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Category: Volume 06 Issue 02 February 2018
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Title: Comparative Study of CT and Ultrasonography in Blunt Abdominal Trauma

Author: Dr Shailja Srivastava

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.64

Abstract

Background: Patients with abdominal trauma present a frequent diagnostic dilemma because of low accuracy of physical examination and clinical diagnosis .Clinical findings are often unreliable and have low sensitivity for diagnosis of intra peritoneal injuries following blunt trauma. It is challenging, even for an experienced trauma surgeon to determine the extent of abdominal injuries and the need for surgical intervention on the basis of clinical presentation alone. Hence there is a need for an accurate imaging modality. In the recent years there is growing trend of conservatism in closed injuries ,where the role of imaging becomes even more paramount for the safe practice of such surgical restraint

Aims and Objectives: To study the various radiology findings associated with blunt abdominal trauma .To analyze the efficacy of ultra sound and CT in the diagnosis of blunt abdominal trauma; and to compare individual merits and demerits and their superiority in the diagnosis.

Materials and Methods: In this prospective study 50cases of blunt abdominal trauma were evaluated by US and CT in the Department of Radiology & Imageology, OGH, Hyderabad between September 2016 to December 2017. All the cases were admitted in the Department of General Surgery, OGH, Hyderabad, where clinical follow - up done.

In this study 50 patients of blunt abdominal trauma were assessed for injuries to various organs using organ injury scale, both USG and CT and the results were compared and the sensitivity and specificity of USG in comparision with CT were calculated and the positive predictive value and negative predictive value of USG for individual organs was calculated.

Result: In this study hepatic trauma was the most common injury detected on both USG and CT; this is a variation from standard surgical description of more common splenic injuries. The reason might be that surgically occult liver lesions are picked up more with the use of abdominal CT. Pancreatic and urinary bladder trauma were low in frequency in accordance with literature; spleen injuries were also common and were second most common injuries detected after hepatic trauma on both USG and CT.

Haemoperitoneum is quite high in incidence probably derived from multiple sources. Few cases of retroperitoneal injuries , abdominal and pelvic fractures were also detected mainly by CT.

Conclusion: Clinical  examination  fails  to  accurately  diagnose  many intra abdominal injuries  in  blunt  abdomen  and  hence  there is  a well rounded need  for a  good  imaging  technique.USG and  CT satisfy this  to a  great extent. With minimum technical limitations and a short time for examination USG  and  CT become extremely  useful in guiding the trauma surgeon.

NECT combined with CECT is a highly useful imaging modality for diagnosis of blunt abdominal trauma. However USG can be used as a useful intial modality. CT is excellent in picking up clinically unsuspected trauma especially involving liver, kidney and bowel.

Keywords: Blunt abdominal trauma, CT, Hemoperitoneum, USG.

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Corresponding Author

Dr Shailja Srivastava

Assistant Professor Radiology, OMC, Hyderabad