Type:
Educational Exhibit
Keywords:
Trauma, Acute, Diagnostic procedure, CT, Thorax, Abdomen
Authors:
C. E. Jenkins, R. Ellis Owen, C. Parry, A. Marin, A. Eynon; Cardiff/UK
DOI:
10.1594/ecr2018/C-1804
Conclusion
Penetrating traumatic injuries result in high morbidity and mortality.
We present multiple cases of penetrating trauma from stab injuries,
highlighting the common and more unusual patterns of injury on imaging.
As illustrated in our case examples,
we highlight multiple key learning points to be considered in the evaluation of imaging in penetrating trauma,
these include:
- The importance of image reconstruction in the attempt to predict the trajectory of the penetrating injury.
This will aid in the identification of potential injury sites related to the path of the wound,
which can then be carefully interrogated.
-
The wound entry point may not exactly correspond to the trajectory of internal injury due to the movement of structures.
-
Free intraperitoneal gas can be introduced from a penetrating wound; therefore the presence of intraperitoneal gas is not a reliable sign for hollow visceral injury in the context of penetrating stab injuries.
-
The presence of gas remote to the trajectory of the injury should promote careful evaluation for secondary signs of bowel injury1:
-
CT has an invaluable role in guiding management in the unstable setting following initial surgical exploration and temporising measures.
-
Delayed haemorrhage is common in the setting of traumatic solid visceral injuries i.e.
liver and spleen.
There should be a low threshold for re-imaging this cohort of patients routinely 48 hours after injury to exclude vascular injury; or earlier if the the patient becomes symptomatic.
-
The importance of assessing for absence of flow in the post-operative patient with vascular injury,
as this may not be apparent at surgical exploration.