Diego Nunez

1,000 Consecutive Ultrasounds for Blunt Abdominal Trauma

Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities used in the evaluation of patients with suspected blunt abdominal trauma (BAT). DPL is fast and accurate but is associated with complications. CT is also accurate, yet requires stability and transportability of the patients. Ultrasound (US) has been suggested as an aid in evaluating BAT. We evaluated US in the initial assessment of BAT in 1000 patients. Patients were eligible for the study if they met specified trauma criteria and had suspected BAT. We then followed the outcome of the patients and their further work-up. US showed a sensitivity of 88%, a specificity of 99%, and an accuracy of 97% for detecting intraabdominal injuries. We conclude that emergency ultrasound may be used as the initial diagnostic modality for suspected blunt abdominal trauma.

Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma

Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities in the evaluation of patients with suspected blunt abdominal trauma (BAT). Diagnostic peritoneal lavage is fast and accurate but associated with complications. Computed tomography is also accurate, yet requires that patients be stable and transportable. A prospective study was designed to determine the utility of emergency ultrasound (US) studies in the initial assessment of BAT. Two hundred acutely injured patients with suspected BAT were evaluated with US. Patients were eligible for the study if they met trauma criteria and had suspected BAT. Subsequently, without knowledge of the US results, DPL or CT was performed. Ultrasound showed a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in detecting intra-abdominal injuries. Six injuries were missed but only one was felt to be significant. If US had been used in all 200 patients, 199 would have had appropriate care. We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT.

Hemoperitoneum score helps determine need for therapeutic laparotomy.

PURPOSE Sonography provides a fast, portable, and noninvasive method for patient assessment. However, the benefit of providing real-time ultrasound (US) imaging and fluid quantification shortly after patient arrival has not been explored. The objective of this study was to prospectively validate a US hemoperitoneum scoring system developed at our institution and determine whether sonography can predict a therapeutic operation. METHODS For 12 months, prospective data on all patients undergoing a trauma sonogram were recorded. All sonograms positive for free fluid were given a hemoperitoneum score. The US score was compared with initial systolic blood pressure and base deficit to assess the ability of sonography to predict a therapeutic laparotomy. RESULTS Forty of 46 patients (87%) with a US score > or = 3 required a therapeutic laparotomy. Forty-six of 54 patients with a US score < 3 (85%) did not need operative intervention. The sensitivity of sonography was 83% compared with 28% and 49% for systolic blood pressure and base deficit, respectively, in determining the need for therapeutic operation. CONCLUSION We conclude that the majority of patients with a score > or = 3 will need surgery. The US hemoperitoneum scoring system was a better predictor of a therapeutic laparotomy than initial blood pressure and/or base deficit.

Portosystemic Communications Studied by Transhepatic Portography

The experience of collecting 120 transhepatic portograms, performed in patients with different degrees of portal hypertension, affords the opportunity for discussing the anatomical and hemodynamic features of portosystemic communications. Multiple pathways of decompression were found. The coronary-gastroesophageal collateral formed pathways in 108 cases, other major collaterals in 41, and minor collaterals in 2. This multiplicity of communications suggests that no one vessel is indispensable as a collateral pathway.

HELICAL CT OF CERVICAL SPINE AND SOFT TISSUE INJURIES OF THE NECK

Helical CT of the neck has revolutionized the diagnostic evaluation of trauma and emergency room patients. This comprehensive examination, with high resolution and fast acquisition times, allows the radiologist to make expeditious diagnoses concerning cervical spine fractures, vascular injuries, and aero-digestive tract lesions. This allows for the more rapid triaging and treatment of various injuries resulting in improved patient priate radiographic examination for each clinical scenario.

Ultrasound in blunt abdominal trauma

Widely accepted in Europe and Asia as a screening tool for blunt abdominal trauma, sonography is gradually gaining popularity among trauma and emergency physicians in the United States. Sonography has been shown to be comparable with DPL and CT for the detection of hemoperitoneum and superior to both modalities because of its rapidity, noninvasiveness, portability, and low cost. With its ability to demonstrate the amount of intraperitoneal hemorrhage within minutes of a patients arrival, sonography may be considered the screening modality of choice for blunt abdominal trauma.

Subhepatic collections complicating laparoscopic cholecystectomy: percutaneous management.

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.

Cost reduction using ultrasound in blunt abdominal trauma

Ultrasound (US) provides a rapid, portable, and noninvasive method for evaluating the blunt trauma patient. In 1993, US was introduced into the workup of blunt abdominal trauma (BAT) at our institution and has rapidly become the modality of choice over computed tomography (CT) and diagnostic peritoneal lavage (DPL). In this study, the cost effectiveness of utilizing US in BAT was evaluated.We compared the number of DPLs and CTs performed during the 6-month period in 1993 preceding the incorporation of US with the number of CTs, DPLs, and USs performed during the last 6 months of 1994. Costs were determined by the finance department based on actual expenditures by the hospital, excluding physician fees, in 1994 U.S. dollars.Six hundred twenty-six patients were evaluated for BAT during the 6-month period in 1993. In this group, 450 patients had CT examinations, 160 had DPL, and 16 had both. This resulted in a cost of

Review of computed tomography findings in thrombosis of the major abdominal venous pathways

254,316. During the last 6 months in 1994,564 patients were evaluated for BAT, including 470 USs, 175 CTs, and 11 DPLs. The cost for this group was

Ultrasound for blunt abdominal trauma: Is it free fluid?

133,077, with a decrease in hospital expenditure of