Determining injuries from posterior and flank stab wounds using computed tomography tractography

Area of Science:

• Trauma Surgery
• Diagnostic Imaging
• Radiology

Background:

• Posterior stab wounds (SW) present unique evaluation challenges compared to anterior SW.
• Traditional triple contrast computed tomography (CT) is cumbersome and technician-dependent for posterior SW assessment.

Purpose of the Study:

• To examine the role of CT tractography in managing select patients with posterior back and flank SW.
• To assess the safety and efficacy of CT tractography as an imaging strategy for posterior torso SW.

Main Methods:

• Hemodynamically stable patients with posterior SW underwent abdominal helical CT with intravenous contrast.
• Sterile sponges soaked with Betadine or Visipaque were inserted into SW to estimate depth.
• Radiologist and trauma surgeon reviewed CT images to evaluate tractogram, trajectory, and injuries.

Main Results:

• CT tractography was performed on 41 patients.
• Tractography detected intra- or retroperitoneal cavity violation in 11 patients, leading to operative exploration.
• Identified injuries included spleen, colon, kidney, diaphragm, pneumothorax, hemothorax, iliac artery, and abdominal wall hernia.

Conclusions:

• CT tractography is a safe and effective imaging strategy for evaluating posterior torso stab wounds.
• The study suggests CT tractography can guide management decisions for posterior SW.
• Further research is needed to compare CT tractography with traditional imaging modalities.