(Radiographics. 2001;21:S191-S199.)
© RSNA, 2001
Helping the Trauma Surgeon |
From the RSNA Refresher Courses
Focused Abdominal US for Trauma1
John P. McGahan, MD,
Lianyi Wang, MD and
John R. Richards, MD
1 From the Department of Radiology (J.P.M.) and Division of Emergency Medicine (J.R.R.), University of California–Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817; and General Hospital of Chinese PLA, Beijing, China (L.W.). Presented as a refresher course at the 2000 RSNA scientific assembly. Received February 13, 2001; revision requested March 28 and received April 16; accepted May 16. Address correspondence to J.P.M.
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Abstract
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Focused abdominal ultrasonography (US) has been introduced in Europe as a method to evaluate blunt abdominal trauma. The main focus of the examination is detection of free fluid in the abdomen secondary to injury of the abdominal organs. The examination takes only a few minutes to perform. In the authors’ experience, trauma patients in unstable condition and in whom significant free fluid is detected are immediately taken to the operating room for surgical exploration without undergoing computed tomographic (CT) correlation. The authors have also used US to identify the specific site of organ injury. Injuries to solid organs such as the liver, spleen, and kidney that are identified with US usually appear heterogeneous or hyperechoic. A hematoma surrounding the injured organ may appear echogenic or hypoechoic. However, pitfalls of focused abdominal US for trauma include failure to show contained solid-organ injuries; injuries to the diaphragm, pancreas, and adrenal gland; and some bowel injuries. Thus, negative findings at US do not exclude an intraperitoneal injury, and close clinical observation or CT is warranted.
Index Terms: Abdomen, injuries, 70.41, 80.41 • Abdomen, US, 70.12981, 80.12981 • Trauma, 70.41, 80.41
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Introduction
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There have been a number of different methods for evaluation of blunt abdominal trauma. Among such tools are comprehensive physical examination, laboratory data to check for serial hematocrit or elevation of liver or pancreatic enzymes, and observation of the patient’s hospital course for specific time periods such as 12 or 24 hours. Other tests include diagnostic peritoneal lavage and computed tomography (CT) of the abdomen. The advantages and disadvantages of these techniques are briefly reviewed in this article. Another technique, focused abdominal sonography for trauma (also known as FAST), has been used in Europe for years but has only recently been introduced in the United States. Herein, we review various aspects of this technique, including how to perform the examination, its sensitivity, the sonographic features of free fluid and solid organ injury, and potential pitfalls.
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Diagnostic Peritoneal Lavage
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Diagnostic peritoneal lavage has been shown to be a useful tool in evaluation of intraperitoneal hemorrhage, with sensitivity reported as great as 95% (1). However, this tool has certain disadvantages. While it is sensitive in the detection of free intraperitoneal blood, it is obviously insensitive to abdominal injuries that do not produce intraperitoneal hemorrhage. Thus, it cannot help detect some injuries of the retroperitoneum and pancreas or contained injuries to solid intraperitoneal organs. Furthermore, not all trauma patients can undergo the procedure, since it must be performed without patient movement. Diagnostic peritoneal lavage is inappropriate for alert patients in stable condition who represent the majority of patients with blunt abdominal trauma. It is an invasive procedure. While complications are few, they have been reported to occur in 1%–2% of patients (2).
A number of studies suggest that ultrasonography (US) can replace diagnostic peritoneal lavage in the evaluation of blunt abdominal trauma (3,4). Certainly, US has several advantages over diagnostic peritoneal lavage in that US is readily available, is a bedside examination, and is less costly than lavage. US is a noninvasive procedure. Furthermore, in some instances, US may be useful to detect solid organ injuries (5–7).
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Assessment of Blunt Abdominal Trauma with CT
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CT has been used for a number of years in patients with blunt abdominal trauma. At our institution, CT is performed in patients in whom intraabdominal injury is strongly suspected. Other indications for CT included equivocal findings of abdominal examination in stable patients, persistent abdominal pain, and decreasing hematocrit. CT may be performed in the comatose patient in whom no physical examination of the abdomen may be reliably performed. The sensitivity of CT is high for most intraabdominal injuries. CT can help with the detection of free intraperitoneal blood, as can diagnostic peritoneal lavage, and can depict retroperitoneal hemorrhage, bone injuries, vascular injuries, and injuries to the lung bases (8,9). CT also depicts solid organ injuries and has been used to classify injuries to the liver and spleen (10–12). Such classification of severity of organ injuries cannot be performed with diagnostic peritoneal lavage. Furthermore, a trend toward more conservative management of solid organ injury has been based in part on CT classification of organ injury. The disadvantages of CT are few but include higher costs than US, use of iodinated contrast medium, and minimal radiation exposure. These disadvantages seem minimal given the inherent sensitivity of CT. Another disadvantage of CT is that the patient needs transport, which may be problematic for the severely injured patient in unstable condition. Also, before CT, some adult and many pediatric patients may need sedation, which may increase the risk of airway compromise.
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Focused Abdominal US for Trauma
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The use of focused abdominal US for evaluating patients with blunt abdominal trauma is certainly one of the newer concepts for many physicians in North America. However, this is not the case in Europe, where Kristensen and associates (13) in 1971 described the use of US in the diagnosis of splenic hematomas. In 1976, Asher et al (14) described the use of US in the evaluation of splenic trauma. Experience with US in patients with blunt abdominal trauma began to grow in Europe and Japan in the late 1980s and early 1990s. It was not until the 1990s that persons in the United States began showing interest in the use of US for blunt abdominal trauma. Most early publications on this topic were written by trauma surgeons and emergency physicians rather than radiologists (15–17).
Of interest is the high sensitivity of focused abdominal US in the detection of significant intraabdominal injury reported by many institutions. For instance, an abbreviated US examination for trauma proposed by Jehle and colleagues (15) had a reported sensitivity of 81.8% and specificity of 93.9% in the identification of hemoperitoneum in patients with blunt abdominal trauma. The high sensitivity was achieved with only a single longitudinal US examination of the hepatorenal fossa. However, in an article published by Branney et al (18), US of the hepatorenal fossa was performed during infusion of fluid for diagnostic peritoneal lavage, and only 10% of patients had visible free fluid after infusion of 400 mL. Only after infusion of 1 L of fluid was free fluid identified in the hepatorenal fossa in 97% of patients. Rothlin and associates (19) proposed a more comprehensive US examination, including that of the right longitudinal, left longitudinal, epigastric, and suprapubic regions. They also reviewed the European literature about US of blunt abdominal trauma and cited reports of sensitivities of 85%–100% and specificities of 98%– 100%.
On the basis of these high percentages, we performed an initial study of US of blunt abdominal trauma at our institution. We found that while our specificity was good at 95%, our sensitivity was 63% (20). One pitfall in this initial report was that many of our patients had an empty bladder with placement of a Foley catheter. Thus, free fluid in the pelvis was frequently overlooked. If detection of free fluid in the pelvis is desired, the patient should not have an empty bladder.
What other factors accounted for the discrepancy between the 63% sensitivity of trauma US in our initial report (20) and the European literature sensitivities of 85%–100% (19,20)? In the European data, "it has become acceptable ... to calculate sensitivities and specificities for sonography considering only the patient’s course" (19). However, in our study, we insisted that in calculations of sensitivity and specificity of US that results of CT or laparotomy be compared with US. We noted a number of contained injuries to the liver or the kidney with no intraperitoneal hemorrhage at CT. Patients with these findings had corresponding negative findings at US. Therefore, what do we want to know about patients with blunt abdominal trauma? Do we wish to know all injuries the patient has, such as a contained hepatic or renal laceration, or is it necessary to detect only those injuries that will not improve and thus may require surgery?
US Technique
The focus of abdominal US is to check for free fluid. However, if time permits, we try to image solid organs, including the liver, spleen, and kidneys, to check for parenchymal abnormalities.
The most crucial portion of focused abdominal US for trauma is evaluation of the right upper quadrant, left upper quadrant, and pelvis for free fluid. If possible, the pelvis should be examined when the patient’s bladder is full or nearly full. Fluid tends to migrate to the dependent portion of the abdomen or pelvis. A full bladder is needed to displace bowel loops and act as an acoustic window to detect free fluid. The examiner first scans the right upper quadrant, checking for fluid in the hepatorenal fossa; then quickly scans the liver for parenchymal abnormalities; and moves the probe along the right flank into the pelvis for detection of fluid. The examiner then evaluates the epigastrium. We recently incorporated a subxiphoid view to check the heart for pericardial fluid. The left upper quadrant, including the spleen and the left kidney, is then examined. The probe is next moved to the left flank.
In our department, we perform a more comprehensive US examination than has been advocated in the trauma literature. We perform the examination first to check for free fluid in the abdomen and pelvis but also to help detect parenchymal organ injury. We examine the solid abdominal organs, including the liver, spleen, both kidneys, and the pleural and pericardial spaces.
US Findings
In evaluation of the abdominal cavity, the main focus is detection of free fluid. Free fluid will usually appear homogeneously hypoechoic but may be hypoechoic with a few internal echoes (Figs 1, 2). At the site of the injured solid organ, there is often echogenic blood, which may be in the form of a subcapsular hematoma. The echogenic fluid may be less obvious than the hypoechoic free fluid but should not be overlooked, since it often pinpoints the exact site of injury (Figs 3, 4).
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Figure 1a. Severe splenic laceration in a 40-year-old man involved in a motor vehicle accident. (a) US scan of the left upper quadrant shows diffuse alternation in the echotexture of the spleen (arrowheads) with a surrounding hypoechoic rim (arrow). (b) Scan through the abdomen shows areas with large amounts of echogenic free fluid. The patient was taken to the operating room for emergency splenectomy.
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Figure 1b. Severe splenic laceration in a 40-year-old man involved in a motor vehicle accident. (a) US scan of the left upper quadrant shows diffuse alternation in the echotexture of the spleen (arrowheads) with a surrounding hypoechoic rim (arrow). (b) Scan through the abdomen shows areas with large amounts of echogenic free fluid. The patient was taken to the operating room for emergency splenectomy.
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Figure 2a. Small bowel laceration and mesenteric tear in a 72-year-old woman involved in a motor vehicle accident. (a) Longitudinal US scan of the right upper quadrant of the abdomen shows a trace amount of free fluid (FF) in the hepatorenal fossa. (b) CT scan of the abdomen shows large amounts of free fluid (arrows) interspersed among the mesentery and the small bowel. The patient proved to have active mesenteric arterial bleeding and small bowel injury. (Reprinted, with permission, from reference 21.)
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Figure 2b. Small bowel laceration and mesenteric tear in a 72-year-old woman involved in a motor vehicle accident. (a) Longitudinal US scan of the right upper quadrant of the abdomen shows a trace amount of free fluid (FF) in the hepatorenal fossa. (b) CT scan of the abdomen shows large amounts of free fluid (arrows) interspersed among the mesentery and the small bowel. The patient proved to have active mesenteric arterial bleeding and small bowel injury. (Reprinted, with permission, from reference 21.)
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Figure 3. Severe splenic laceration in a 43-year-old man who had been assaulted. Longitudinal US scan of the left upper quadrant of the abdomen shows that the spleen is surrounded by a slightly hyperechoic rim (arrow). Free fluid was present in the abdomen. The patient was taken to the operating room for splenectomy.
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Figure 4a. Liver laceration in a 33-year-old man involved in a motor vehicle accident. (a) Longitudinal US scan of the right upper quadrant of the abdomen shows a small amount of free fluid in the renal fossa (arrow) and fairly normal appearance of the liver. (b) CT scan obtained at the same time as the US scan in a shows, among other findings, a large liver laceration (arrow). (c) Follow-up US scan obtained 13 days later shows a hypoechoic region (arrow) in the right lobe of the liver that represents the patient’s resolving liver laceration.
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Figure 4b. Liver laceration in a 33-year-old man involved in a motor vehicle accident. (a) Longitudinal US scan of the right upper quadrant of the abdomen shows a small amount of free fluid in the renal fossa (arrow) and fairly normal appearance of the liver. (b) CT scan obtained at the same time as the US scan in a shows, among other findings, a large liver laceration (arrow). (c) Follow-up US scan obtained 13 days later shows a hypoechoic region (arrow) in the right lobe of the liver that represents the patient’s resolving liver laceration.
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Figure 4c. Liver laceration in a 33-year-old man involved in a motor vehicle accident. (a) Longitudinal US scan of the right upper quadrant of the abdomen shows a small amount of free fluid in the renal fossa (arrow) and fairly normal appearance of the liver. (b) CT scan obtained at the same time as the US scan in a shows, among other findings, a large liver laceration (arrow). (c) Follow-up US scan obtained 13 days later shows a hypoechoic region (arrow) in the right lobe of the liver that represents the patient’s resolving liver laceration.
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Liver.—
A few articles have concentrated on the specific US appearance of solid organ injuries. Richards and associates (7) evaluated the US appearance of blunt liver injuries. While parenchymal injuries were documented in only 12% of patients, three distinct patterns were observed. The most common US pattern observed in 10 patients was a discrete hyperechoic area (Fig 5). A diffuse hyperechoic pattern was seen in six cases, and a discrete hypoechoic pattern was seen in two cases (Fig 6). An echogenic clot often surrounds the liver, and hypoechoic fluid may be in other portions of the abdomen. Also, the appearance of the hepatic laceration changes with time, a finding noted in other solid organs. The laceration may initially be difficult to recognize or may appear slightly echogenic. Hepatic lacerations appear more hypoechoic or cystic when they are scanned days after the initial injury (Fig 4).
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Figure 5a. Liver laceration in a 46-year-old woman struck by an automobile. (a) US scan shows focal echogenicity (arrows) within the liver. (b) Corresponding CT scan shows two fairly well-demarcated low-attenuation regions surrounding the portal vein that correspond to liver lacerations.
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Figure 5b. Liver laceration in a 46-year-old woman struck by an automobile. (a) US scan shows focal echogenicity (arrows) within the liver. (b) Corresponding CT scan shows two fairly well-demarcated low-attenuation regions surrounding the portal vein that correspond to liver lacerations.
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Figure 6. Small liver laceration in a 29-year-old man involved in a high-speed motor vehicle accident. US scan shows a small hypoechoic structure (between calipers) that corresponds to a laceration within the right lobe of the liver.
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Spleen.—
Richards and colleagues (6) identified parenchymal injuries of the spleen in 31 of 162 patients. The most common pattern was a diffuse heterogeneous appearance, seen in 14 cases (Fig 1). This pattern may be difficult to recognize. Discrete hyperechoic (n = 5) or hypoechoic (n = 4) regions within the traumatized spleen may also be identified with US (Figs 7, 8). A hyperechoic (n = 9) or hypoechoic (n = 6) rim or crescent, representing a clot, often surrounds the spleen (Figs 1, 3). We have identified large amounts of free fluid in the abdomen and pelvis in severe splenic injuries (Fig 1).
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Figure 7. Severe splenic laceration in a 35-year-old man after an assault. US scan of the left upper quadrant of the abdomen shows a spleen with focal echogenic regions (arrow). Free fluid was found in the abdomen. The patient was taken to the operating room for a splenectomy.
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Figure 8. Severe splenic laceration in a 29-year-old man involved in a motor vehicle accident. US scan of the left upper quadrant shows hypoechoic areas (arrow), which were noted throughout the spleen. This finding was associated with free fluid in the patient’s abdomen. The patient was taken to the operating room for a splenectomy.
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Kidney.—
McGahan and associates (5) reviewed data regarding 32 patients with 37 injured kidneys and found that results of renal US were abnormal in eight kidneys and normal in 29. The more severe the renal injury, the more likely a parenchymal injury was identified with US. If a kidney was severely injured, the US appearance was that of an enlarged, mixed, echogenic renal fossa (Fig 9) with loss of the normal renal shape (Fig 10). Mild renal lacerations were difficult to detect with US.
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Figure 9. Severe renal laceration in a 27-year-old man involved in a jet ski accident. Longitudinal US scan shows a mixed isoechoic-hyperechoic region in the renal fossa (arrowheads), which at nephrectomy was found to contain renal fragments with active hemorrhage. (Reprinted, with permission, from reference 5.)
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Figure 10. Severe renal laceration in a 14-year-old girl hit by an automobile while on a bicycle. US scan shows an echogenic region in the right renal fossa with loss of the reniform shape (between calipers). Surgical findings included a fractured kidney with a large hematoma. (Reprinted, with permission, from reference 5.)
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Pitfalls
There are certainly a number of potential pitfalls in the use of US in patients with blunt abdominal trauma. For instance, US sensitivity in detection of free fluid associated with bowel or mesenteric injury was reported to be only 44% in the largest series published on this topic (22). US did not directly depict any of the injured bowel or mesentery (Fig 2). Furthermore, US may not depict injuries to the diaphragm, the pancreas, the adrenal gland, and bone. It is probably limited in the detection of many vascular injuries as well. Shanmuganathan and co-workers (23) performed a multi-institutional study with more than 11,000 trauma patients, and only 4% (467 patients) had documented intraabdominal injury. No free fluid was detected at US in 157 (34%) of these 467 patients. Twenty-six of these 157 patients without free fluid needed radiologic intervention (embolization) or surgery. While only 26 of 11,000 patients without free fluid at US needed surgery, this finding does point to the fact that certain injuries may be missed with US.
Present Use
There is no uniform approach to focused abdominal US in patients with blunt abdominal trauma. However, there is no doubt that US can be used to detect free fluid in such patients. We have found that patients in unstable condition and in whom a large amount of hemoperitoneum is detected are often immediately transported to surgery (21). In addition, patients who are in stable condition but in whom large amounts of free fluid are detected may also be sent to surgery immediately (Fig 1). A question arises about the group of patients in whom US findings are negative. In an article by Lingawi et al (24), the authors performed US in patients with blunt abdominal trauma. If US findings were positive for free fluid, the patient underwent CT (an approach somewhat different from ours). If free fluid was not found at US, the patient was observed for 12 hours. If abdominal pain was still present, the patient underwent CT, but if there were no further abdominal complaints, the patient could be discharged from observation. With this approach, the authors found a sensitivity of US of 94% and a specificity of 98%. Other institutions use US selectively in patients with severe trauma and unstable or potentially unstable conditions. There is no uniform approach in trauma patients. However, there is little reason to believe that the use of US in trauma patients will decrease in the future. In fact, there has been great interest in this diagnostic tool, as shown in the use of US in the emergency department in patients with blunt abdominal trauma, as well as in those with penetrating injuries to the thorax and abdomen. However, it should be cautioned that while US may be useful in a large number of patients, pitfalls still exist.
US Coverage
Throughout Europe, emergency physicians and trauma surgeons perform focused abdominal US for trauma. In the United States, emergency physicians, trauma surgeons, and radiologists perform such scanning. It may be impossible in a number of institutions for the radiologist to provide 24-hour coverage for trauma US. In other institutions, a radiologist is available 24 hours a day and the radiology department can provide coverage for focused abdominal US. Our institution has in-house physician coverage provided for radiology services and has recently instituted 24-hour in-house sonographer coverage (25). The sonographer provides immediate response for focused abdominal US in cases of blunt abdominal trauma. This situation has been helpful to provide coverage not only to the emergency department for focused abdominal US but also for hospital inpatients for whom US is requested on a 24-hour basis.
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Summary
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Focused abdominal US for trauma is a noninvasive, readily available method of detection of free fluid in the trauma patient. US has also been used to detect injury to parenchymal organs such as the liver, spleen, and kidney. In most situations, lacerations of these solid organs appear as either a hyperechoic region or a diffusely heterogeneous region. The more severe the injury, the higher the likelihood of detection of injury with US. However, US may not be used to detect contained solid organ injuries and may not reveal injuries to the diaphragm, pancreas, or adrenal gland and some injuries to the bowel. When US is used to evaluate blunt abdominal trauma, the lack of detection of free fluid does not always exclude a significant intraabdominal injury. If there is any doubt about intraabdominal injury, then either continued clinical observation or CT of the abdomen is warranted.
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References
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-
Day AC, Rankin N, Charlesworth P. Diagnostic peritoneal lavage: integration with clinical information to improve diagnostic performance. J Trauma 1992; 32:52-57.[Medline]
-
Powell DC, Bivins BA, Bell RM. Diagnostic peritoneal lavage. Surg Gynecol Obstet 1982; 155:257-264.[Medline]
-
Liu M, Lee CH, P’eng FK. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 1993; 35:267-270.[Medline]
-
McKenney M, Lentz K, Nunez D, et al. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma?. J Trauma 1994; 37:439-441.[Medline]
-
McGahan JP, Richards JR, Jones CD, Gerscovich EO. Use of ultrasonography in the patient with acute renal trauma. J Ultrasound Med 1999; 18:207-213.[Abstract]
-
Richards JR, McGahan JP, Jones CD, Zhan S, Gerscovich EO. Ultrasound detection of blunt splenic injury. Injury 2001; 32:95-103.[Medline]
-
Richards JR, McGahan JP, Pali MJ, Bohnen PA. Sonographic detection of blunt hepatic trauma: hemoperitoneum and parenchymal patterns of injury. Trauma 1999; 47:1092-1097.[Medline]
-
Kinnunen J, Kivioja A, Poussa K, et al. Emergency CT in blunt abdominal trauma of multiple injury patients. Acta Radiol 1994; 35:319-322.[Medline]
-
Richards JR, Derlet RW. Computed tomography for blunt abdominal trauma in the ED: a prospective study. Am J Emerg Med 1998; 16:338-342.[Medline]
-
Becker CD, Gal I, Baer HU, Vock P. Blunt hepatic trauma in adults: correlation of CT injury grading with outcome. Radiology 1996; 201:215-220.[Abstract/Free Full Text]
-
Mirvis SE, Whitley NO, Vainwright JR, Gens DR. Blunt hepatic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology 1989; 171:27-32.[Abstract/Free Full Text]
-
Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995; 38:323-324.[Medline]
-
Kristensen JK, Buemann B, Kuhl E. Ultrasonic scanning in the diagnosis of splenic haematomas. Acta Chir Scand 1971; 137:653-657.[Medline]
-
Asher WM, Parvin S, Virgilio RW, Haber K. Echographic evaluation of splenic injury after blunt trauma. Radiology 1976; 118:411-415.[Abstract]
-
Jehle D, Guarino J, Karamanoukian H. Emergency department ultrasound in the evaluation of blunt abdominal trauma. Am J Emerg Med 1993; 11:342-346.[Medline]
-
McKenney MG, McKenney KL, Compton RP, et al. Can surgeons evaluate emergency ultrasound scans for blunt abdominal trauma?. J Trauma 1998; 44:649-653.[Medline]
-
Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma 1993; 34:516-527.[Medline]
-
Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma 1995; 39:375-380.[Medline]
-
Rothlin MA, Naf R, Amgwerd M, et al. Ultrasound in blunt abdominal and thoracic trauma. J Trauma 1993; 34:488-495.[Medline]
-
McGahan JP, Rose J, Coates TL, Wisner DH, Newberry P. Use of ultrasonography in the patient with acute abdominal trauma. J Ultrasound Med 1997; 16:653-662.[Abstract]
-
McGahan JP, Richards JR. Blunt abdominal trauma: the role of emergent sonography and a review of the literature. AJR Am J Roentgenol 1999; 172:897-903.[Free Full Text]
-
Richards JR, McGahan JP, Simpson JL, Tabar P. Bowel and mesenteric injury: evaluation with emergency abdominal US. Radiology 1999; 211:399-403.[Abstract/Free Full Text]
-
Shanmuganathan K, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology 1999; 212:423-430.[Abstract/Free Full Text]
-
Lingawi SS, Buckley AR. Focused abdominal US in patients with trauma. Radiology 2000; 217:426-429.[Abstract/Free Full Text]
-
McGahan JP, Cronan M, Richards JR, Jones CD. Comparison of US utilization and technical costs before and after establishment of 24-hour in-house coverage for US examinations. Radiology 2000; 216:788-791.[Abstract/Free Full Text]
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Abstract
Introduction
