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Blunt Trauma of the Pancreas and Biliary Tract: A Multimodality Imaging Approach to Diagnosis¹

¹ From the Department of Radiology, Boston University Medical Center and Boston University, Mass. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received January 7, 2004; revision requested February 17 and received March 25; accepted March 29. All authors have no financial relationships to disclose. Address correspondence to A.G., Department of Radiology, Beth Israel Deaconess Medical Center, One Deaconess Rd, Boston, MA 02215 (e-mail: agupta@bidmc.harvard.edu).

Injuries of the pancreas, gallbladder, and bile ducts due to blunt trauma are relatively uncommon and difficult to detect but are associated with high morbidity and mortality, especially if diagnosis is delayed. Accurate and early diagnosis is imperative, and imaging plays a key role in detection. Knowledge of the mechanisms of injury, the types of injuries, and the roles of various imaging modalities is essential for prompt and accurate diagnosis. Early recognition of disruption of the main pancreatic duct is important because such disruption is the principal cause of delayed complications. Computed tomography (CT) can demonstrate pancreatic parenchymal injuries and complications such as abscess, fistula, pancreatitis, and pseudocyst. CT findings can also suggest disruption of the pancreatic duct; however, the ability of CT to indicate this finding depends on the degree of parenchymal injury. Magnetic resonance (MR) cholangiopancreatography allows direct imaging of the pancreatic duct and sites of disruption. Gallbladder injuries can be detected with CT, ultrasonography, hepatobiliary scintigraphy, or MR cholangiopancreatography. CT findings include a collapsed gallbladder, wall thickening, inhomogeneous mural enhancement, and pericholecystic fluid. Bile duct injuries can be suggested with CT, which may show ascites and associated liver injuries, and can be confirmed with hepatobiliary scintigraphy.

© RSNA, 2004

Index Terms: Bile ducts, injuries, 76.41 • Bile ducts, leakage, 76.41 • Gallbladder, injuries, 762.41 • Gallbladder, perforation, 762.41 • Pancreas, injuries, 770.41

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