CT Clinical Case Study Trauma CT Stomach Rupture & Other Chest, Abdominal & Pelvic Traumatic Injuries

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1 GE Healthcare CT Clinical Case Study Trauma CT Stomach Rupture & Other Chest, Abdominal & Pelvic Traumatic Injuries Jorge Soto, M.D. Stephan Anderson, M.D. Boston University Medical Center Boston, MA imagination at work

2 CT Clinical Case Study Trauma CT Stomach Rupture & Other Chest, Abdominal, & Pelvic Traumatic Injuries Jorge Soto, M.D. Stephan Anderson, M.D. Boston University Medical Center Boston, MA Figure 1 Axial MIP View demonstrating gastric rupture involving the lesser curvature with extensive pneumoperitoneum, mesenteric free air, and perigastric fluid with active extravasations adjacent to the gastric rupture. Figure 2 Coronal MIP View demonstrating gastric rupture involving the lesser curvature with extensive pneumoperitoneum, mesenteric free air, and perigastric fluid with active extravasations adjacent to the gastric rupture. Patient History An 84-year-old female patient was med flighted to the emergency department after having sustained a high-speed motor vehicle collision (MVC). The patient was initially hypotensive but responded to some fluid resuscitation. She also had issues with desaturation, as well as difficulty with intubation in the trauma bay. Therefore, a cricothyroidotomy (an emergency procedure that must be performed only when a secure airway is needed and attempts at orotracheal and nasotracheal intubation have failed, and is contraindicated if any other less radical means of securing an airway is feasible) was performed in the trauma bay prior to going for a trauma Computed Tomography (CT) exam to further evaluate the extent of her injuries and determine whether the patient needed to go to surgery. Acquisition Protocol Scanner: LightSpeed VCT Scan Type: Helical Rotation Speed: 0.5 seconds Detector Configuration: 64 x Slice Thickness: 1.25mm and 2.5mm Pitch: 0.984:1 SFOV: 50.0cm DFOV: 37.0cm kvp: 120 ma: Z-Modulation (Average = 264mAs) Noise Index: Chest, abdomen, and pelvis: 11.5 seconds Delayed abdomen and pelvis: 11.5 seconds Total Scan Time: 15 seconds Chest CTA: 3.4 seconds Abdomen and pelvis: 5.8 seconds Delayed abdomen and pelvis: 5.8 seconds Total Scan Coverage: 73cm Chest CTA: 27cm Abdomen and pelvis: 46cm Delayed abdomen and pelvis: 46cm

3 Figure 3 Axial MIP View demonstrating small laceration at the splenic hilum. Figure 4 Coronal MIP View demonstrating small laceration at the splenic hilum. Figure 5 Axial MIP View demonstrating hyperenhancing gastric mucosa. Figure 6 Axial MIP View demonstrating hyperenhancing gastric mucosa and adrenal glands. Figure 7 Axial MIP View demonstrating periportal edema. Figure 8 Coronal MIP View demonstrating a large left hemopneumothorax. Contrast Injection Parameters Double-Barrel Injector: Prep Delay = 30 seconds Chest CTA 70 seconds Abdomen and Pelvis 5-Minute Delayed Abdomen and Pelvis 100 ml of contrast at 5cc/sec ml of saline at 5cc/sec. Contrast Type: Non-Ionic 320mg I/ml

4 Clinical Findings The CT chest, abdomen, and pelvis exam assisted the radiologist in determining the following clinical diagnostic imaging findings: 1. There is a gastric rupture involving the lesser curvature with extensive pneumoperitoneum. There is mesenteric free air and perigastric fluid. Active extravasation adjacent to the gastric rupture is demonstrated. 2. There is a small laceration at the splenic hilum measuring approximately 1.4cm with no active extravasation that is visualized. The spleen is hypodense with hypoenhancing areas that may represent splenic infarcts. Additionally, there is a superimposed small laceration and splenic hemangiomas. Figure 9 Axial MIP View demonstrating a large left hemopneumothorax. 3. There is hyperenhancing gastric mucosa, small bowel mucosa, and adrenal glands are consistent with shock. 4. There is a large left hemopneumothorax, as well as multiple left-sided rib fractures from second to twelfth. Also, the rib fractures on the right involve the lower rib case. 5. The vascular structures are free of dissection and transsection. There are contour abnormalities and atherosclerotic disease. 6. There are fractures of the pelvis involving the right superior and inferior rami, and a buckling of the left inferior pubic ramus. The left anterior acetabular column has a non-displaced fracture and fracture through the left sacral ala. The left scapula has a comminuted fracture as well. In addition, there is a compression fracture of T8 which is likely old in nature. Finally, there is extensive thoracolumbar scoliosis with superimposed spondylosis. Discussion Based on the CT findings, the patient subsequently went to surgery where they repaired repaired the gastric rupture. The spleen was intact with no bleeding, therefore no intervention was warranted. Figure 10 3D Volume Rendered View demonstrating left sided rib fractures.

5 Figure 11 3D Volume Rendered View demonstrating right sided rib fractures. Figure 12 Oblique MIP View demonstrating T5 & T6 left transverse process fractures and a T8 compression fracture, which is likely old in nature. Figure 13 3D Volume Rendered View demonstrating left scapula-comminuted fracture. Figure 14 3D Volume Rendered View demonstrating a fracture of the pelvis involving the right superior and inferior rami as well as a buckling of the left inferior pubic ramus. Figure 15 Coronal MIP View demonstrating a non-displaced fracture of the left anterior acetabulum.

6 2006 General Electric Company All rights reserved. GE and GE Monogram are trademarks of General Electric Company. LightSpeed is a registered trademark of GE Medical Systems. GE Medical Systems, a General Electric company, going to market as GE Healthcare. GE Healthcare 3000 North Grandview Waukesha, WI U.S.A. imagination at work CT EN-US

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