Journal
RADIOGRAPHICS
Volume 41, Issue 4, Pages 1064-1081Publisher
RADIOLOGICAL SOC NORTH AMERICA
DOI: 10.1148/rg.2021200181
Keywords
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Funding
- National Institutes of Health [T32-EB021955]
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Penetrating abdominopelvic trauma presents diagnostic challenges for radiologists due to its complexity and subtle imaging findings. Contrast-enhanced CT is the preferred modality for evaluating these injuries, providing good sensitivity and specificity. Familiarity with the projectile kinetics and the use of CT trajectography are important skills for radiologists in diagnosing both overt and subtle injuries.
Penetrating abdominopelvic trauma usually results from abdominal cavity violation from a firearm injury or a stab wound and is a leading cause of morbidity and mortality from traumatic injuries. Penetrating trauma can have subtle or complex imaging findings, posing a diagnostic challenge for radiologists. Contrast-enhanced CT is the modality of choice for evaluating penetrating injuries, with good sensitivity and specificity for solid-organ and hollow viscus injuries. Familiarity with the projectile kinetics of penetrating injuries is an important skill set for radiologists and aids in the diagnosis of both overt and subtle injuries. CT trajectography is a useful tool in CT interpretation that allows the identification of subtle injuries from the transfer of kinetic injury from the projectile to surrounding tissue. In CT trajectography, after the entry and exit wounds are delineated, the two points can be connected by placing cross-cursors and swiveling the cut planes obliquely in orthogonal planes to obtain a double-oblique orientation to visualize the wound track in profile. The path of the projectile and its ensuing damage is not always straight, and the imaging characteristics of free fluid of different attenuation in the abdomen (including hemoperitoneum) can support the diagnosis of visceral and vascular injuries. In addition, CT is increasingly used for evaluation of patients after damage control surgery and helps guide the management of injuries that were overlooked at surgery.
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