017-02-10

    Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

  13. What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma?

    Science.gov (United States)

    Kea, Bory; Gamarallage, Ruwan; Vairamuthu, Hemamalini; Fortman, Jonathan; Lunney, Kevin; Hendey, Gregory W; Rodriguez, Robert M

    2013-08-01

    Computed tomography (CT) has been shown to detect more injuries than plain radiography in patients with blunt trauma, but it is unclear whether these injuries are clinically significant. This study aimed to determine the proportion of patients with normal chest x-ray (CXR) result and injury seen on CT and abnormal initial CXR result and no injury on CT and to characterize the clinical significance of injuries seen on CT as determined by a trauma expert panel. Patients with blunt trauma older than 14 years who received emergency department chest imaging as part of their evaluation at 2 urban level I trauma centers were enrolled. An expert trauma panel a priori classified thoracic injuries and subsequent interventions as major, minor, or no clinical significance. Of 3639 participants, 2848 (78.3%) had CXR alone and 791 (21.7%) had CXR and chest CT. Of 589 patients who had chest CT after a normal CXR result, 483 (82.0% [95% confidence interval [CI], 78.7-84.9%]) had normal CT results, and 106 (18.0% [95% CI, 15.1%-21.3%]) had CTs diagnosing injuries-primarily rib fractures, pulmonary contusion, and incidental pneumothorax. Twelve patients had injuries classified as clinically major (2.0% [95% CI, 1.2%-3.5%]), 78 were clinically minor (13.2% [95% CI, 10.7%-16.2%]), and 16 were clinically insignificant (2.7% (95% CI, 1.7%-4.4%]). Of 202 patients with CXRs suggesting injury, 177 (87.6% [95% CI, 82.4%-91.5%]) had chest CTs confirming injury and 25 (12.4% [95% CI, 8.5%-17.6%]) had no injury on CT. Chest CT after a normal CXR result in patients with blunt trauma detects injuries, but most do not lead to changes in patient management. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient: A Rare Complication of Blunt Chest Trauma.

    Science.gov (United States)

    Orlik, Kseniya; Simon, Erin Leslie; Hemmer, Carrie; Ramundo, Maria

    2016-07-01

    We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.

  15. Gastrointestinal Injuries Following Blunt Abdominal Trauma In ...

    African Journals Online (AJOL)

    Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries ...

  16. Total Pancreatic Fracture Due to Blunt Trauma: Report of a Rare Case

    Directory of Open Access Journals (Sweden)

    Kamil Gulpinar

    2016-05-01

    Full Text Available A rare case of pancreatic fracture due to blunt trauma was presented. The patient was 70 year old male who had a motor vehicle collision and was suspected a pancreatic trauma due his examinations with ultrasound and computerized tomography. The diagnosis of splenic injury and pancreas body total fracture in the point where the portal vein crosses the pancreatic body was made with the help of magnetic resonance cholangiopancreatography. He was taken to emergency surgery where a splenectomy and a distal pancreatectomy were performed. We represented this infrequent case of pancreatic fracture and its complications after blunt abdominal trauma and discuss the diagnostic and management practices.

  17. Reconstruction of a total avulsion of the hepatic veins and the suprahepatic inferior vena cava secondary to blunt thoracoabdominal trauma.

    Science.gov (United States)

    Kaemmerer, Daniel; Daffner, Wolfgang; Niwa, Martin; Kuntze, Thomas; Hommann, Merten

    2011-02-01

    Blunt injury to the inferior vena cava is a rare but dramatic event having a high mortality up to 80%. The mortality increases after total avulsion especially in combination with secondary intra-abdominal injuries. We report on a 15-year-old boy who sustained a blunt trauma with a total, partially covered avulsion of the hepatic veins and the suprahepatic inferior vena cava. We treated the patient under internal bypassing of the retrohepatic vena cava by using the heart-lung machine and reconstructed the hepatic veins and suprahepatic vena cava with a conduit made of pericard.

  18. Homicide by blunt force in 2 Scandinavian capitals

    DEFF Research Database (Denmark)

    Rogde, Sidsel; Hougen, Hans P; Poulsen, Klaus

    2003-01-01

    In the Oslo and Copenhagen areas, 77 instances of blunt force homicides were committed from 1985-1994, accounting for 18% of all homicides in that 10-year period. Fifty-four (70%) of the victims were male, often killed by an acquaintance during a fight. Almost 70% of the female victims were kille...... were battered children. Many of the victims with a blood alcohol level of 0 turned out to have lived for some time after the injury....

  19. The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma.

    Science.gov (United States)

    Chou, Yi-Pin; Kuo, Liang-Chi; Soo, Kwan-Ming; Tarng, Yih-Wen; Chiang, Hsin-I; Huang, Fong-Dee; Lin, Hsing-Lin

    2014-07-01

    Retained haemothorax and pneumothorax are the most common complications after blunt chest traumas. Lung lacerations derived from fractures of the ribs are usually found in these patients. Video-assisted thoracoscopic surgery (VATS) is usually used as a routine procedure in the treatment of retained pleural collections. The objective of this study was to find out if there is any advantage in adding the procedure for repairing lacerated lungs during VATS. Patients who were brought to our hospital with blunt chest trauma were enrolled into this prospective cohort study from January 2004 to December 2011. All enrolled patients had rib fractures with type III lung lacerations diagnosed by CT scans. They sustained retained pleural collections and surgical drainage was indicated. On one group, only evacuation procedure by VATS was performed. On the other group, not only evacuations but also repair of lung injuries were performed. Patients with penetrating injury or blunt injury with massive bleeding, that required emergency thoracotomy, were excluded from the study, in addition to those with cardiovascular or oesophageal injuries. During the study period, 88 patients who underwent thoracoscopy were enrolled. Among them, 43 patients undergoing the simple thoracoscopic evacuation method were stratified into Group 1. The remaining 45 patients who underwent thoracoscopic evacuation combined with resection of lung lacerations were stratified into Group 2. The rates of post-traumatic infection were higher in Group 1. The durations of chest-tube drainage and ventilator usage were shorter in Group 2, as were the lengths of patient intensive care unit stay and hospital stay. When compared with simple thoracoscopic evacuation methods, repair and resection of the injured lungs combined may result in better clinical outcomes in patients who sustained blunt chest injuries. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio

  20. Association of a Guardian's Report of a Child Acting Abnormally With Traumatic Brain Injury After Minor Blunt Head Trauma.

    Science.gov (United States)

    Nishijima, Daniel K; Holmes, James F; Dayan, Peter S; Kuppermann, Nathan

    2015-12-01

    Increased use of computed tomography (CT) in children is concerning owing to the cancer risk from ionizing radiation, particularly in children younger than 2 years. A guardian report that a child is acting abnormally is a risk factor for clinically important traumatic brain injury (ciTBI) and may be a driving factor for CT use in the emergency department. To determine the prevalence of ciTBIs and TBIs in children younger than 2 years with minor blunt head trauma and a guardian report of acting abnormally with (1) no other findings or (2) other concerning findings for TBI. Secondary analysis of a large, prospective, multicenter cohort study that included 43 399 children younger than 18 years with minor blunt head trauma evaluated in 25 emergency departments. The study was conducted on data obtained between June 2004 and September 2006. Data analysis was performed between August 21, 2014, and March 9, 2015. A guardian report that the child was acting abnormally after minor blunt head trauma. The prevalence of ciTBI (defined as death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights in association with TBI on CT imaging) and TBI on CT imaging in children with a guardian report of acting abnormally with (1) no other findings and (2) other concerning findings for TBI. Of 43 399 children in the cohort study, a total of 1297 children had reports of acting abnormally, of whom 411 (31.7%) had this report as their only finding. Reported as percentage (95% CI), 1 of 411 (0.2% [0-1.3%]) had a ciTBI, and 4 TBIs were noted on the CT scans in 185 children who underwent imaging (2.2% [0.6%-5.4%]). In children with reports of acting abnormally and other concerning findings for TBI, 29 of 886 (3.3% [2.2%-4.7%]) had ciTBIs and 66 of 674 (9.8% [7.7%-12.3%]) had TBIs on CT. Clinically important TBIs are very uncommon, and TBIs noted on CT are uncommon in children younger than 2 years with minor blunt head trauma and guardian reports of the child acting

  1. Development of a blunt chest injury care bundle: An integrative review.

    Science.gov (United States)

    Kourouche, Sarah; Buckley, Thomas; Munroe, Belinda; Curtis, Kate

    2018-04-07

    Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes. To review and integrate the BCI management interventions to inform the development of a BCI care bundle. A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus were searched from 1990-April 2017. A two-step data extraction process was conducted using pre-defined data fields, including research quality indicators. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the APEASE criteria then integrated to develop a BCI care bundle. Eighty-one articles were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesia interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation. The key components of a BCI care bundle are respiratory support, analgesia, complication prevention including chest physiotherapy and surgical fixation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Outcomes of endovascular management of acute thoracic aortic emergencies in an academic level 1 trauma center.

    Science.gov (United States)

    Echeverria, Angela B; Branco, Bernardino C; Goshima, Kay R; Hughes, John D; Mills, Joseph L

    2014-12-01

    Thoracic aortic emergencies account for 10% of thoracic-related admissions in the United States and remain associated with high morbidity and mortality rates. Open repair has declined owing to the emergence of thoracic endovascular aortic repair (TEVAR), but data on emergency TEVAR use for acute aortic pathology remain limited. We therefore reviewed our experience. We retrospectively evaluated emergency descending thoracic aortic endovascular interventions performed at a single academic level 1 trauma center between January 2005 and August 2013 including all cases of traumatic aortic injury, ruptured descending thoracic aneurysm, penetrating atherosclerotic ulcer, aortoenteric fistula, and acute complicated type B dissection. Demographics, clinical data, and outcomes were extracted. Stepwise logistic regression was used to identify independent risk factors for death. During the study period, 51 patients underwent TEVAR; 22 cases (43.1%) were performed emergently (11 patients [50.0%] traumatic aortic injury; 4 [18.2%] ruptured descending thoracic aneurysm; 4 [18.2%] complicated type B dissection; 2 [9.1%] penetrating aortic ulcer; and 1 [4.5%] aortoenteric fistula). Overall, 72.7% (n = 16) were male with a mean age of 54.8 ± 15.9 years. Nineteen patients (86.4%) required only a single TEVAR procedure, whereas 2 (9.1%) required additional endovascular therapy, and 1 (4.5%) open thoracotomy. Four traumatic aortic injury patients required exploratory laparotomy for concomitant intra-abdominal injuries. During a mean hospital length of stay of 18.9 days (range, 1 to 76 days), 3 patients (13.6%) developed major complications. In-hospital mortality was 27.2%, consisting of 6 deaths from traumatic brain injury (1); exsanguination in the operating room before repair could be achieved (2); bowel ischemia (1) and multisystem organ failure (1); and family withdrawal of care (1). A stepwise logistic regression model identified 24-hour packed red blood cell requirements ≥4

  3. Two weeks delayed bleeding in blunt liver injury: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Chulsky Alexander

    2011-04-01

    Full Text Available Abstract Most cases of blunt hepatic trauma are treated nowadays non-operatively. This type of conservative treatment has resulted in increased complication rate. Delayed complications occur in cases that didn't require surgical intervention during the first 24 hours. The most common late complication is hemorrhage. We report a case of two weeks delayed hemorrhage after blunt hepatic trauma in an adult. We describe the diagnostic procedures, the surgical treatment and review the relevant literature.

  4. Combined pancreatic and duodenal transection injury: A case report

    OpenAIRE

    Mungazi, Simbarashe Gift; Mbanje, Chenesa; Chihaka, Onesai; Madziva, Noah

    2017-01-01

    Introduction: Combined pancreatic-duodenal injuries in blunt abdominal trauma are rare. These injuries are associated with high morbidity and mortality, and their emergent management is a challenge. Case presentation: We report a case of combined complete pancreatic (through the neck) and duodenal (first part) transections in a 24-year-old male secondary to blunt abdominal trauma following a motor vehicle crash. The duodenal stumps were closed separately and a gastrojejunostomy performed f...

  5. Intracranial pressure monitoring in severe blunt head trauma: does the type of monitoring device matter?

    Science.gov (United States)

    Aiolfi, Alberto; Khor, Desmond; Cho, Jayun; Benjamin, Elizabeth; Inaba, Kenji; Demetriades, Demetrios

    2018-03-01

    OBJECTIVE Intracranial pressure (ICP) monitoring has become the standard of care in the management of severe head trauma. Intraventricular devices (IVDs) and intraparenchymal devices (IPDs) are the 2 most commonly used techniques for ICP monitoring. Despite the widespread use of these devices, very few studies have investigated the effect of device type on outcomes. The purpose of the present study was to compare outcomes between 2 types of ICP monitoring devices in patients with isolated severe blunt head trauma. METHODS This retrospective observational study was based on the American College of Surgeons Trauma Quality Improvement Program database, which was searched for all patients with isolated severe blunt head injury who had an ICP monitor placed in the 2-year period from 2013 to 2014. Extracted variables included demographics, comorbidities, mechanisms of injury, head injury specifics (epidural, subdural, subarachnoid, intracranial hemorrhage, and diffuse axonal injury), Abbreviated Injury Scale (AIS) score for each body area, Injury Severity Score (ISS), vital signs in the emergency department, and craniectomy. Outcomes included 30-day mortality, complications, number of ventilation days, intensive care unit and hospital lengths of stay, and functional independence. RESULTS During the study period, 105,721 patients had isolated severe traumatic brain injury (head AIS score ≥ 3). Overall, an ICP monitoring device was placed in 2562 patients (2.4%): 1358 (53%) had an IVD and 1204 (47%) had an IPD. The severity of the head AIS score did not affect the type of ICP monitoring selected. There was no difference in the median ISS; ISS > 15; head AIS Score 3, 4, or 5; or the need for craniectomy between the 2 device groups. Unadjusted 30-day mortality was significantly higher in the group with IVDs (29% vs 25.5%, p = 0.046); however, stepwise logistic regression analysis showed that the type of ICP monitoring was not an independent risk factor for death

  6. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    International Nuclear Information System (INIS)

    Lagisetty, Jyothi; Slovis, Thomas; Thomas, Ronald; Knazik, Stephen; Stankovic, Curt

    2012-01-01

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  7. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

    2012-07-15

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  8. Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan--a meta-analysis and cohort study.

    Science.gov (United States)

    Raza, Mushahid; Elkhodair, Samer; Zaheer, Asif; Yousaf, Sohail

    2013-11-01

    A true gold standard to rule out a significant cervical spine injury in subset of blunt trauma patients with altered sensorium is still to be agreed upon. The objective of this study is to determine whether in obtunded adult patients with blunt trauma, a clinically significant injury to the cervical spine be ruled out on the basis of a normal multidetector cervical spine computed tomography. Comprehensive database search was conducted to include all the prospective and retrospective studies on blunt trauma patients with altered sensorium undergoing cervical spine multidetector CT scan as core imaging modality to "clear" the cervical spine. The studies used two main gold standards, magnetic resonance imaging of the cervical spine and/or prolonged clinical follow-up. The data was extracted to report true positive, true negatives, false positives and false negatives. Meta-analysis of sensitivity, specificity, negative and positive predictive values was performed using Meta Analyst Beta 3.13 software. We also performed a retrospective investigation comparing a robust clinical follow-up and/or cervical spine MR findings in 53 obtunded blunt trauma patients, who previously had undergone a normal multidetector CT scan of the cervical spine reported by a radiologist. A total of 10 studies involving 1850 obtunded blunt trauma patients with initial cervical spine CT scan reported as normal were included in the final meta-analysis. The cumulative negative predictive value and specificity of cervical spine CT of the ten studies was 99.7% (99.4-99.9%, 95% confidence interval). The positive predictive value and sensitivity was 93.7% (84.0-97.7%, 95% confidence interval). In the retrospective review of our obtunded blunt trauma patients, none was later diagnosed to have significant cervical spine injury that required a change in clinical management. In a blunt trauma patient with altered sensorium, a normal cervical spine CT scan is conclusive to safely rule out a clinically

  9. Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management.

    Science.gov (United States)

    Firetto, Maria Cristina; Sala, Francesco; Petrini, Marcello; Lemos, Alessandro A; Canini, Tiberio; Magnone, Stefano; Fornoni, Gianluca; Cortinovis, Ivan; Sironi, Sandro; Biondetti, Pietro R

    2018-04-27

    Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

  10. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only

    Science.gov (United States)

    Garner, Alan A; Mann, Kristy P; Fearnside, Michael; Poynter, Elwyn; Gebski, Val

    2015-01-01

    Background Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Methods Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score <9 (original definition), or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 (modified definition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. Results 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), p<0.01, Number needed to treat =6. 338 patients met the modified definition, of which 182 were allocated to physician care. The 6-month GOS scores were not significantly different on intention-to-treat analysis (OR 1.14, 95% CI 0.73 to 1.75, p=0.56) nor was the 30-day mortality (OR 1.05, 95% CI 0.66 to 1.66, p=0.84). As-treated analyses were also not significantly different. Conclusions This trial suggests a potential mortality reduction in patients with blunt trauma with GCS<9 receiving additional physician care (original definition only). Confirmatory studies which also address non-compliance issues are needed. Trial registration number NCT00112398. PMID:25795741

  11. Wound Ballistics Modeling for Blast Loading Blunt Force Impact and Projectile Penetration.

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Paul A. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States)

    2015-11-01

    Light body armor development for the warfighter is based on trial-and-error testing of prototype designs against ballistic projectiles. Torso armor testing against blast is nonexistent but necessary to protect the heart and lungs. In tests against ballistic projectiles, protective apparel is placed over ballistic clay and the projectiles are fired into the armor/clay target. The clay represents the human torso and its behind-armor, permanent deflection is the principal metric used to assess armor protection. Although this approach provides relative merit assessment of protection, it does not examine the behind-armor blunt trauma to crucial torso organs. We propose a modeling and simulation (M&S) capability for wound injury scenarios to the head, neck, and torso of the warfighter. We will use this toolset to investigate the consequences of, and mitigation against, blast exposure, blunt force impact, and ballistic projectile penetration leading to damage of critical organs comprising the central nervous, cardiovascular, and respiratory systems. We will leverage Sandia codes and our M&S expertise on traumatic brain injury to develop virtual anatomical models of the head, neck, and torso and the simulation methodology to capture the physics of wound mechanics. Specifically, we will investigate virtual wound injuries to the head, neck, and torso without and with protective armor to demonstrate the advantages of performing injury simulations for the development of body armor. The proposed toolset constitutes a significant advance over current methods by providing a virtual simulation capability to investigate wound injury and optimize armor design without the need for extensive field testing.

  12. Management of blunt and penetrating biliary tract trauma.

    Science.gov (United States)

    Thomson, Benjamin N J; Nardino, Benson; Gumm, Kellie; Robertson, Amanda J; Knowles, Brett P; Collier, Neil A; Judson, Rodney

    2012-06-01

    Penetrating or blunt injury to the biliary tree remains a rare complication of trauma occurring in 0.1% of trauma admissions. Because of the different presentations, sites of biliary tract injury, and associated organ injury, there are many possible management pathways to be considered. A retrospective analysis of prospectively gathered data was performed for all gallbladder and biliary tract injuries presenting to the trauma service or hepatobiliary unit of the Royal Melbourne Hospital between January 1, 1999, and March 30, 2011. There were 33 biliary injuries in 30 patients (0.1%) among 26,014 trauma admissions. Three of the 30 patients (10%) died. Of 10 gallbladder injuries, 8 were managed with cholecystectomy. There were 23 injuries to the biliary tree. Fourteen patients had injuries to the intrahepatic biliary tree of which seven involved segmental ducts. Of these, four segmental duct injuries required hepatic resection or debridement. Nine patients had injury to the extrahepatic biliary tree of which five required T-tube placement ± bilioenteric anastomosis and one a pancreaticoduodenectomy. Biliary injury is a rare but important consequence of abdominal trauma, and good outcomes are possible when a major trauma center and hepatopancreaticobiliary service coexist. Cholecystectomy remains the gold standard for gallbladder injury. Drainage with or without endoscopic stenting will resolve the majority of intrahepatic and partial biliary injuries. Hepaticojejunostomy remains the gold standard for complete extrahepatic biliary disruption. Hepatic and pancreatic resection are only required in the circumstances of unreconstructable biliary injury. Therapeutic study, level V. Copyright © 2012 by Lippincott Williams & Wilkins.

  13. Urological injuries following trauma

    International Nuclear Information System (INIS)

    Bent, C.; Iyngkaran, T.; Power, N.; Matson, M.; Hajdinjak, T.; Buchholz, N.; Fotheringham, T.

    2008-01-01

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated

  14. Urological injuries following trauma

    Energy Technology Data Exchange (ETDEWEB)

    Bent, C. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)], E-mail: clare.bent@bartsandthelondon.nhs.uk; Iyngkaran, T.; Power, N.; Matson, M. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom); Hajdinjak, T.; Buchholz, N. [Department of Urology, Barts and The London NHS Trust, London (United Kingdom); Fotheringham, T. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)

    2008-12-15

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

  15. Urological injuries following trauma.

    Science.gov (United States)

    Bent, C; Iyngkaran, T; Power, N; Matson, M; Hajdinjak, T; Buchholz, N; Fotheringham, T

    2008-12-01

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

  16. Traumatic injury to the colon and rectum in Scotland: demographics and outcome.

    Science.gov (United States)

    Brady, R R; O'Neill, S; Berry, O; Kerssens, J J; Yalamarthi, S; Parks, R W

    2012-01-01

    An analysis of a multi-centred database of trauma patients was performed. The study used data from a prospective multi-centre trauma database containing details of 52 887 trauma patients admitted to participating Scottish Hospitals over an 11-year period. Three hundred and forty (0.64%) of 52 887 trauma patients (284 male) with colorectal injuries were identified; 43.9% of colorectal injuries occurred following blunt trauma and 56.1% following penetrating injury. Patients in the latter group were younger, had less haemodynamic compromise and were less likely to die than those with blunt trauma (P 0.05). Female gender, increased age, road traffic accidents and those admitted as a result of a blunt traumatic injury were associated with increased mortality. Age > 65 years (P = 0.01), increasing injury severity score (ISS) at presentation (P trauma has a high morbidity. Clinical features associated with death allow stratification of mortality risk. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  17. Retrospective Analysis of 513 Cases Diagnosed with Rib Fracture Secondary to Blunt Thorax Trauma

    Directory of Open Access Journals (Sweden)

    Serdar Ozkan

    2017-05-01

    Full Text Available Aim: This study aimed to analyze blunt chest trauma cases who were diagnosed with rib fracture and to examine the regional differences likely to appear in trauma cases and treatment approaches. Material and Method: 513 cases who applied to the Emergency Service and Department of Thoracic Surgery between October 2013 and December 2014 due to blunt trauma and were diagnosed with rib fracture were retrospectively examined. The cases were evaluated in terms of etiological factors, thoracic, and other system injuries accompanying the rib fracture, prognosis, and the treatments applied. Results: Isolated rib fracture was present in 266 of the cases. Thoracic organ injuries such as pneumothorax, hemothorax, hemopneumothorax, lung contusion, or laceration and sternal fracture accompanying the rib fracture were present in 247 of the cases. While one or two rib fractures were detected in 298 cases, six or more rib fractures were present in 28 cases. 78.2% of hemothorax cases, 85.3% of pneumothorax cases, 95.4% of hemopneumothorax cases, 81.8% of bilateral pneumothorax cases, 26% of bilateral hemothorax cases, and 71.4% of bilateral hemopneumothorax cases were treated by applying tube thoracostomy. 129 cases diagnosed with thoracic organ injury in addition to rib fracture but not subjected to surgical intervention, and 266 cases diagnosed with isolated rib fracture were discharged with full recovery after appropriate medical treatment. Discussion: Most of the rib fractures occurring due to blunt trauma are treated successfully with medical treatments and conservative approaches and do not need advanced surgical treatments.

  18. Pediatric blunt splenic trauma: a comprehensive review

    Energy Technology Data Exchange (ETDEWEB)

    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); Sullivan, Ashley N. [St. George' s University School of Medicine, Grenada, West Indies (Grenada); Bloom, David A. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); William Beaumont Hospital, Section of Pediatric Radiology, Department of Radiology, Royal Oak, MI (United States)

    2009-09-15

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  19. Pediatric blunt splenic trauma: a comprehensive review

    International Nuclear Information System (INIS)

    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H.; Sullivan, Ashley N.; Bloom, David A.

    2009-01-01

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  20. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

    OpenAIRE

    Idris, Baig M.; Hefny, Ashraf F.

    2016-01-01

    Introduction: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. Presentation of case: A 63- year- old man presented...

  1. Pancreatic injury in children: good outcome of nonoperative treatment.

    NARCIS (Netherlands)

    Blaauw, I. de; Winkelhorst, J.T.; Rieu, P.N.M.A.; Staak, F.H.J.M. van der; Wijnen, M.H.W.A.; Severijnen, R.S.V.M.; Vugt, A.B. van; Wijnen, R.M.H.

    2008-01-01

    PURPOSE: Treatment of blunt injury of the pancreas in children remains controversial. Some prefer nonoperative treatment, whereas others prefer operative management in selected cases. This report reviews the treatment of patients with blunt pancreatic trauma admitted to a level I pediatric trauma

  2. Blunt traumatic bronchial transection in a 28-month-old child

    Directory of Open Access Journals (Sweden)

    Sung Mi Hwang

    2014-01-01

    Full Text Available Tracheobronchial injury is uncommon in children, but may result in life-threatening conditions. We present a case of transection of the right intermediate bronchus, right middle lobe bronchus and right lower lobe bronchus in a 28-month-old child with blunt chest injury. The gold standard for diagnosis is tracheobronchoscopy, however, the bronchoscopy may not always be available for little children. For diagnosis in similar cases, a high index of suspicion should be needed based on symptoms, chest X-ray and computed tomography findings. In addition, anesthesiologists should be aware of this dangerous condition and must be fully prepared for rapid and appropriate management during operation.

  3. An outcome prediction model for exsanguinating patients with blunt abdominal trauma after damage control laparotomy: a retrospective study.

    Science.gov (United States)

    Wang, Shang-Yu; Liao, Chien-Hung; Fu, Chih-Yuan; Kang, Shih-Ching; Ouyang, Chun-Hsiang; Kuo, I-Ming; Lin, Jr-Rung; Hsu, Yu-Pao; Yeh, Chun-Nan; Chen, Shao-Wei

    2014-04-28

    We present a series of patients with blunt abdominal trauma who underwent damage control laparotomy (DCL) and introduce a nomogram that we created to predict survival among these patients. This was a retrospective study. From January 2002 to June 2012, 91 patients underwent DCL for hemorrhagic shock. We excluded patients with the following characteristics: a penetrating abdominal injury, age younger than 18 or older than 65 years, a severe or life-threatening brain injury (Abbreviated Injury Scale [AIS] ≥ 4), emergency department (ED) arrival more than 6 hours after injury, pregnancy, end-stage renal disease, or cirrhosis. In addition, we excluded patients who underwent DCL after ICU admission or later in the course of hospitalization. The overall mortality rate was 61.5%: 35 patients survived and 56 died. We identified independent survival predictors, which included a preoperative Glasgow Coma Scale (GCS) score blunt abdominal trauma with exsanguination. The nomogram presented here may provide ED physicians and trauma surgeons with a tool for early stratification and risk evaluation in critical, exsanguinating patients.

  4. Weapon identification using antemortem CT with 3D reconstruction, is it always possible?--A report in a case of facial blunt and sharp injuries using an ashtray.

    Science.gov (United States)

    Aromatario, Mariarosaria; Cappelletti, Simone; Bottoni, Edoardo; Fiore, Paola Antonella; Ciallella, Costantino

    2016-01-01

    An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. [Value of fractional flow reserve measurement in endovascular therapy for patients with Stanford B type aortic dissection complicated with renal blood flow injury].

    Science.gov (United States)

    Guo, Xi; Li, Peng; Liu, Guangrui; Huang, Xiaoyong; Yong, Qiang; Wang, Guoqin; Huang, Lianjun

    2015-10-01

    To analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis. Clinical data of 12 patients with Stanford B type aortic dissection complicated with renal blood flow injury in Anzhen hospital hospitalized from May 2013 to February 2014 were retrospectively analyzed. Renal artery angiography was performed and fractional flow reserve (FFR) was measured before Thoracic endovascular aortic repair. After operation, renal artery FFR was measured again, and renal artery stenting was performed in patients with FFR ≤ 0.90 or average pressure difference between proximal and distal of renal artery > 20 mmHg (1 mmHg = 0.133 kPa) and not applied for patients with FFR > 0.90.The patients were then subsequently followed up clinically. Kidney function were measured after 1 month, and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively. The FFR of 1 patient was 0.90, while the FFR of other patients were less than 0.90 before thoracic endovascular aortic repair. After the procedure,the angiography showed that the blood flow of renal artery in 8 patients were fluency, and the FFR index was over 0.90. There were 4 patients with FFR less than 0.90. After renal artery stenting, the FFR of these 4 patients were all above 0.90. Compared with pre-procedure, blood urea nitrogen ((8.84 ± 3.99) mmol/L vs. (5.18 ± 1.69) mmol/L, P = 0.011) and uric acid ((359.3 ± 77.3) µmol/L vs. (276.9 ± 108.3) µmol/L, P = 0.008) decreased significantly after 1 month, and there was no significant difference in serum creatinine (P = 0.760). Contrast-enhanced ultrasonography results showed that blood flow of renal artery were fluency after 1 month and 3 months. In patients with aortic dissection complicating renal blood flow injury, the FFR measurement is meaningful in evaluating the blood flow status of target organs and guide the endovascular revascularization.

  6. Aortic rupture complicating a fracture of an ankylosed thoracic spine. A case report.

    Science.gov (United States)

    Savolaine, E R; Ebraheim, N A; Stitgen, S; Jackson, W T

    1991-11-01

    A 34-year-old man was injured in a motorcycle accident and suffered both aortic rupture and thoracic spinal fracture, complicated by an underlying undetected ankylosing spondylitis. The latter disease can affect the integrity of vascular and spinal structure. Aortography is recommended as a high priority for the patient in an unstable cardiovascular condition requiring a definitive diagnosis. Aortic rupture and thoracic spine fracture may occur from high energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are most commonly involved, although airline accidents and high falls also generate some cases. Mediastinal widening, displacement of esophagus and trachea, apical dissection of blood, and, especially, paravertebral pleural space widening are common to both injuries. Whereas most mediastinal hematomas are nonaortic in origin, a combined injury must be considered because clinical features may also overlap. These include hypotension (hypovolemic or spinal shock), paraplegia, and severe back pain. In light of the high mortality and time constraints associated with aortic rupture, immediate diagnostic resolution is necessary for appropriate management and priority of investigation.

  7. Role of myeloperoxidase in abdominal aortic aneurysm formation: mitigation by taurine.

    Science.gov (United States)

    Kim, Ha Won; Blomkalns, Andra L; Ogbi, Mourad; Thomas, Manesh; Gavrila, Daniel; Neltner, Bonnie S; Cassis, Lisa A; Thompson, Robert W; Weiss, Robert M; Lindower, Paul D; Blanco, Victor M; McCormick, Michael L; Daugherty, Alan; Fu, Xiaoming; Hazen, Stanley L; Stansfield, Brian K; Huo, Yuqing; Fulton, David J; Chatterjee, Tapan; Weintraub, Neal L

    2017-12-01

    Oxidative stress plays a fundamental role in abdominal aortic aneurysm (AAA) formation. Activated polymorphonuclear leukocytes (or neutrophils) are associated with AAA and express myeloperoxidase (MPO), which promotes inflammation, matrix degradation, and other pathological features of AAA, including enhanced oxidative stress through generation of reactive oxygen species. Both plasma and aortic MPO levels are elevated in patients with AAA, but the role of MPO in AAA pathogenesis has, heretofore, never been investigated. Here, we show that MPO gene deletion attenuates AAA formation in two animal models: ANG II infusion in apolipoprotein E-deficient mice and elastase perfusion in C57BL/6 mice. Oral administration of taurine [1% or 4% (wt/vol) in drinking water], an amino acid known to react rapidly with MPO-generated oxidants like hypochlorous acid, also prevented AAA formation in the ANG II and elastase models as well as the CaCl 2 application model of AAA formation while reducing aortic peroxidase activity and aortic protein-bound dityrosine levels, an oxidative cross link formed by MPO. Both MPO gene deletion and taurine supplementation blunted aortic macrophage accumulation, elastin fragmentation, and matrix metalloproteinase activation, key features of AAA pathogenesis. Moreover, MPO gene deletion and taurine administration significantly attenuated the induction of serum amyloid A, which promotes ANG II-induced AAAs. These data implicate MPO in AAA pathogenesis and suggest that studies exploring whether taurine can serve as a potential therapeutic for the prevention or treatment of AAA in patients merit consideration. NEW & NOTEWORTHY Neutrophils are abundant in abdominal aortic aneurysm (AAA), and myeloperoxidase (MPO), prominently expressed in neutrophils, is associated with AAA in humans. This study demonstrates that MPO gene deletion or supplementation with the natural product taurine, which can scavenge MPO-generated oxidants, can prevent AAA formation

  8. Intrathoracic Kidney after Blunt Abdominal Trauma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Fikret Halis

    2015-01-01

    Full Text Available Abdominal trauma is responsible for most genitourinary injuries. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic diaphragmatic rupture. The traumatic intrathoracic kidney is an extremely rare case. We presented intrathoracic kidney case after traumatic posterior diaphragmatic rupture.

  9. Severe Juxtahepatic Venous Injury: Survival after Prolonged Hepatic Vascular Isolation Without Shunting

    Directory of Open Access Journals (Sweden)

    J. E. J. Krige

    1990-01-01

    Full Text Available Survival following major juxtahepatic venous injury is rare in blunt liver trauma despite the use of intracaval shunting. Prolonged liver arterial inflow control, total hepatic venous isolation and lobectomy without shunting was used in a patient to repair a combined vena caval and hepatic venous injury after blunt liver injury. An extended period of normothermic hepatic ischemia was tolerated. Early recognition of retrohepatic venous injury and temporary liver packing to control bleeding and correct hypovolemia are essential before caval occlusion. Hepatic vascular isolation without shunting is an effective simple alternative technique allowing major venous repair in complex liver trauma.

  10. Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma.

    Science.gov (United States)

    Kong, Ya-Lin; Zhang, Hong-Yi; He, Xiao-Jun; Zhao, Gang; Liu, Cheng-Li; Xiao, Mei; Zhen, Yu-Ying

    2014-04-01

    Angiographic embolization (AE) as an adjunct non-operative treatment of intrahepatic arterial bleeding has been widely used. The present study aimed to evaluate the efficacy of selective AE in patients with hepatic trauma. Seventy patients with intrahepatic arterial bleeding after blunt abdominal trauma who had undergone selective AE in 10 years at this institution were retrospectively reviewed. The criteria for selective AE included active extravasation on contrast-enhanced CT, an episode of hypotension or a decrease in hemoglobin level during the non-operative treatment. The data of the patients included demographics, grade of liver injuries, mechanism of blunt abdominal trauma, associated intra-abdominal injuries, indications for AE, angiographic findings, type of AE, and AE-related hepatobiliary complications. In the 70 patients, 32 (45.71%) had high-grade liver injuries. Extravazation during the early arterial phase mainly involved the right hepatic segments. Thirteen (18.57%) patients underwent embolization of intrahepatic branches and the extrahepatic trunk and these patients all developed AE-related hepatobiliary complications. In 19 patients with AE-related complications, 14 received minimally invasive treatment and recovered without severe sequelae. AE is an adjunct treatment for liver injuries. Selective and/or super-selective AE should be advocated to decrease the incidence and severity of AE-related hepatobiliary complications.

  11. Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment.

    Science.gov (United States)

    Tang, Jie; Li, Wenxiu; Lv, Faqin; Zhang, Huiqin; Zhang, Lihai; Wang, Yuexiang; Li, Junlai; Yang, Li

    2009-04-01

    To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with contrast-enhanced computed tomography (CECT) for the detection of different grading of solid organ injuries in blunt abdominal trauma in animals. A self-made miniature tools were used as models to simulate a blunt hepatic or splenic trauma in 16 and 14 anesthetized dogs, respectively. Baseline ultrasound, CEUS and CECT were used to detect traumatic injuries of livers and spleens. The degree of injuries was determined by CEUS according to the American Association for the Surgery of Trauma (AAST) scale and the results compared with injury scale based on CECT evaluation. CEUS showed 22 hepatic injury sites in 16 animals and 17 splenic injury sites in other 14 animals. According to AAST scale, 2 grade I, 4 grade II, 3 grade III, 5 grade IV and 2 grade V hepatic lesions were present in 16 animals; 2 grade I, 4 grade II, 6 grade III and 2 grade IV splenic lesions in 14 animals. On CECT scan, 21 hepatic and 17 splenic injuries were demonstrated. According to Becker CT scaling for hepatic injury, 1 grade I, 2 grade II, 4 grade III, 5 grade IV and 2 grade V hepatic injuries were present. On the basis of Buntain spleen scaling, 2 grade I, 5 grade II, 5 grade III, 2 grade IV splenic injuries were showed. After Spearman rank correlation analysis, the agreement of CEUS with CECT on the degree of hepatic and splenic injury is 93.3% and 92.9%, respectively. CT is currently considered as the reference method for grading blunt abdominal trauma, according to experiment results, CEUS grading showed high levels of concordance with CECT. CEUS can accurately determine the degree of injury and will play an important role in clinical application.

  12. Traumatic gastric rupture following blunt abdominal trauma: a case report about an atypical modality of presentation

    Directory of Open Access Journals (Sweden)

    Dario Giambelluca

    2017-04-01

    Full Text Available Gastric rupture following blunt abdominal trauma is a rare presentation with a reported incidence of 0.02-1.7% in current literature. Traumatic gastric rupture is usually associated with other visceral injuries, such as splenic lesions and fractures. Prompt diagnosis and early intervention reduce mortality and morbidity. History of a recent meal has been implicated in traumatic gastric rupture. We report a case of blunt abdominal trauma with an isolated gastric rupture after a motor vehicle accident, managed successfully without any post-operative morbidity and mortality.

  13. The significance of routine thoracic computed tomography in patients with blunt chest trauma.

    Science.gov (United States)

    Çorbacıoğlu, Seref Kerem; Er, Erhan; Aslan, Sahin; Seviner, Meltem; Aksel, Gökhan; Doğan, Nurettin Özgür; Güler, Sertaç; Bitir, Aysen

    2015-05-01

    The purpose of this study is to investigate whether the use of thoracic computed tomography (TCT) as part of nonselective computed tomography (CT) guidelines is superior to selective CT during the diagnosis of blunt chest trauma. This study was planned as a prospective cohort study, and it was conducted at the emergency department between 2013 and 2014. A total of 260 adult patients who did not meet the exclusion criteria were enrolled in the study. All patients were evaluated by an emergency physician, and their primary surveys were completed based on the Advanced Trauma Life Support (ATLS) principles. Based on the initial findings and ATLS recommendations, patients in whom thoracic CT was indicated were determined (selective CT group). Routine CTs were then performed on all patients. Thoracic injuries were found in 97 (37.3%) patients following routine TCT. In 53 (20%) patients, thoracic injuries were found by selective CT. Routine TCT was able to detect chest injury in 44 (16%) patients for whom selective TCT would not otherwise be ordered based on the EP evaluation (nonselective TCT group). Five (2%) patients in this nonselective TCT group required tube thoracostomy, while there was no additional treatment provided for thoracic injuries in the remaining 39 (15%). In conclusion, we found that the nonselective TCT method was superior to the selective TCT method in detecting thoracic injuries in patients with blunt trauma. Furthermore, we were able to demonstrate that the nonselective TCT method can change the course of patient management albeit at low rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. On the pressure response in the brain due to short duration blunt impacts.

    Directory of Open Access Journals (Sweden)

    Christopher W Pearce

    Full Text Available When the head is subject to non-penetrating (blunt impact, contusion-type injuries are commonly identified beneath the impact site (the coup and, in some instances, at the opposite pole (the contre-coup. This pattern of injury has long eluded satisfactory explanation and blunt head injury mechanisms in general remain poorly understood. There are only a small number of studies in the open literature investigating the head's response to short duration impacts, which can occur in collisions with light projectiles. As such, the head impact literature to date has focussed almost exclusively on impact scenarios which lead to a quasi-static pressure response in the brain. In order to investigate the response of the head to a wide range of impact durations, parametric numerical studies were performed on a highly bio-fidelic finite element model of the human head created from in vivo magnetic resonance imaging (MRI scan data with non-linear tissue material properties. We demonstrate that short duration head impacts can lead to potentially deleterious transients of positive and negative intra-cranial pressure over an order of magnitude larger than those observed in the quasi-static regime despite reduced impact force and energy. The onset of this phenomenon is shown to be effectively predicted by the ratio of impact duration to the period of oscillation of the first ovalling mode of the system. These findings point to dramatically different pressure distributions in the brain and hence different patterns of injury depending on projectile mass, and provide a potential explanation for dual coup/contre-coup injuries observed clinically.

  15. Will Transcatheter Aortic Valve Replacement (TAVR be the Primary Therapy for Aortic Stenosis?

    Directory of Open Access Journals (Sweden)

    Jose F. Condado, MD, MS

    2016-05-01

    Full Text Available Transcatheter aortic valve replacement (TAVR is increasingly used for the treatment of high or very high surgical risk patients with severe aortic stenosis (AS or failing surgical bioprosthesis (valve-in-valve, VIV-TAVR. In TAVR, the collapsed transcatheter heart valve (THV is introduced using the delivery system inserted from the femoral artery (preferred or other alternative accesses (transapical, transaortic, transcarotid, subclavian/transinnominate or transcaval. The delivery system is then advanced until coaxially aligned with the aortic annulus, where the THV is deployed. This procedure can be associated with complications such as access site injury (vascular complication, paravalvar leak, cerebrovascular events and conduction disturbances. However, the rapid acceptance and successes observed with TAVR have been made possible through careful patient selection, preprocedural planning (i.e. MDCT annular sizing, THV technology (i.e. new generation valves, and procedural techniques (i.e. minimalist TF-TAVR and alternative percutaneous access options, as well as a decrease in complications as TAVR experience grows. Though the results or ongoing clinical trials evaluating TAVR in intermediate surgical risk patients are pending, it is likely that TAVR will soon be approved for lower risk patients as well.

  16. Specific Characteristics of Injuries Inflicted by Claw Hammer.

    Science.gov (United States)

    Buchaillet, Céline; Gaudin, Arnaud; Rougé-Maillart, Clotilde; Jousset, Nathalie

    2016-09-01

    Claw hammers have the specific characteristic of having two distinct ends: one a flat head of variable form, the other bifurcated. So the use of this tool as a blunt instrument will cause varying injuries. The authors present two clinical cases of assault with a claw hammer. Examinations revealed two types of wound. A first injury composed of integumentary lacerations and underlying bone injuries in terms of "shape" suggested the use of a blunt instrument. A second injury made up of damage showing two parallel wounds or two wounds located one in the extension of the other suggested the use of an object with a bifurcated end. The combination of both types of injury should alert examiners to the possibility of the use of a claw hammer in causing the injuries in order to help direct investigators in their investigations and in the search for the weapon used. © 2016 American Academy of Forensic Sciences.

  17. Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve.

    Science.gov (United States)

    Wang, Yongshi; Wu, Boting; Li, Jun; Dong, Lili; Wang, Chunsheng; Shu, Xianhong

    2016-05-01

    Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Isolated free intra-abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma.

    Science.gov (United States)

    Kong, Victor Y; Jeetoo, Damon; Naidoo, Leah C; Oosthuizen, George V; Clarke, Damian L

    2015-01-01

    The clinical significance of isolated free fluid (FF) without solid organ injury on computed to- mography (CT) continues to pose significant dilemma in the management of patients with blunt abdominal trauma (BAT). We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa. We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service. Of the 121 CTs, FF was identified in 36 patients (30%). Seven patients (6%) had isolated FF. Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified. 86% (25/ 29) of all 29 patients had a single organ injury and 14% had multiple organ injuries. There were 26 solid organ injuries and 7 hollow organ injuries. The 33 organs injured were: spleen, 12; liver, 8; kidney, 5; pancreas, 2; small bowel, 4; duodenum, 1. Six (21%) patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases. All 7 patients with isolated FF were initially observed, and 3 (43%) were eventually subjected to operative intervention. They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in 1 case, and a negative laparotomy in 1 case. Four (57%) patients were successfully managed without surgical interventions. Isolated FF is uncommon and the clinical significance remains unclear. Provided that reli- able serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.

  19. Changing pattern and outcome of pediatric chest injuries in urban Syria.

    Science.gov (United States)

    Darwish, Bassam; Mahfouz, Mohammad Z; Al-Nosairat, Saeed; Izzat, Mohammad Bashar

    2018-01-01

    Background Pediatric chest injuries were infrequent in our practice, but the outbreak of the Syrian crisis resulted in an increase in number and a change in the pattern of thoracic trauma incidents. We compared our experience of pediatric chest injuries before and during the crisis. Methods We reviewed the records of 256 children aged 12.8 ± 5 years who were admitted to our hospital with the diagnosis of chest trauma over a 12-year period. Collected data included mechanism of injury, associated injuries, method of management, length of hospital stay, complications, and mortality. Results The incidence of pediatric chest injuries increased significantly following the outbreak of the crisis, and penetrating injuries prevailed, mainly due to shrapnel, bullets, and stab wounds. Forty percent of patients with blunt injuries and 20% of those with penetrating injuries were managed conservatively, whereas urgent thoracotomies were indicated in 10%, mostly in patients with penetrating injuries. Associated injuries were more frequent in patients with blunt injuries and resulted in a longer hospital stay and an increased mortality rate. The overall mortality rate was 7.8% and it was higher in children younger than 7 years of age and in patients who had been subjected to blunt injuries. Conclusions There has been a recent substantial upsurge in the incidence of pediatric thoracic trauma, with a predominance of penetrating injuries. Most patients could be managed nonoperatively, but a small subset required an open thoracotomy. The presence of associated injuries constitutes the main determinant of prognosis in this group of patients.

  20. Efficacy and tolerability of a new ibuprofen 200mg plaster in patients with acute sports-related traumatic blunt soft tissue injury/contusion.

    Science.gov (United States)

    Predel, Hans-Georg; Giannetti, Bruno; Connolly, Mark P; Lewis, Fraser; Bhatt, Aomesh

    2018-01-01

    Ibuprofen is used for the treatment of non-serious pain. This study assessed the efficacy and safety of a new ibuprofen plaster for the treatment of pain associated with acute sports impact injuries/contusions. In this randomised, double-blind, multi-centre, placebo controlled, parallel group study, adults (n = 130; 18-58 years of age) diagnosed with acute sports-related blunt soft tissue injury/contusion were randomized to receive either ibuprofen 200 mg plaster or placebo plaster. Plasters were administered once daily for five consecutive days. The primary assessment was area under the visual analogue scale (VAS) of pain on movement (POM) over 0 to three days (VAS AUC 0-3d ). Other endpoints included algometry AUC from 0 to three days (AUC 0-3d ) and 0 to five days (AUC 0-5d ), to evaluate improvement of sensitivity at the injured site, and patient and investigator global assessment of efficacy. Safety was monitored throughout the study. The ibuprofen plaster resulted in superior reduction in AUC 0-3d compared with placebo; the Least Squares (LS) mean difference was 662.82 mm*h in favour of the ibuprofen 200mg plaster (P = 0.0011). The greater improvement in VAS AUC of POM was also observed after 12 h, 24 h, and five days of therapy. Tenderness also significantly improved with the ibuprofen plaster compared with placebo; LS mean difference in algometry/tenderness AUC 0-3d was 1.87 N/cm 2 *d and AUC 0-5d was 1.87 N/cm 2 *d (P values ≤0.0004). At all study timepoints, a greater percentage of patients and investigators rated the effectiveness of the ibuprofen 200 mg plaster as good/excellent than the placebo plaster. Treatment-emergent adverse events for the ibuprofen plaster were few (≤1.5%) and were mild in severity. The results of this study indicate 200 mg plaster is effective and safe for the treatment of pain due to acute sports-related traumatic blunt soft tissue injury/contusion in adults.

  1. Endovascular Repair of Traumatic Rupture of the Thoracic Aorta: Single-Center Experience

    International Nuclear Information System (INIS)

    Saratzis, Nikolaos A.; Saratzis, Athanasios N.; Melas, Nikolaos; Ginis, Georgios; Lioupis, Athanasios; Lykopoulos, Dimitrios; Lazaridis, John; Dimitrios, Kiskinis

    2007-01-01

    Purpose. Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency and a common cause of death, usually following violent collisions. The objective of this retrospective report was to evaluate the efficacy of endovascular treatment of thoracic aortic disruptions with a single commercially available stent-graft. Methods. Nine men (mean age 29.5 years) were admitted to our institution between January 2003 and January 2006 due to blunt aortic trauma following violent motor vehicle collisions. Plain chest radiography, spiral computed tomography, aortography, and transesophageal echocardiography were used for diagnostic purposes in all cases. All patients were diagnosed with contained extramural thoracic aortic hematomas, secondary to aortic disruption. One patient was also diagnosed with a traumatic thoracic aortic dissection, secondary to blunt trauma. All subjects were poor surgical candidates, due to major injuries such as multiple bone fractures, abdominal hematomas, and pulmonary contusions. All repairs were performed using the EndoFit (LeMaitre Vascular) stent-graft. Results. Complete exclusion of the traumatic aortic disruption and pseudoaneurysm was achieved and verified at intraoperative arteriography and on CT scans, within 10 days of the repair in all patients. In 1 case the deployment of a second cuff was necessary due to a secondary endoleak. In 2 cases the left subclavian artery was occluded to achieve adequate graft fixation. No procedure-related deaths have occurred and no cardiac or peripheral vascular complications were observed within the 12 months (range 8-16 months) follow-up. Conclusions. This is the first time the EndoFit graft has been utilized in the treatment of thoracic aortic disruptions secondary to chest trauma. The repair of such pathologies is technically feasible and early follow-up results are promising

  2. Detection of active intraabdominal hemorrhage after blunt trauma: value of delayed CT scanning

    Energy Technology Data Exchange (ETDEWEB)

    Sivit, C.J. [Department of Radiology, Rainbow Babies and Children' s Hospital of the University Hospitals of Cleveland and Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH (United States)

    2000-02-01

    Active hemorrhage is a rare finding at CT following blunt abdominal trauma. The time interval between IV contrast administration and scanning the abdomen may impact on the ability to visualize active hemorrhage at CT. We report a case of active hemorrhage associated with splenic injury that was identified only at delayed CT scanning. (orig.)

  3. Detection of active intraabdominal hemorrhage after blunt trauma: value of delayed CT scanning

    International Nuclear Information System (INIS)

    Sivit, C.J.

    2000-01-01

    Active hemorrhage is a rare finding at CT following blunt abdominal trauma. The time interval between IV contrast administration and scanning the abdomen may impact on the ability to visualize active hemorrhage at CT. We report a case of active hemorrhage associated with splenic injury that was identified only at delayed CT scanning. (orig.)

  4. Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study.

    Science.gov (United States)

    Cunningham, Aaron J; Lofberg, Katrine M; Krishnaswami, Sanjay; Butler, Marilyn W; Azarow, Kenneth S; Hamilton, Nicholas A; Fialkowski, Elizabeth A; Bilyeu, Pamela; Ohm, Erika; Burns, Erin C; Hendrickson, Margo; Krishnan, Preetha; Gingalewski, Cynthia; Jafri, Mubeen A

    2017-12-01

    An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar. An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. Retrospective cohort study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Atheroembolization and potential air embolization during aortic declamping in open repair of a pararenal aortic aneurysm: A case report.

    Science.gov (United States)

    Dregelid, Einar Børre; Lilleng, Peer Kåre

    2016-01-01

    When ischemic events ascribable to microembolization occur during open repair of proximal abdominal aortic aneurysms, a likely origin of atheroembolism is not always found. A 78-year old man with enlargement of the entire aorta underwent open repair for a pararenal abdominal aortic aneurysm using supraceliac aortic clamping for 20min. Then the graft was clamped, the supraceliac clamp was removed, and the distal and right renal anastomoses were also completed. The patient was stable throughout the operation with only transient drop in blood pressure on reperfusion. Postoperatively the patient developed ischemia, attributable to microembolization, in legs, small intestine, gall bladder and kidneys. He underwent fasciotomy, small bowel and gall bladder resections. Intestinal absorptive function did not recover adequately and he died after 4 months. Microscopic examination of hundreds of intestinal, juxtaintestinal mesenteric, and gall bladder arteries showed a few ones containing cholesterol emboli. It is unsure whether a few occluded small arteries out of several hundred could have caused the ischemic injury alone. There had been only moderate backbleeding from aortic branches above the proximal anastomosis while it was sutured. Inadvertently, remaining air in the graft, aorta, and aortic branches may have been whipped into the pulsating blood, resulting in air microbubbles, when the aortic clamp was removed. Although both atheromatous particles and air microbubbles are well-known causes of iatrogenic microembolization, the importance of air microembolization in open repair of pararenal aortic aneurysms is not known and need to be studied. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. In Vivo Effects of Quercetin in Association with Moderate Exercise Training in Improving Streptozotocin-Induced Aortic Tissue Injuries

    Directory of Open Access Journals (Sweden)

    Irina C. Chis

    2015-12-01

    Full Text Available Background: Diabetes mellitus (DM is a chronic endocrine-metabolic disorder associated with endothelial dysfunction. Hyperglycemia, dyslipidemia and abnormal nitric oxide-mediated vasodilatation are the major causal factors in the development of endothelial dysfunction in DM. The prevention of endothelial dysfunction may be a first target against the appearance of atherosclerosis and cardiovascular diseases. We have investigated the synergistic protective effects of quercetin administration and moderate exercise training on thoracic aorta injuries induced by diabetes. Methods: Diabetic rats that performed exercise training were subjected to a swimming training program (1 h/day, 5 days/week, 4 weeks. The diabetic rats received quercetin (30 mg/kg body weight/day for 4 weeks. At the end of the study, the thoracic aorta was isolated and divided into two parts; one part was immersed in 10% formalin for histopathological evaluations and the other was frozen for the assessment of oxidative stress markers (malondialdehyde, MDA and protein carbonyls groups, PC, the activity of antioxidant enzymes (superoxide dismutase, SOD and catalase, CAT, nitrite plus nitrate (NOx production and inducible nitric oxide synthase (iNOS protein expression. Results: Diabetic rats showed significantly increased MDA and PC levels, NOx production and iNOS expression and a reduction of SOD and CAT activity in aortic tissues. A decrease in the levels of oxidative stress markers, NOx production and iNOS expression associated with elevated activity of antioxidant enzymes in the aortic tissue were observed in quercetin-treated diabetic trained rats. Conclusions: These findings suggest that quercetin administration in association with moderate exercise training reduces vascular complications and tissue injuries induced by diabetes in rat aorta by decreasing oxidative stress and restoring NO bioavailability.

  7. Inflammatory Cell Infiltrates in Acute and Chronic Thoracic Aortic Dissection.

    Science.gov (United States)

    Wu, Darrell; Choi, Justin C; Sameri, Aryan; Minard, Charles G; Coselli, Joseph S; Shen, Ying H; LeMaire, Scott A

    2013-12-01

    Thoracic aortic dissection (TAD) is a highly lethal cardiovascular disease. Injury to the intima and media allows pulsatile blood to enter the media, leading to dissection formation. Inflammatory cells then infiltrate the site of aortic injury to clear dead cells and damaged tissue. This excessive inflammation may play a role in aneurysm formation after dissection. Using immunohistochemistry, we compared aortic tissues from patients with acute TAD (n = 11), patients with chronic TAD (n = 35), and donor controls (n = 20) for the presence of CD68+ macrophages, neutrophils, mast cells, and CD3+ T lymphocytes. Tissue samples from patients with acute or chronic TAD generally had significantly more inflammatory cells in both the medial and adventitial layers than did the control samples. In tissues from patients with acute TAD, the adventitia had more of the inflammatory cells studied than did the media. The pattern of increase in inflammatory cells was similar in chronic and acute TAD tissues, except for macrophages, which were seen more frequently in the adventitial layer of acute TAD tissue than in the adventitia of chronic TAD tissue. The inflammatory cell content of both acute and chronic TAD tissue was significantly different from that of control tissue. However, the inflammatory cell profile of aneurysmal chronic TAD was similar to that of acute TAD. This may reflect a sustained injury response that contributes to medial degeneration and aneurysm formation.

  8. Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review.

    Science.gov (United States)

    Mikhael, Marco; Frost, Elizabeth; Cristancho, Maria

    2017-05-19

    Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury. PBI was one of the exclusion criteria in the second edition of guidelines for the acute medical management of severe TBI in infants, children, and adolescents that was published in 2012 (it is referred to as "pediatric guidelines" in this review). Many reviews of TBI do not differentiate between the mechanisms of injury. We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies. More clinical trials specific to penetrating head injuries in children, focusing mainly on pathophysiology and management, are needed. The term PBI is specific to penetrating injury only, whereas TBI, a more inclusive term, describes mainly, but not only, blunt injury.

  9. Treatment strategy for ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Davidovic, L

    2014-07-01

    Rupture is the most serious and lethal complication of the abdominal aortic aneurysm. Despite all improvements during the past 50 years, ruptured abdominal aortic aneurysms are still associated with very high mortality. Namely, including patients who die before reaching the hospital, the mortality rate due to abdominal aortic aneurysm rupture is 90%. On the other hand, during the last twenty years, the number of abdominal aortic aneurysms significantly increased. One of the reasons is the fact that in majority of countries the general population is older nowadays. Due to this, the number of degenerative AAA is increasing. This is also the case for patients with abdominal aortic aneurysm rupture. Age must not be the reason of a treatment refusal. Optimal therapeutic option ought to be found. The following article is based on literature analysis including current guidelines but also on my Clinics significant experience. Furthermore, this article show cases options for vascular medicine in undeveloped countries that can not apply endovascular procedures at a sufficient level and to a sufficient extent. At this moment the following is evident. Thirty-day-mortality after repair of ruptured abdominal aortic aneurysms is significantly lower in high-volume hospitals. Due to different reasons all ruptured abdominal aortic aneurysms are not suitable for EVAR. Open repair of ruptured abdominal aortic aneurysm should be performed by experienced open vascular surgeons. This could also be said for the treatment of endovascular complications that require open surgical conversion. There is no ideal procedure for the treatment of AAA. Each has its own advantages and disadvantages, its own limits and complications, as well as indications and contraindications. Future reductions in mortality of ruptured abdominal aortic aneurysms will depend on implementation of population-based screening; on strategies to prevent postoperative organ injury and also on new medical technology

  10. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma.

    Science.gov (United States)

    Stengel, Dirk; Rademacher, Grit; Ekkernkamp, Axel; Güthoff, Claas; Mutze, Sven

    2015-09-14

    Ultrasonography (performed by means of a four-quadrant, focused assessment of sonography for trauma (FAST)) is regarded as a key instrument for the initial assessment of patients with suspected blunt abdominal and thoraco-abdominal trauma in the emergency department setting. FAST has a high specificity but low sensitivity in detecting and excluding visceral injuries. Proponents of FAST argue that ultrasound-based clinical pathways enhance the speed of primary trauma assessment, reduce the number of unnecessary multi-detector computed tomography (MDCT) scans, and enable quicker triage to surgical and non-surgical care. Given the proven accuracy, increasing availability of, and indication for, MDCT among patients with blunt abdominal and multiple injuries, we aimed to compile the best available evidence of the use of FAST-based assessment compared with other primary trauma assessment protocols. To assess the effects of diagnostic algorithms using ultrasonography including in FAST examinations in the emergency department in relation to the early, late, and overall mortality of patients with suspected blunt abdominal trauma. The most recent search was run on 30th June 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, MEDLINE (OvidSP), EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), clinical trials registers, and screened reference lists. Trial authors were contacted for further information and individual patient data. We included randomised controlled trials (RCTs). Participants were patients with blunt torso, abdominal, or multiple trauma undergoing diagnostic investigations for abdominal organ injury. The intervention was diagnostic algorithms comprising emergency ultrasonography (US). The control was diagnostic algorithms without US examinations (for example, primary computed tomography (CT) or diagnostic peritoneal lavage (DPL)). Outcomes were mortality, use of CT or invasive procedures (DPL

  11. Determinants of splenectomy in splenic injuries following blunt ...

    African Journals Online (AJOL)

    Introduction. The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic ...

  12. [Associated factors to non-operative management failure of hepatic and splenic lesions secondary to blunt abdominal trauma in children].

    Science.gov (United States)

    Echavarria Medina, Adriana; Morales Uribe, Carlos Hernando; Echavarria R, Luis Guillermo; Vélez Marín, Viviana María; Martínez Montoya, Jorge Alberto; Aguillón, David Fernando

    2017-01-01

    The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients.Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen. 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) 2 g/dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.

  13. Selective angiographic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management.

    Science.gov (United States)

    Bhullar, Indermeet S; Frykberg, Eric R; Siragusa, Daniel; Chesire, David; Paul, Julia; Tepas, Joseph J; Kerwin, Andrew J

    2012-05-01

    To determine whether angioembolization (AE) in hemodynamically stable adult patients with blunt splenic trauma (BST) at high risk for failure of nonoperative management (NOM) (contrast blush [CB] on computed tomography, high-grade IV-V injuries, or decreasing hemoglobin) results in lower failure rates than reported. The records of patients with BST from July 2000 to December 2010 at a Level I trauma center were retrospectively reviewed using National Trauma Registry of the American College of Surgeons. Failure of NOM (FNOM) occurred if splenic surgery was required after attempted NOM. Logistic regression analysis was used to identify factors associated with FNOM. A total of 1,039 patients with BST were found. Pediatric patients (age <17 years), those who died in the emergency department, and those requiring immediate surgery for hemodynamic instability were excluded. Of the 539 (64% of all BST) hemodynamically stable patients who underwent NOM, 104 (19%) underwent AE and 435 (81%) were observed without AE (NO-AE). FNOM for the various groups were as follows: overall NOM (4%), NO-AE (4%), and AE (4%). There was no significant difference in FNOM for NO-AE versus AE for grades I to III: grade I (1% vs. 0%, p = 1), grade II (2% vs. 0%, p = 0.318), and grade III (5% vs. 0%, p = 0.562); however, a significant decrease in FNOM was noted with the addition of AE for grades IV to V: grade IV (23% vs. 3%, p = 0.04) and grade V (63% vs. 9%, p = 0.03). Statistically significant independent risk factors for FNOM were grade IV to V injuries and CB. Application of strictly defined selection criteria for NOM and AE in patients with BST resulted in one of the lowest overall FNOM rates (4%). Hemodynamically stable BST patients are candidates for NOM with selective AE for high-risk patients with grade IV to V injuries, CB on initial computed tomography, and/or decreasing hemoglobin levels. III, therapeutic study.

  14. Delayed rupture of common carotid artery following rugby tackle injury: a case report

    Directory of Open Access Journals (Sweden)

    Abbas Saleh

    2008-03-01

    Full Text Available Abstract Background Common Carotid Artery (CCA is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above. Case presentation Mr H. presented to the Emergency Department with an expanding neck haematoma and shortness of breath. He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA. He underwent emergency surgery with repair of the defect and made an uneventful recovery post operatively. Conclusion Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism. A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

  15. Laryngeal fracture due to blunt trauma presenting with pneumothorax and pneumomediastinum.

    Science.gov (United States)

    Narcı, Adnan; Embleton, Didem Baskın; Ayçiçek, Abdullah; Yücedağ, Fatih; Cetinkurşun, Salih

    2011-01-01

    Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis. Copyright © 2011 S. Karger AG, Basel.

  16. High-grade renal injuries are often isolated in sports-related trauma.

    Science.gov (United States)

    Patel, Darshan P; Redshaw, Jeffrey D; Breyer, Benjamin N; Smith, Thomas G; Erickson, Bradley A; Majercik, Sarah D; Gaither, Thomas W; Craig, James R; Gardner, Scott; Presson, Angela P; Zhang, Chong; Hotaling, James M; Brant, William O; Myers, Jeremy B

    2015-07-01

    Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure 110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, pinjury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (psports and non-sports renal injuries (p=0.30). Sports injuries had lower transfusion (7% vs. 47%, psports vs. 18% non-sports, p=0.95). High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims

    Directory of Open Access Journals (Sweden)

    JOSÉ GUSTAVO PARREIRA

    Full Text Available ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle or B (victims of other mechanisms of blunt trauma. Variables were compared between groups. We considered p<0.05 as significant.Results:a total of 5785 cases were included, and 1217 (21,0% of which were in group A. Pedestrians struck by vehicles presented (p<0.05 higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.Conclusion:pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

  18. Emergency Department Ultrasound Is not a Sensitive Detector of Solid Organ Injury

    Directory of Open Access Journals (Sweden)

    Kendall, John L

    2009-02-01

    Full Text Available Objective: To estimate the sensitivity and specificity of emergency department (ED ultrasound for the detection of solid organ injury following blunt abdominal trauma.Methods: A prospective cohort study performed in the ED of an urban Level I trauma center on patients who sustained blunt abdominal trauma. Following initial standard trauma evaluation, patients underwent a secondary ultrasound examination performed specifically to identify injury to the liver or spleen, followed by computed tomography (CT scan of the abdomen. Ultrasound examinations were performed by emergency medicine residents or attending physicians experienced in the use of ultrasound for detecting hemoperitoneum. Ultrasonographers prospectively determined the presence or absence of liver or spleen injury. CT findings were used as the criterion standard to evaluate the ultrasound results.Results: From July 1998 through June 1999, 152 patients underwent secondary ultrasound examination and CT. Of the 152 patients, nine (6% had liver injuries and 10 (7% had spleen injuries. Ultrasound correctly detected only one of the liver injuries for a sensitivity of 11% (95% CI: 0%-48% and a specificity of 98% (95% CI: 94%-100%. Ultrasound correctly detected eight spleen injuries for a sensitivity of 80% (95% CI: 44%-98% and a specificity of 99% (95% CI: 95%-100%.Conclusion: Emergency ultrasound is not sensitive or specific for detecting liver or spleen injuries following blunt abdominal trauma.[WestJEM. 2009;10:1-5.

  19. Splenic injury diagnosis & splenic salvage after trauma

    NARCIS (Netherlands)

    Olthof, D.C.

    2014-01-01

    Non-operative management (NOM) has replaced surgery as the treatment of choice for hemodynamically stable patients with splenic injury after trauma. The growing use of NOM for blunt abdominal organ injury has been made possible by the progress in the quality and availability of the multidetector CT

  20. External air compression: A rare cause of blunt esophageal injury, managed by a stent

    Directory of Open Access Journals (Sweden)

    Mohammed Muneer

    2014-01-01

    CONCLUSION: High index of suspicion is needed for early diagnosis of esophageal perforation after blunt trauma. Appropriate drainage, antibiotic and temporary endoscopic esophageal stenting may be an optimal approach in selected patients, especially with delayed diagnosis.

  1. Successful Kidney and Lung Transplantation From a Deceased Donor With Blunt Abdominal Trauma and Intestinal Perforation

    NARCIS (Netherlands)

    van Smaalen, Tim C.; Krikke, Christina; Haveman, Jan Willem; van Heurn, L. W. Ernest

    2016-01-01

    The number of organ donors is limited by many contraindications for donation and poor quality of potential organ donors. Abdominal infection is a generally accepted contraindication for donation of abdominal organs. We present a 43-year-old man with lethal brain injury, blunt abdominal trauma, and

  2. Blunt traumatic axillary artery truncation, in the absence of associated fracture.

    Science.gov (United States)

    Bokser, Emily; Caputo, William; Hahn, Barry; Greenstein, Josh

    2018-02-01

    Axillary artery injuries can be associated with both proximal humeral fractures (Naouli et al., 2016; Ng et al., 2016) [1,2] as well as shoulder dislocations (Leclerc et al., 2017; Karnes et al., 2016) [3,4]. We report a rare case of an isolated axillary artery truncation following blunt trauma without any associated fracture or dislocation. A 58-year-old male presented to the emergency department for evaluation after falling on his outstretched right arm. The patient was found to have an absent right radial pulse with decreased sensation to the right arm. Point of care ultrasound showed findings suspicious for traumatic axillary artery injury, and X-rays did not demonstrate any fracture. Computed tomography with angiography confirmed axillary artery truncation with active extravasation. The patient underwent successful vascular repair with an axillary artery bypass. Although extremity injuries are common in emergency departments, emergency physicians need to recognize the risk for vascular injuries, even without associated fracture or dislocation. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Acute Aortic Arch Perforation During Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch.

    Science.gov (United States)

    Millan-Iturbe, Oscar; Sawaya, Fadi J; Bieliauskas, Gintautas; Chow, Danny H F; De Backer, Ole; Søndergaard, Lars

    2017-09-01

    Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high/intermediate-risk patients with severe symptomatic aortic stenosis (AS). Although TAVR is used to treat bicuspid severe AS, the large randomized trials typically excluded bicuspid AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a "gothic aortic arch"; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled a sharply angulated aortic arch. This life-threatening complication was successfully treated by thoracic endovascular aortic repair. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital

    Science.gov (United States)

    Hefny, Ashraf F; Kunhivalappil, Fathima T; Matev, Nikolay; Avila, Norman A; Bashir, Masoud O; Abu-Zidan, Fikri M

    2018-01-01

    INTRODUCTION Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital. METHODS Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality. RESULTS CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL. CONCLUSION Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL. PMID:28741012

  5. Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital.

    Science.gov (United States)

    Hefny, Ashraf F; Kunhivalappil, Fathima T; Matev, Nikolay; Avila, Norman A; Bashir, Masoud O; Abu-Zidan, Fikri M

    2018-03-01

    Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital. Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality. CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL. Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL. Copyright: © Singapore Medical Association.

  6. Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers

    Directory of Open Access Journals (Sweden)

    Ortner Clemens M

    2012-02-01

    Full Text Available Abstract Background Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar techniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip are currently commercially available. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate. Methods Twenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped tube kits in 100 fresh human cadavers (100 thoracostomies with each kit. Time until tube insertion served as primary outcome. Complications and success rate were examined by pathological dissection and served as further outcomes parameters. Results Difference in mean time until tube insertion (63s vs. 59s was statistically not significant. In both groups, time for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver's BMI and on the individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped kits and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p = 0.04. Conclusion Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.

  7. Targeted treatment of severe head injury

    African Journals Online (AJOL)

    injury is not a homogeneous concept and is poorly classified for the purposes of treatment.1 The separation of patients into 3 categories of severity (mild, moderate and severe) remains a blunt measure used to guide therapy in individual patients. Patients with severe traumatic brain injury (TBI), i.e. a Glasgow Coma Score ...

  8. Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience.

    Science.gov (United States)

    Jabbour, Gaby; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Peralta, Ruben; Ellabib, Mohammed; Al-Jogol, Hisham; Asim, Mohammed; Al-Thani, Hassan

    2017-07-12

    BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I-III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. CONCLUSIONS Most BSI patients had grade I-III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for

  9. THE ROLE OF LAPAROSCOPY IN BLUNT ABDOMINAL TRAUMA: DIAGNOSTIC, THERAPEUTIC OR BOTH?

    Science.gov (United States)

    Mosai, F

    2017-09-01

    The use of laparoscopy in blunt abdominal trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. But the feasibility of using laparoscopy for therapeutic intervention in these patients has been debated. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted. A retrospective analysis of a prospectively collected data was done. All adult patients who presented with abdominal trauma and were offered laparoscopic surgery at DGMAH from 2012 to 2015 were reviewed. Data was retrieved from our departmental database and analysed using descriptive statistics. A total of 318 patients were reviewed and 35 patients had blunt abdominal trauma and were included in the study. All the patients were offered laparoscopy. The median age was 30, with 91% of our patients being males. The highest injury severity score calculated was 38. At least 77% of the patients were managed using laparoscopy. This includes 43% who had both diagnostic and therapeutic intervention and 34% had only diagnostic laparoscopy. Eight patients were converted to open surgery mainly due to active bleeding and complex injuries. We did not have any non-therapeutic laparotomies, with no documented procedure related morbidity and mortality. The positive outcomes seen from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients. A conversion to open surgery should not be regarded as a failure but rather as a sign of mature and sound clinical judgement acknowledging the limitations of laparoscopy and/or the surgeon.

  10. Numerical simulation of flows in a circular pipe transversely subjected to a localized impulsive body force with applications to blunt traumatic aortic rupture

    Energy Technology Data Exchange (ETDEWEB)

    Labbio, G Di; Keshavarz-Motamed, Z; Kadem, L, E-mail: lcfd@encs.concordia.ca [Department of Mechanical and Industrial Engineering, Concordia University, Montreal, Quebec, H3G 1M8 (Canada)

    2017-06-15

    Much debate surrounds the mechanisms responsible for the occurrence of blunt traumatic aortic rupture in car accidents, particularly on the role of the inertial body force experienced by the blood due to the abrupt deceleration. The isolated influence of such body forces acting on even simple fluid flows is a fundamental problem in fluid dynamics that has not been thoroughly investigated. This study numerically investigates the fundamental physical problem, where the pulsatile flow in a straight circular pipe is subjected to a transverse body force on a localized volume of fluid. The body force is applied as a brief rectangular impulse in three distinct cases, namely during the accelerating, peak, and decelerating phases of the pulsatile flow. A dimensionless number, termed the degree of influence of the body force (Ψ), is devised to quantify the relative strength of the body force over the flow inertia. The impact induces counter-rotating cross-stream vortices at the boundaries of the forced section accompanied by complex secondary flow structures. This secondary flow is found to develop slowest for an impact occurring during an accelerating flow and fastest during a decelerating flow. The peak skewness of the velocity field, however, occurred at successively later times for the three respective cases. After the impact, these secondary flows act to restore the unforced state and such dominant spatial structures are revealed by proper orthogonal decomposition of the velocity field. This work presents a new class of problems that requires further theoretical and experimental investigation. (paper)

  11. Numerical simulation of flows in a circular pipe transversely subjected to a localized impulsive body force with applications to blunt traumatic aortic rupture

    Science.gov (United States)

    Di Labbio, G.; Keshavarz-Motamed, Z.; Kadem, L.

    2017-06-01

    Much debate surrounds the mechanisms responsible for the occurrence of blunt traumatic aortic rupture in car accidents, particularly on the role of the inertial body force experienced by the blood due to the abrupt deceleration. The isolated influence of such body forces acting on even simple fluid flows is a fundamental problem in fluid dynamics that has not been thoroughly investigated. This study numerically investigates the fundamental physical problem, where the pulsatile flow in a straight circular pipe is subjected to a transverse body force on a localized volume of fluid. The body force is applied as a brief rectangular impulse in three distinct cases, namely during the accelerating, peak, and decelerating phases of the pulsatile flow. A dimensionless number, termed the degree of influence of the body force (Ψ), is devised to quantify the relative strength of the body force over the flow inertia. The impact induces counter-rotating cross-stream vortices at the boundaries of the forced section accompanied by complex secondary flow structures. This secondary flow is found to develop slowest for an impact occurring during an accelerating flow and fastest during a decelerating flow. The peak skewness of the velocity field, however, occurred at successively later times for the three respective cases. After the impact, these secondary flows act to restore the unforced state and such dominant spatial structures are revealed by proper orthogonal decomposition of the velocity field. This work presents a new class of problems that requires further theoretical and experimental investigation.

  12. Hyphema as a Complication of Blunt Ocular Trauma and Additional Ocular Findings

    OpenAIRE

    Mehmet Giray Ersöz; Seda Adıyeke; Gamze Türe; Ekrem Talay; Hakkı Özgür Konya

    2014-01-01

    Objectives: To investigate the frequency of angle recession, commotio retinae, and other ocular findings in patients with hyphema due to blunt ocular trauma. Materials and Methods: The medical records of 66 patients hospitalized between July 2010 and May 2012 with a diagnosis of traumatic hyphema were retrospectively reviewed. The age, gender, period between injury and the first examination, visual acuity at presentation, intraocular pressure (IOP), time of disappearance of hyphem...

  13. The Use of CT Scan in Hemodynamically Stable Children with Blunt Abdominal Trauma : Look before You Leap

    NARCIS (Netherlands)

    Nellensteijn, David R.; Greuter, Marcel J.; el Moumni, Moustafa; Hulscher, Jan B.

    We set out to determine the diagnostic value of computed tomographic (CT) scans in relation to the radiation dose, tumor incidence, and tumor mortality by radiation for hemodynamically stable pediatric patients with blunt abdominal injury. We focused on the changes in management because of new

  14. Cardiopulmonary bypass after severe blunt hepatic injury: management of multi-system blunt trauma in an adolescent.

    Science.gov (United States)

    Streit, Stephanie; Kavarana, Minoo; Scheurer, Mark A; Cina, Robert A

    2013-06-01

    A 16-year-old adolescent male sustained combined injuries to the tricuspid valve and liver. This injury is exceptional due to the mechanism and the circumstances in which it took place: a flying pumpkin thrown from a sport utility vehicle. An echocardiogram demonstrated a flail chordal apparatus associated with the posterior leaflet of the tricuspid valve, creating substrate for severe tricuspid regurgitation with preserved right heart function. He was treated with non-operative management for the liver injury; he remained hemodynamically stable and was discharged home. He underwent successful repair of the tricuspid valve 17 days following the initial injury necessitating systemic anticoagulation and was discharged home two days later. The patient recovered fully without residual valvular pathology or hepatic sequelae. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Splenic injuries in athletes: a review.

    Science.gov (United States)

    Gannon, Elizabeth H; Howard, Thomas

    2010-01-01

    Splenic injuries can be challenging to the sports medicine physician. While these injuries are not common among athletes, they can have serious, potentially fatal consequences if not properly diagnosed and managed in a prompt and timely fashion. Currently, there are no evidence-based guidelines on returning athletes to previous levels of activity after sustaining a splenic injury. In addition, there is no consensus on follow-up imaging after injury. This article discusses the evaluation of athletes with blunt abdominal trauma for splenic injury, including the imaging, management, and current return-to-play guidelines.

  16. [Blunt trauma with bullet-proof vests. Skin lesions are no reliable predictor of injury severity].

    Science.gov (United States)

    Doll, D; Illert, B; Bohrer, S; Richter, C; Woelfl, C

    2009-04-01

    It is well known that so-called bullet-proof vests offer protection against a wide range of penetrating trauma, but their protection against blunt trauma is less well understood. Fast projectiles may result in hematomas and contusions behind the armour. We report a traffic accident involving a young soldier wearing a ballistic protection vest resulting in a right thoracoabdominal blunt trauma leading to a confined liver compression rupture. As nearly no skin marks were detectable, we point out that every emergency department surgeon should be very suspicious if a patient wore a ballistic vest at the time of the accident--there may be no skin marks despite severe intra-abdominal trauma. Our patient recovered following hypotensive ICU treatment, thrombocyte mobilization, and factor VIIa substitution.

  17. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Science.gov (United States)

    Lagisetty, Jyothi; Slovis, Thomas; Thomas, Ronald; Knazik, Stephen; Stankovic, Curt

    2012-07-01

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.

  18. Diagnostic Accuracy of Secondary Ultrasound Exam in Blunt Abdominal Trauma

    International Nuclear Information System (INIS)

    Rajabzadeh Kanafi, Alireza; Giti, Masoumeh; Gharavi, Mohammad Hossein; Alizadeh, Ahmad; Pourghorban, Ramin; Shekarchi, Babak

    2014-01-01

    In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients. Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams. Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid

  19. Real chimney technique for total debranching of supra-aortic trunks.

    Science.gov (United States)

    Kato, Masaaki; Kagaya, Hideo; Kubo, Yoji; Banno, Hiroshi; Ohkubo, Nobukazu

    2015-02-01

    Side-clamping of the ascending aorta is an indispensable technique for proximal anastomosis in total debranching of supra-aortic trunks and in endovascular aneurysm repair for arch aneurysm. However, this procedure may lead to the dislodging of multiple plaques and to clamp injury of the ascending aorta. We developed a clampless technique to achieve proximal anastomosis between the ascending aorta and an artificial graft used for total debranching of supra-aortic trunks. We applied this method in six patients with arch aneurysm and a plaque-rich ascending aorta and were able to achieve total debranching of the supra-aortic trunks in all of the patients without side-clamping the ascending aorta and no procedurally related complications. This clampless anastomosis technique ("real chimney technique") in the ascending aorta is a valuable option for total debranching of supra-aortic trunks in the hybrid repair of arch aneurysms. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Multidetector CT of blunt cervical spine trauma in adults.

    Science.gov (United States)

    Dreizin, David; Letzing, Michael; Sliker, Clint W; Chokshi, Falgun H; Bodanapally, Uttam; Mirvis, Stuart E; Quencer, Robert M; Munera, Felipe

    2014-01-01

    A number of new developments in cervical spine imaging have transpired since the introduction of 64-section computed tomographic (CT) scanners in 2004. An increasing body of evidence favors the use of multidetector CT as a stand-alone screening test for excluding cervical injuries in polytrauma patients with obtundation. A new grading scale that is based on CT and magnetic resonance (MR) imaging findings, the cervical spine Subaxial Injury Classification and Scoring (SLIC) system, is gaining acceptance among spine surgeons. Radiographic measurements described for the evaluation of craniocervical distraction injuries are now being reevaluated with the use of multidetector CT. Although most patients with blunt trauma are now treated nonsurgically, evolution in the understanding of spinal stability, as well as the development of new surgical techniques and hardware, has driven management strategies that are increasingly favorable toward surgical intervention. It is therefore essential that radiologists recognize findings that distinguish injuries with ligamentous instability or a high likelihood of nonfusion that require surgical stabilization from those that are classically stable and can be treated with a collar or halo vest alone. The purpose of this article is to review the spectrum of cervical spine injuries, from the craniocervical junction through the subaxial spine, and present the most widely used grading systems for each injury type. ©RSNA, 2014.