Trauma radiology: part I. Computerized tomographic imaging of abdominal trauma

The value of computerized tomography (CT) scanning for identification of injuries sustained primarily from blunt trauma to the abdomen and pelvis is well established. During the 1980s, numerous articles appeared comparing the value of CT versus diagnostic peritoneal lavage (DPL) as a screening test for intraperitoneal injury. A consensus emerged recognizing the complimentary and different kinds of information provided by each study. CT is indicated in hemodynamically stable patients; to assess the retroperitoneum; after indeterminant DPL results; potentially in patients with positive DPL results by cell count; whenever DPL is contraindicated; in patients with persistent abdominal pain despite a negative DPL; for penetrating flank trauma; for mild abdominal tenderness in alert patients; and arguably for patients with unreliable physical examination. The accuracy of CT is dependent on speed and quality of the scanner, attention to technique to provide optimal oral and intravenous contrast enhancement, and experience of the image interpreter. In general, the accuracy of the CT for detection of solid visceral injuries (including in the liver, the spleen, and the kidneys) and for evaluation of the retroperitoneum is well established. Recent studies indicate that CT also offers important information regarding pancreatic and hollow viscous injuries. Fast scanning with a power-injected intravenous contrast bolus can provide localization of active bleeding sites, with important implications for management by surgery or interventional angiography. We review the CT imaging findings typically observed with a variety of abdominal/pelvic injuries.