Blunt pancreatic trauma: evaluation with MDCT technology
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ORIGINAL ARTICLE
Blunt pancreatic trauma: evaluation with MDCT technology Robert W. Gordon & Stephan W. Anderson & Al Ozonoff & Satinder Rekhi & Jorge A. Soto
Received: 28 December 2012 / Accepted: 25 February 2013 / Published online: 21 April 2013 # Am Soc Emergency Radiol 2013
Abstract The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. MDCT imaging findings suggestive of pancreatic injury included low attenuation peripancreatic fluid (n=51), hyperattenuating peripancreatic fluid (n=13), pancreatic contusion (n=7), active hemorrhage (n=2), and pancreatic laceration (n=16). Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity,
R. W. Gordon Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA S. W. Anderson (*) : J. A. Soto Department of Radiology, Boston University Medical Center, FGH Building, 3rd Floor 820 Harrison Avenue, Boston, MA 02218, USA e-mail: [email protected] A. Ozonoff Biostatistics Core, Children’s Hospital Boston, Clinical Research Program, 300 Longwood Avenue, Boston, MA 02115, USA S. Rekhi Department of Radiology, George Washington University, 900 23rd St., NW, Washington, DC 20037, USA
100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance. Keywords Blunt pancreatic trauma . Multi-detector CT . Diagnostic accuracy in predicting main pancreatic duct injury
Introduction Though rare, with an incidence in blunt abdominal trauma reported to range from 0.2 to 12 %, pancreatic trauma is associated with significant morbidity and mortality [1–12]. Mortality rates in blunt pancreatic injury are reported to be as high as 30 %, with most deaths occurring within the first 48 h of the inciting traumatic event [1–5, 12, 13]. When not recognized at admission, the delayed complications sec
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