Imaging Evaluation Of Abdominal Trauma

Don’t miss signs which indicate a surgical or interventional radiological intervention

- Dr Atin Kumar

When a patient of suspected abdominal trauma presents to the emergency room, he is managed by initial evaluation, resuscitation and stabilisation as a part of the primary survey. Radiographs of chest and pelvis and FAST (Focussed assessment with sonography in trauma) ultrasound are done during the primary survey itself. FAST ultrasound is done to detect free fluid in the peritoneal cavity which in this setting as considered as hemoperitoneum. Gray scale ultrasound has been shown to be ineffective in ruling out abdominal organ injuries and hence is not used for the same. The FAST can be extended to chest to detect hemothorax and hemopericardium.

If the patient does not stabilise after the initial resuscitation, then often surgical management is done by the form of diagnostic laparotomy or thoracotomy without any further imaging. But if the patient is hemodynamically stable, then he is subjected to contrast enhanced CT scan of chest and abdomen. At our level-1 trauma centre, all patients who are positive for abdominal fluid by FAST examination are subjected to CT scan. Patients with a dangerous mechanism of injury including fall from a significant height, high speed motor vehicle collision etc are also subjected to CT scan even if they are FAST negative. We consider chest and abdomen together as part of torso trauma and image them together in all patients suspected of either chest or abdominal trauma.