EVALUACION DEL TRAUMA ABDOMINAL CON MDCT

Dra Maria Fernanada Sanchez V. Universidad de la Sabana.

Radiol Clin N Am 43 (2005) Multidetector CT Evaluation of Abdominal Trauma

TRAUMA DE ABDOMEN VALORACION CON MDCT

Tcnica:
Abdomen, pelvis 600 ml VO 150 ml 6 cc/s 2.5 mm 2-3 min

Radiol Clin N Am 43 (2005) Multidetector CT Evaluation of Abdominal Trauma

Trauma de Abdomen.

Liquido intraperitoneal y hemoperitoneo:

Liquido libre. B. Morison, G parietocolicas, post vesical. E. peri heptico. E. Peri esplnico Densidad:
0-15 UH Ascitis 20-40 UH Liquido 40-70 UH Coagulo.

Trauma de Abdomen.

Liquido Libre:
Lesin rgano slido Correlacionar Evaluacin causa:
Obs. Seriadas peritonitis MDCT 4-6 h control Lavado peritoneal Laparoscopia Laparotoma

Trauma Esplnico

Ms comn Manejo no operatorio Hemodinmicamente estable Seleccin pctes 98% precisin

Grados de severidad de la lesin esplenica y TC

Grade I: Capsular avulsion, laceration, or subcapsular hematoma <1cm diameter Grade II:Laceration 13 cm deep, central/subcapsular hematoma 13 cm diameter Grade III: Laceration 310 cm deep, central/ subcapsular hematoma >3 cm diameter

Grade IV:Laceration >10 cm deep, central/ subcapsular hematoma>10 cm diameter, massive lobar maceration or devascularization
Grade V: Bilobar tissue maceration or devitalization

Trauma Esplnico y MDCT

Alta precisin Fase portal Fase arterial heterogneo. Contusin:

Hipodensidad mal delimitada

Trauma Esplnico y MDCT

Laceracin:
Lineal bien definida hipodensa 2-3 das resolucin

Trauma Esplnico

Hematoma Subcapsular:

Trauma Esplnico

Trauma Esplnico

Lesiones vasculares:
Pseudoaneurismas Bien definidos Baja atenuacin Fstulas Extravasacin

Trauma Esplnico

Trauma Esplnico

Trauma Esplnico

Fase excretora

Trauma Heptico

2 causa Lobulo derecho (80%) Lob izq pncreas, duodeno 50% aisladas 70% Qx

CT in Blunt Liver Trauma: RadioGraphics 2005; 25: 87-104.

Trauma Heptico

Contusin. Laceracin.
Liq peri heptico Cpsula intraperitoneal rea desnuda Qx: porta, venas. Cava retrohepatica 90-100% mort.

Trauma Heptico

Hematoma sub capsular:

Lat heptico/derecho. Comprimen parenq. 6-8 sem resuelve

Trauma Heptico

Grade I: Capsular avulsion, laceration <1 cm deep, subcapsular hematoma <1 cm thick Grade II:Laceration(s) 13 cm deep, intraparenchymal/ subcapsular hematoma 13 cm in diameter

Grade III: Laceration >3 cm deep, intraparenchymal/ subcapsular hematoma >3 cm in diameter
Grade IV: Intraparenchymal/subcapsular hematoma >10 cm in diameter,lobar maceration or devascularization Grade V:Bilobar maceration or devascularization

Grado I

Grado II

Grado II

Grado III

Grado IV

Grado V

Trauma heptico

Trauma Heptico

G V.

Trauma Heptico

Trauma Heptico

Trauma Heptico

Vasculares:
Pseudoaneurismas Fstulas S: 65-100% E: 76-85% Complicaciones: 10-25%
Hemorragia tarda Abscesos Biliomas (1.5-5.9%) (0.6-4%)

Complicaciones

Bilioma

Trauma de la vescula biliar

2-8% No Sx especficos Contusin:

Engrosamiento focal Hematoma intraluminal Vescula colapsada liquido Flap

Trauma vescula biliar

Trauma vescula biliar

Trauma intestinal y mesenterico.

Colon 0.3% Intestino delgado 1.1% Yeyuno, ileon 81% Complicaciones:

Peritonitis, Hemorragia Isquemia, necrosis

Evaluation of Bowel and Mesenteric Blunt Trauma with Multidetector CT RadioGraphics 2006; 26: 1119-1131

Trauma intestinal y mesenterico

CT: 84-94% Parcial y total 3-4 mm focal 4-6 h resolucin Extravasacin medio, CI. Discontinuidad pared. Neumoperitoneo

Trauma intestinal y mesenterico

Trauma intestinal y mesenterico

Hematoma mesenterico

Perf duodenal y yeyunal.

Perf. duodenal

Trauma renal

10% Sx: dolor flanco, hematuria Micro 25-35%

CT Findings in Blunt Renal Trauma: RadioGraphics 2001; 21: 201.

Trauma renal

Grade I : Renal contusion or subcapsular hematoma

Grade II : Laceration <1 cm deep that does not involve the collecting system, nonexpanding perinephric hematoma Grade III: Laceration >1 cm deep without collecting system involvement

Grade IV:Laceration extending into the collecting system, main renal artery,or vein injury with contained hemorrhage
Grade V:Shattered kidney, avulsion of renal hilum with devascularized kidney

Grado I

Trauma renal

Grado II

Grado III

Grado IV

Grado V

Trauma renal

Menor: Contusiones, hematoma perin frico, subcapsular, laceraciones. Isquemia local HT Imgenes: Excretora. 1-2 min Infarto total, subtotal Lesin vascular parenquimatosa
Imaging of Renal Trauma: A Comprehensive Review RadioGraphics 2001; 21: 557.

Trauma renal

Trauma renal